Evidence Based Dentistry

Is the prognosis of endodontic treatment different from that of retreatment?

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

Preoperative periapical status Apical limit of obturation Quality of obturation Quality of the coronal restoration

RCT Studies
Author % Healed # Cases

Strindberg Seltzer & Bender Grossman

Ingle Kerekes & Tronstad Swartz Sjogren Smith

87 80
86 92 91 88 91 84

529 2921
432 1229 501 1007 356 821 265 8061

Follow-up period 4 years

Date

1956 1963
1964 1965 1979 1983 1990 1993 2002

0.5 years
1-5 years 2 years 3-5 years 1 years 8-10 years 5 years 20 years

Molven & Halse 86 Average 87.22222

Complete Healing Following Endodontic Treatment

Vital PA Lesion

Chugal et al., OOO 2001 (4y)

Hoskinson et al., OOO 2002 (4-5y) Friedman et al., JOE 2003 (4-6y) Peters et al. 2004 IEJ (mean 2y) Farzaneh et al., JOE 2004 (4-6y)

88%
88% 92% 95% 97%

63%
74% 74% 76% 78%

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

94%

77%

Chevigny et al. JOE 2008 (4-6y) T4

Average

93% 92%

82%
75%

FACTORS 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 Studies
Author % Healed # Cases Follow-up period Date

Allen, Newton & 73 Brown

1300

0.5 years

1989

Sjogren

98 without AP 62 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 teethradiographic 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 Studies

Author % Healed # Cases Follow-up period 6mos-10years 6mos-8 years Date

Dorn Friedman

95 44

488 136

1990 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 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.