Failure of endodontic treatment: The usual suspects

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Abstract

Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.

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Most cited references 17

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Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.

U Sjögren, D Figdor, S. Persson … (1997)

This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.

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Influence of coronal restorations on the periapical health of endodontically treated teeth.

L Tronstad, K Asbjørnsen, I Pedersen … (2000)

The purpose of the study was to evaluate a possible relationship between the quality of the coronal restoration, the root canal obturation and the periapical status of endodontically treated teeth. Full mouth series of radiographs from randomly selected patient charts at the Dental Faculty, University of Oslo were examined. A total of 1001 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. According to a predetermined set of radiographic criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the technical quality of the coronal restoration was scored as good (GR) or poor (PR). The root and the surrounding structures were then evaluated and according to the periradicular findings, the treatment was categorized as success or failure. The success rate for all endodontically treated teeth was 67.4% (n = 1001). Teeth with root canal posts had a success rate of 70.7% (n = 527) and teeth without posts had a success rate of 63.6% (n = 472). The two groups with technically good endodontics had the highest success rates. In combination with technically good restorations the success rate was 81% (GE + GR, 81%) and combined with technically poor restorations the success rate was 71% (GE + PR, 71%). The two groups with technically poor endodontics combined with either good restorations or poor restorations had significantly lower success rates (PE + GR, 56% and PE + PR, 57%). The technical quality of the endodontic treatment as judged radiographically was significantly more important than the technical quality of the coronal restoration when the periapical status of endodontically treated teeth was evaluated.

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Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration.

Richard H. Ray, M Trope (1994)

The purpose of this study was to evaluate the relationship of the quality of the coronal restoration and of the root canal obturation on the radiographic periapical status of endodontically treated teeth. Full-mouth radiographs from randomly selected new patient folders at Temple University Dental School were examined. The first 1010 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. Post and core type restorations were excluded. According to a predetermined radiographic standard set of criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the quality of the coronal restoration similarly good (GR) or poor (PR). The apical one-third of the root and surrounding structures were then evaluated radiographically and the periradicular status categorized as (a) absence of periradicular inflammation (API) or (b) presence of periradicular inflammation (PPI). The rate of API for all endodontically treated teeth was 61.07%. GR resulted in significantly more API cases than GE, 80% versus 75.7%. PR resulted in significantly more PPI cases than PE, 30.2% versus 48.6%. The combination of GR and GE had the highest API rate of 91.4%, significantly higher than PR and PE with a API rate of 18.1%.

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Journal

Journal ID (nlm-ta): Eur J Dent

Journal ID (iso-abbrev): Eur J Dent

Journal ID (publisher-id): EJD

Title: European Journal of Dentistry

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 1305-7456

ISSN (Electronic): 1305-7464

Publication date (Print): Jan-Mar 2016

Volume: 10

Issue: 1

Pages: 144-147

Affiliations

[1 ]Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan

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Correspondence: Dr Sadia Tabassum Email: sadyatabassum@ 123456gmail.com

Article

Publisher ID: EJD-10-144

DOI: 10.4103/1305-7456.175682

PMC ID: 4784145

PubMed ID: 27011754

SO-VID: bbf5269e-5dc5-4908-91ab-da290a961874

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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Failure of endodontic treatment: The usual suspects

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Arab Journal of Forensic Sciences & Forensic Medicine (AJFSFM)

Most cited references 17

Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.

Influence of coronal restorations on the periapical health of endodontically treated teeth.

Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration.

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