How to assess the outcome of endodontic treatment...

How to assess the outcome of endodontic treatment...

09 Jan 2011

Whe n carefully planned and executed, by far the majority of endodontic procedures will eventually result in a successful outcome.

However, as soon as there is an associated lesion in an infected tooth, the success rates drop and the ultimate outcome may not be immediately obvious to the clinician. In these cases, healing may take months or even years.

‘Success’ means different things to different people and may not be an absolute, black and white term. In endodontics, success has many definitions, from the absolute-complete absence of symptoms and complete healing on a radiograph, down to healing with a much reduced lesion, which may indicate scar tissue formation.

• Where symptoms remain: A decision has to be made as to whether this is due to slow healing with some residual bruising or it is an indication of failure. Short-term after-pain is normal and handled with analgesics. Persistent pain may be indicative of slow healing, a misdiagnosis or the early signs of failure.

A digital radiograph with an appropriate sensor holder is usually the best way of comparing changes at six months and one year after surgery. The changes can be incredibly subtle and may not be immediately evident at the six-month mark.

With slow healing apparent, many factors should be considered, including the initial size of the lesion, the patient’s age and their health. If, after four years healing has not occurred, or symptoms have recurred at any point, then healing is unlikely.

• In the absence of symptoms: Here we are guided by the radiograph. It is, however, impossible to look at an apparent lesion around a tooth in a new patient and judge whether this is a success or a failure. Only by seeing earlier radiographs can we judge whether things are going in the right direction.

If, after the follow-up the patient has noticed a worsening of their symptoms or the lesion has increased, real decisions have to be made as to how the situation can be improved. The prime offender is predominately bacteria. More uncommonly, a persistent cyst or even something more sinister may be the source of apparent failure.

Further information may be provided by a conebeam CT scanner. If the area is inaccessible or other pathology is suspected, surgery may well be
indicated.

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