9. Endodontic Treatment Outcomes

Question 1

When is a reasonable time to follow-up on an endodontically treated tooth?

Answer 1

• 6 months is the time lapse for significant radiographic changes
• Lesions that remained unchanged or increased in size after 4 years are unlikely to resolve

Question 2

The Strindberg 1956 paper was a landmark study for the evaluation of endodontic treatment outcomes. What were the findings of this paper?

Answer 2

Strindberg (1956) established strict criteria for clinical and radiographic evaluation of the endodontically-treated tooth at follow-up examinations. The absence of clinical symptoms, and the presence or absence of periapical radiolucency became the principal outcome measures of endodontic treatment. The three main outcomes were Success, Failure and Uncertain.

Question 3

What are the causes of persistent disease in endodontics?

Answer 3

• Errors in Dx and Tx planning
• Coronal leakage
• Lack knowledge of pulp and root anatomy
• Inadequate debridement and disfection
• Inadequate restorative protection
• Iatrogenic errors
• Vertical root fractures

These can be classified into pre, intra and post-op causes

Question 4

What should we look out for in the radiographs taken during endo recall visits?

Answer 4

• Check if the radiolucency has resolved. If it persists, continued patient recalls are indicated
• Check for the coronal seal of the GP
• If the radiolucency increased in size or clinical symptoms have developed (sinus tract, tenderness, painful symptoms), retreatment, endodontic surgery or extraction should be considered

Question 5

When we see extrusion of material at the apex of an endodontically treated tooth, how can we tell if it is GP or sealant?

Answer 5

Sealant can be removed by the macrophages while GP cannot. Wait for 6 months and take another radiograph to see if the extruded material has been removed