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Abstract

Outcome assessment of endodontic treatment is critical for appropriate case selection and treatment planning. However, reports on outcomes of nonsurgical endodontic treatment vary considerably. Epidemiological studies done in a large patient population and over a long follow-up period can provide the clinician with useful tools for clinical decision-making and assessment of tooth prognosis. In this study, outcomes of initial endodontic treatment done in 1,462,936 teeth of 1,126,288 patients from 50 states across the USA was assessed over a period of 8 yr. Treatment was done by private general practitioners and endodontists participating in the Delta Dental Insurance plan that insures approximately 14 million individuals in the USA. Overall, 97% of teeth were retained in the oral cavity 8 yr after initial nonsurgical endodontic treatment. The combined incidence of untoward events such as retreatments, apical surgeries, and extractions was 3% and occurred mostly within 3 yr from completion of treatment. Analysis of the extracted teeth revealed that 85% had no full coronal coverage. A significant difference was found between covered and noncovered teeth for all tooth groups tested (p < 0.001). In conclusion, it appears that initial nonsurgical endodontic treatment is a predictable procedure with high incidence of tooth retention after 8 yr.

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Reduction in tooth stiffness as a result of endodontic and restorative procedures.

Ernest Reeh, Harold Messer, William Douglas (1989)

Endodontically treated teeth are thought to be more susceptible to fracture as a result of the loss of tooth vitality and tooth structure. This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids. An encapsulated strain gauge was bonded on enamel just above the cementoenamel junction on both the buccal and lingual surfaces, and the teeth were mounted in nylon rings leaving 2 mm of root surface exposed. Under load control, each tooth was loaded at a rate of 37 N per s for 3 s and unloaded at the same rate in a closed loop servo-hydraulic system to measure stiffness. A stress-strain curve was generated from each gauge prior to alteration of the tooth and after each procedure performed on the tooth. Cuspal stiffness, as a measure of tooth strength, was evaluated on one of two series of sequentially performed procedures: 1. (a) unaltered tooth, (b) access preparation, (c) instrumentation, (d) obturation, and (e) MOD cavity preparation; or 2. (a) unaltered tooth, (b) occlusal cavity preparation, (c) two-surface cavity preparation, (d) MOD cavity preparation, (e) access, (f) instrumentation, and (g) obturation. Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

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Time-course and risk analyses of the development and healing of chronic apical periodontitis in man.

D Orstavik (1996)

Roots with and without preoperative chronic apical periodontitis were root canal treated and followed clinically and radiographically yearly for up to 4 years. Of 732 roots treated, 599 (82%) were available for evaluation at one or several recalls. Chronic apical periodontitis (CAP) was recorded with the periapical index scoring system. CAP developed in 29 of 473 (6%) of teeth without preoperative signs of disease, whereas 111 of 126 (88%) initially diseased roots showed signs of healing. The rate of healing CAP and the rate of emerging CAP were calculated, and analyses of event occurrence each year of observation were performed. Peak incidence of healing or emerging CAP was at 1 year in both instances. Risk assessments at 2, 3, and 4 years did not indicate an added risk of filled roots developing CAP during this period. Complete healing of preoperative CAP in some instances required 4 years for completion, while signs of initiated, but incomplete, healing were visible in at least 89% of all healing roots after 1 year. Risk analyses may provide relevant information in addition to or in substitution for success/failure analyses.

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Relationship between crown placement and the survival of endodontically treated teeth.

Elisabeth A. Aquilino, D Caplan (2002)

Crowns have been considered the restoration of choice for endodontically treated teeth, but their selection has been based primarily on anecdotal evidence. This study tested the hypothesis that crown placement (coronal coverage) is associated with improved survival of endodontically treated teeth when preaccess, endodontic, and restorative factors are controlled. A University of Iowa College of Dentistry treatment database was used to identify permanent teeth that had undergone initial obturation between July 1, 1985, and December 31, 1987. Study patients were restricted to persons with at least 1 dental visit in each 2-year interval from 1985 to 1996; a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 203 teeth that satisfied study inclusion criteria. Multivariate Cox proportional hazards regression models were developed, with standard errors adjusted to account for clustering of teeth within patients. When tooth type and radiographic evidence of caries at access were controlled, the final Cox model showed that endodontically treated teeth not crowned after obturation were lost at a 6.0 times greater rate than teeth crowned after obturation (95% confidence interval: 3.2 to 11.3). Within the limitations of this study, a strong association between crown placement and the survival of endodontically treated teeth was observed. These results may impact treatment planning if long-term tooth retention is the primary goal.

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PubMed ID:: 15564861

ScienceOpen disciplines: Chemistry

Keywords: Dental Restoration Failure,Epidemiologic Studies,Humans,Retrospective Studies,Root Canal Therapy,statistics & numerical data,Treatment Outcome,United States

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ScienceOpen disciplines: Chemistry

Keywords: Dental Restoration Failure, Epidemiologic Studies, Humans, Retrospective Studies, Root Canal Therapy, statistics & numerical data, Treatment Outcome, United States

Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study.

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A Sustainable Future

Most cited references 20

Reduction in tooth stiffness as a result of endodontic and restorative procedures.

Time-course and risk analyses of the development and healing of chronic apical periodontitis in man.

Relationship between crown placement and the survival of endodontically treated teeth.

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