Prognosis Retreat vs Initial Rct

Evidence Based DentistryEvidence Based DentistryIs the prognosis of endodontic treatment Is the prognosis of endodontic treatment

different from that of retreatment?different from that of retreatment?

FACTORS INFLUENCING THE LONG TERM FACTORS INFLUENCING THE LONG TERM RESULTS OF ENDO TREATMENTRESULTS OF ENDO TREATMENTBasmadijan-Charles C et al, IDJ 2002Basmadijan-Charles C et al, IDJ 2002

• Preoperative periapical status

• Apical limit of obturation

• Quality of obturation

• Quality of the coronal restoration

RCT StudiesRCT StudiesAuthor % Healed # Cases Follow-up

periodDate

Strindberg 87 529 4 years 1956

Seltzer & Bender

80 2921 0.5 years 1963

Grossman 86 432 1-5 years 1964

Ingle 92 1229 2 years 1965

Kerekes & Tronstad

91 501 3-5 years 1979

Swartz 88 1007 1 years 1983

Sjogren 91 356 8-10 years 1990

Smith 84 821 5 years 1993

Molven & Halse 86 265 20 years 2002

Average 87.22222 8061

Complete Healing Following Endodontic Complete Healing Following Endodontic TreatmentTreatment

VitalVital PA Lesion PA Lesion Chugal et al., OOO 2001 (4y)Chugal et al., OOO 2001 (4y) 88%88% 63%63%

Hoskinson et al., OOO 2002 (4-5y)Hoskinson et al., OOO 2002 (4-5y) 88%88% 74%74%

Friedman et al., JOE 2003 (4-6y)Friedman et al., JOE 2003 (4-6y) 92%92% 74%74%

Peters et al. 2004 IEJ (mean 2y)Peters et al. 2004 IEJ (mean 2y) 95%95% 76%76%

Farzaneh et al., JOE 2004 (4-6y)Farzaneh et al., JOE 2004 (4-6y) 97%97% 78%78%

Marquis et al., JOE 2006 (4-6y)Marquis et al., JOE 2006 (4-6y) 94%94% 77%77%

Chevigny et al. JOE 2008 (4-6y) T4Chevigny et al. JOE 2008 (4-6y) T4 93%93% 82%82%

Average 92% 75%

FACTORS AFFECTING RETREATMENTFACTORS AFFECTING RETREATMENT

Duration since original treatment Periapical status at the time of original treatment Quality of coronal restoration :

Adequate/Inadequate Use of rubber dam in the placement of coronal

restoration Quality of Primary endo therapy : If Adequate /

Inadequate, is it correctable. NSRCT VS NSRCT + SURGERY VS ONLY SURGERY

Type of coronal restoration: Crown / PC(Cast or Prefab) / Amalgam or composite

Retreatment StudiesRetreatment StudiesAuthor % Healed # Cases Follow-up

periodDate

Allen, Newton & Brown

73 1300 0.5 years 1989

Sjogren 98 without AP62 with AP

356 8 years 1990

Sundqvist 74 54 5 years 1998

Retreatment of endodontic fillings. Bergenholtz G, Lekholm U, Milthon R, Heden G, Odesjo B, Engstrom B. Scand J Dent Res 87:217-224. 1979.

The success rate of ReTx is equivalent to initial RCT if the cause of failure is identified and corrected. -Bergenholtz 1979“Seventy-eight percent of the cases with

pathologic lesion present periapically prior to retreatment either completely healed or displayed an obvious size-reduction of the process. Retreatments carried out because of technical inadequacies alone were successful in 94% of the cases.”

Nonsurgically retreated root filled teeth-radiographic findings after 20-27 years.

Fristad I, Molven O, Halse A. Int Endod J. 2004

From an original material of 429 roots, retreated by undergraduate students in a teaching clinic, 112 roots in 70 individuals could be evaluated radiographically 20-27 years after treatment.

The percentage of cases recorded as normal condition at the final follow-up was 95.5%

Late periapical changes, with more successful cases, were recorded when a 10-17-year follow-up after root canal treatment was extended for another 10 years. Persistent asymptomatic periapical radiolucencies, especially those with overfill, should generally not be classified as failures, as many of them will heal after an extended observation period.

Surgical RCT StudiesSurgical RCT Studies

Author % Healed # Cases Follow-up period

Date

Dorn 95 488 6mos-10years 1990

Friedman 44 136 6mos-8 years 1991

Frank 58 104 15 years 1992

August 63 39 10 years 1996

Testori 85 302 6 years 1999

Rubinstein 92 59 5 years 2002

Surgical RCT StudiesSurgical RCT Studies

The use of MTA as a root-end filling, following microsurgical techniques, showed a high success rate. The overall success rate was 88.8%. SAUNDERS, J Endod 2008

Skeptical??

Levels of evidence for the outcome of nonsurgical endodontic treatment. Torabinejad M, Kutsenko D, Machnick TK, Ismail A, Newton CW.

Systematic review of articles published from 1966- 2004 ranking the levels of evidence used.

Results: “few high-level studies have been published in the past four decades related to the success and failure of nonsurgical root canal therapy”.

Skeptical??

Levels of evidence for the outcome of endodontic retreatment. Paik S, Sechrist C, Torabinejad M.

Systematic review of articles published from 1970 ranking the levels of evidence used.

Results: “few high level studies have been published in the past 34 yr related to the success and failure of endodontic retreatment”.