Evaluation of Endodontic Treatment Flashcards
What criteria should be used to assess the outcome of endodontic treatment?
Histological (can’t be assessed in the clinical situation with patients but used during research)
Clinical
Radiographic
Functional
Patient’s perceptions
What are the criteria for favourable outcomes?
Lack of symptoms
Lack of evidence of ongoing pathosis
Radiographic signs of bone repair
No radiographic signs of resorption
Function maintained
Patient - comfortable tooth, no complaints
what does lack of symptoms imply about outcome?
A lack of symptoms does not ALWAYS imply the lack of disease
When should outcome of endodontic treatment be assessed?
6 months - initial indication
1 - 3 years - more accurate assessment
5 years - generally considered the time required to accurately assess outcome of endodontic treatment.
> 5 years - really assessing the restoration rather than the RCF
What does an unfavourable outcome consist of?
Bacteria persisting in the canals
New bacteria entering the canals
Ongoing periapical disease (True cyst, extra-radicular infection, FBR)
What are the criteria for uncertain/surviving cases?
When at least one of the criteria for a favourable outcome has not been achieved but the other criteria have been achieved
The pre-op radiolucency has not healed completely or not healed at all
AND
The patient has no symptoms
There are no other clinical signs
The patient can function normally on the tooth
Typically noted at review appointment
What does timing of the radiolucency tell us about the condition?
Early:
May be a failure of the endodontic treatment or the operator
May be due to a true cyst, an extra radicular infection, a foreign body reaction or a periapical scar.
Late:
Occurs many years later and can be a result of a new disease rather than a failure of endodontic treatment.
When do true failures of endodontic treatment typically occur?
A short time after treatment (Due to bacteria being left behind at the time of the previous treatment)
What do failures up to 5 years after treatment indicate?
Inadequate treatment techniques
Inadequate asepsis during treatment
Inadequate temporaries during treatment
Inadequate restoration after the RCF
What is the infected canal disease cycle?
Small number of bacteria are left in the canal after treatment
Gradual proliferation / increase in numbers
Periapical response develops (chronic situation for some time)
Gradual increase in periapical involvement (no symptoms until response well established)
Acute phase when conditions are suitable. (many factors can affect the “balance” situation such as other illnesses, treatment, stress, tiredness etc)
What causes late radiolucency?
Not a failure of endodontics but a new disease caused by bacteria re-entering the tooth through: Broken down restoration, caries, cracks, trauma, etc
What is more important for the quality of an RCF, the coronal or apical restoration?
The quality of the coronal restoration was more important than the quality of the RCF for apical periodontal healing
What additional factors can cause persistance of periapical radiolucencies?
Intra-radicular infection
Extra-radicular infection
Foreign body reaction
Periapical true cyst
Periapical scar
What are the guidelines for dealing with periapical radiolucencies associated with RCFs?
Intra-radicular infection = endodontic re-treatment
Extra-radicular infection, foreign body reaction, and periapical true cyst are treated with periapical surgery
Periapical scar is observed and reassessed
What is the problem with treating periapical radiolucencies following retreatment?
They can’t be told apart. They look very similar.
