Endodontics
Course Review
Enoch Ng, DDS 2014
Non-Surgical Outcomes
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Multifactorial, not all factors can be IDed
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Should try to ID as many factors as possible pre-op, during op, post-op
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Prognosis can change due to additional findings or iatrogenic damage
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Keep patient informed
Overall healing from initial therapy
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Complete healing = 83-86%
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Incomplete healing = 86-91%
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Functionally retained = 95%
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97% NSRCT teeth retained after 8 years
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85% extracted teeth did not have a crown
Overall healing from retreatment therapy
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Complete healing = 80-82%
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Incomplete healing = 86%
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Functionally retained = 94%
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98% healing if retreatment is due to defective
filling, much lower if due to persistent
radiolucency
Surgical Outcomes
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74% healing rate over 4-8 years
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91% functionally retained
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Microsurgery = 91.5% healing at 5-7 years
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Success rates for endo and implants are equal
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Smoking only factor to significantly affect both
Non-Healing of RCT
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Consider etiology
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Address restorability
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Options
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No treatment
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Retreatment
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Apical surgery
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Extraction (with or without replacement)
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Symptomatic patients – POOR PAST
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Perforation
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Obturation
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Overfill
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Root Canal Missed
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Periodontal Disease
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Another tooth
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Split tooth
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Trauma (occlusion)
Microbiology
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E. faecalis – 22-77% of post-treatment apical periodontitis cases
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Resistant to intracanal medicaments
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Tolerates pH up to 11.5, can survive prolonged starvation
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May grow as monoinfection, can create biofilms, can undergo genetic mutation inside biofilms
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Actinomyces – extraradicular colonies
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Symptoms – multiple sinus tracts, extraoral sinus tracts, yellow “sulfur granules”
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Can perpetuate apical inflammation even after ideal NSRCT, must be treated surgically
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Fungi
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Dentinal Tubule sequalae
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Serves as a reservoir for microbes