A review on Success and Failure in endodontic treatment

Points from ingle

5 year study conducted by the University of Washington-patients recalled at 6 months, 1,2,5 years. Success/failure evaluated mainly by radiographic assessment at recall time. Success-teeth that demonstrated decided periradicular improvement and those with continuing periradicular health. Failure those teeth that initially demonstrated periradicular damage and that had not improved, as well as those that had deteriorated since treatment. Results at 2 year recall were discussed-total 3678 patients, 1229 at 2 year recall 104 failures reported.

Failure in Washington study:

13 causes, subdivided into 3 groups:
Apical percolation Operative error Errors in case selection

Apical percolation 63.46%

Incomplete obturation Unfilled canal Ag point inadvertently removed

Operative error 14.42%

Root perforation Canal grossly overfilled or overextended Broken instrument

 Errors in case selection 22.12%

External root resorption Coexistent periodontal-periradicular lesion Developing apical cyst Adjacent pulpless tooth Accessory canal overfilled Constant trauma Perforation, nasal floor

Distribution of Failures of Treated Endodontic Cases: Two-Year Recall by Frequency of Occurrence

Causes of failure
Incomplete obturation Root perforation External root resorption

No of failures
61 10 8

% failures
58.66 9.61 7.7

Coexistent periodontal-periradicular lesion

Canal grossly overfilled or overextended Canal left unfilled Developing apical cyst Adjacent pulpless tooth Silver point inadvertently removed

6
4 3 3 3 2

5.78
3.85 2.88 2.88 2.88 1.92

Broken instrument
Accessory canal unfilled Constant trauma Perforation, nasal floor Total failures

1
1 1 1 104

0.96
0.96 0.96 0.96

Prognosis: 1. The more extensive and severe the endodontic pathosis, the poorer the prognosis. 2. The more dental treatment that is done, the poorer the prognosis. The worst prognosis lies with teeth that have been retreated nonsurgically and then re-treated surgically once or twice more.

 Grossman divided the causes into four categories:

poor diagnosis, poor prognosis, technical difficulties, and careless treatment. POOR PAST, (Crump et al DCNA 1979)
Perforation, Obturation, Overfill, Root canal missed Periodontal disease, another tooth, split, Trauma," all of which may cause endodontic failure.

Postoperative causes of failure

Post space preparation and placement Inadequate restoration Occlusal trauma and bruxism Superimposed nonendodontic causesorthodontic treatment and periodontal pathology Others

Post space preparation and placement

1. 2. 3. 4. Perforation improper orientation Disturbance of remaining obturated material Inadequate thickness of obturating material left Lateral forces on dentine during post placementespecially tapered, threaded posts. Tapered posts create a wedging effect. Post width exceeding 1/3rd of the canal width. Absence of ferrule can predispose the crown to fracture Delay in post cementation leading to leakage due to a leaking interim post and artificial crown.

5. 6. 7.
8.

Improper coronal restoration

Time period between obturation and permanent restoration is long. Temporary restoration is left for a long time. Inadequate thickness of temporary restoration minimum 3.5mm. Lack of marginal seal of leading to secondary caries Tooth is non-vital any progressing caries does not cause symptoms and generally remains undetected until clinical examination. Margin of the restoration impinging on the biological width improper cleaning, periodontal pocketing, secondary caries, lack of marginal integrity.

Occlusal trauma and bruxism

Crown/tooth fracture due to overloading- as abutment for precision attachments, distal extension base RPDs, posterior cantilevered fpd. Inadequate coronal restoration In cases of bruxism, full coverage restorations are essential(Abou Rass) Night bruxism intensifies normal pressure 10 times because proprioception is lost in REM sleep.

Superimposed nonendodontic causes

Orthodontic treatment Periodontal problems

Other factors
1. Lack of proximal contacts 2. Systemic diseases

prevention
1. Long-term followup

 Cases of unresolving post-treatment periapical radiolucencies are commonly referred to as 'endodontic failures'. It is generally acknowledged that most failures occur when treatment procedures have not reached a satisfactory standard for the control and elimination of infection. Common problems that may lead to endodontic failure include inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, and leaking temporary or permanent fillings (Sundqvist and Figdor, 1998).

references
An Evaluation of Coronal Microleakage in Endodontically Treated Teeth. Part I. Time Periods JOE vol 13 no2 Shigeyuki S, Masahiko I, Hiroshi K, et al. Analysis of bruxism occlusal force concerning formation of facet on occlusal splint for estimation of bruxism. Japanese Journal of Conservative Dentistry. 2006;49(1):6-16. Restoration of Endodontically Treated Teeth Paul R. Chalifoux, DDS