Seminar 12: Outcomes Flashcards
What outcome measures can we use?
PROM Peripapical status Pain Functionality Tooth survival
What is health ?
Complete state of physical mental and social well being NOT JUST absence of disease
How can we undertake PROMs?
Patient questionnaires completed by themselves
Should be undertaken for all NHS FUNDED procedures
How can we measure periapical healing for a tooth?
Using radiographs or CBCT
Use tooth as whole
Per root
What is the importance of measuring / assessing for apical healing ?
This will allow us to identify if the protocol has worked or not
When measuring periapical healing what must be stipulated?
Criteria for assessing
Time frame for the assessment to be carried out after treatment completed
What are the risks of using root as a unit of measure of success?
Can overestimate compared to tooth as a unit
What are the benefits of using a single root as an outcome measure ?
Help to identify pre operative prognostic factors eg perforation/ledge and how this can impact outcome
What are the clinical signs for assessing healing ?
Tenderness to palpate on TTP Sinus/ swelling Radiographic signs of reduction in size of lesion Normal PDL space over time
Between radiographs and CBCT which shows lower healing rates ?
CBCT
What are the problems with CBCT with regards to diagnosing apical lesions
Kruse et al 2019: CBCT better at detecting lesions in non root filled teeth
Healing rates with CBCT strict and PA strict were?
58% CBCT
72% PA
How long should we follow up healing ?
Peak incidence of healing was at 1 year
Orstavic 1996 and Azim et al 2015
What is the ESE guidelines for following RCT for four years based upon?
Strindberg 1956
Stabilisation of Healing not seen until 3 years after operation
What three factors may affect healing time?
Few studies have looked at this but (Azim et al 2015)
- medically compromised
- over extended
- more complex root anatomy
How does poor recall rate effect outcome rates ?
Can over or underestimate
If tooth been extracted and patient has been lost to follow up this will caused outcomes to be more positive for example
How can you categorise prognostic indicators of success into two groups ?
Patient related
Operator related
Which systemic disease has an impact on periapical healing ?
Diabetes
Impaired innate immune response
Smokers
Gene polymorphism eg IL 6
Why is healing rate similar amongst ant and post teeth?
As the apical anatomy is complex no matter if ant or post teeth and this cleaning and shaping of this area poses a challenge to the operator no matter which tooth it is
What impact does vital or non vital pulp have on outcome ?
None- healing is the same EXCEPT if there is an apical lesion then success is reduced
What is the effect on apical lesion size?
Ng et al 2011
Every 1mm increase in apical lesion a 14/15% reduction in healing
Access cavity design is dictated by what?
Proximity of pulp chamber to external tooth structure providing straight line access to apical tissues
What is apical disturbance?
Extension of instruments beyond canal terminus
Which type of apical disturbance may have a positive impact on outcome ?
Patency filing
What is the evidence behind use of CaOH
Trope et al 1999
Cheung et al 2002
Better success rate when CaOH used
What is the biological impact of a periapical
Lesion?
Root canal infection
What is the biological impact of the size of the PA lesion?
Species diversity
What is the biological impact of a negative culture test following root canal preparation?
Negative test means adequate cleaning
What is the biological impact of the quality of coronal restoration?
Risk of new infection
What are the mechanical and biological reasons compromising tooth survival ?
Pre op deep pocketing
Pre op or intra op perforation
What are the biological reasons compromising tooth survival ?
Pre op pain and sinus tract
Lack of patency
Extrusion
What are the mechanical reasons compromising tooth survival ?
Lone standing teeth
Absence of cast restoration
Abutments for prosthesis
