Should I Restore this Tooth?

Question 1

What factors should you consider before endodontically treating a tooth?

Answer 1

• Restorability: amount of tooth structure remaining
• State of remaining tooth structure: is it cracked, caries stable
• Perio condition
• Strategic value of tooth
• Access to tooth
• MHx: if pt on bisphosphonate, has delayed healing or bleeding disorders try to avoid extraction
• Patient wishes
• Fanancial

Question 2

What is a radiographic sign of vertical root fracture?

Answer 2

-widening of PDL

Question 3

What are the success rates of:

• Primary RCT
• Primary RCT with PA lesion
• Retreatment of RCT with lesion
• Surgical retreatment

Retreatment?
Retreatment with morphology respected?
Retreatment with altered morphology?

Answer 3

-Primary RCT: 90-95%
-Primary RCT with PA lesion: 85%
-Retreatment of RCT with lesion: 65-85%
-Surgical retreatment: 60-90%
(Sjogren 2002)

Retreatment: 69%
Retreatment with morphology respected: 87%
Retreatment with altered morphology: 47%
(Fabio, 2009)

Question 4

What factors influence treatment success?

Answer 4

• Access to apex and maintenance of patency (blockage reduces success by a factor of 1/2)
• Rubber dam, infection control adhered to
• Irrigated, medicated and obturated, restored well