Elsevier

Journal of Endodontics

Volume 37, Issue 1, January 2011, Pages 21-25
Journal of Endodontics

Clinical Research
Long-Term Prognosis of Endodontically Treated Teeth: A Retrospective Analysis of Preoperative Factors in Molars

https://doi.org/10.1016/j.joen.2010.10.005Get rights and content

Abstract

Introduction

Long-term predictability of restored endodontically treated teeth is important for the decision of tooth retention versus extraction and implant placement. The purpose of this study was to validate the hypothesis that preoperative factors can predict the long-term prognosis of molars requiring endodontic and restorative treatment for future prognostic investigations.

Methods

A clinical database was searched for molar endodontic treatments with crown placement and a minimum of 4-year follow-up. Charts of 42 patients with 50 individual treatments were randomly selected. Information concerning crown lengthening; periodontal diagnosis; attachment loss; furcation involvement; mobility; and internal, external, or periradicular resorption was recorded. Radiographs from treatment initiation and follow-up were digitalized. The presence of apical periodontitis was evaluated. Available ferrule was calculated from bitewing radiographs using CAD software (AutoCAD; Autodesk, Cupertino, CA). The resulting data, age, sex, and times of restoration and follow-up were analyzed for correlation with the presence of apical radiolucency at follow-up and the following four possible outcome scenarios: “no event,” “nonsurgical retreatment,” “surgical retreatment,” or “extraction” using Spearman rank order correlation analysis.

Results

Patients’ ages ranged from 19 to 87 years, 22 were male and 20 female, and 48 teeth (96.0%) were retained at follow-up. Of those, 44 (88.0%) were without intervention (“no event”), and four (8.0%) underwent surgical or nonsurgical retreatment. Two teeth (4.0%) had been extracted. Significant positive correlations existed between “untoward events” (any form of retreatment or extraction) and “prognostic value according to periodontal status” (p = 0.047) and “attachment loss” (p = 0.042).

Conclusion

The only preoperative factors significant for the prognosis of restored endodontically treated molars were related to periodontal prognostic value and attachment loss. It can be concluded that it may be difficult to predict the prognosis of molars in need for endodontic treatment and restoration from prognostic factors not related to periodontal disease.

Section snippets

Materials and Methods

The clinical database of the University of Pennsylvania School of Dental Medicine was searched for patients with a history of molar endodontic treatment performed between 1999 and 2005, subsequent permanent crown restoration, and a minimum of a 4-year follow-up in the form of a full-mouth series of radiographs was performed. Forty-two charts with 50 individual teeth that had matching criteria were randomly selected.

With the variables’ abbreviation in parenthesis, the following data were

Results

The mean follow-up period from endodontic treatment to the control full mouth series was 5.4 years. The patients’ age ranged from 19 to 87 years. Out of all patients, 22 were male and 20 female. Of all teeth, 48 (96.0%) were retained at follow-up. Of those, 44 (88.0%) had no untoward event, and 2 (4.0%) each underwent surgical or nonsurgical retreatment. Two teeth (4.0%) had been extracted. At start (AP start), 18 teeth had apical periodontitis (36.0%). Of these, five lesions healed completely,

Discussion

This study attempts to isolate and define preoperative parameters for the long-term prognosis of endodontically treated molars. The long-term predictability of any tooth undergoing dental treatment has been subject to debate. Depending on whether the outcome assessment was periodontic, endodontic, or restorative in nature, different parameters were investigated. Most endodontic treatment prognosis studies investigated success and failure based on the endodontic status of the tooth depending on

Conclusion

Within the limitations of this study, it may be concluded that, for endodontically treated molars, certain preoperative periodontal conditions are reliable indicators for the long-term clinical outcome in terms of the necessity of extraction or retreatment. An enlarged patient pool will be needed to define predictive criteria for the long-term-prognosis of endodontically treated teeth. The current model appears to be valid for the evaluation of retrospective data to find ad hoc information;

Acknowledgment

We would like to thank Elaine Bellucci, Statistician, Murrietta, CA, for the conduction of the statistical analyses presented in this review.

References (33)

  • G. Greenstein et al.

    Prerequisite for treatment planning implant dentistry: periodontal prognostication of compromised teeth

    Compend Contin Educ Dent

    (2007)
  • G. Avila et al.

    A novel decision-making process for tooth retention or extraction

    J Periodontol

    (2009)
  • L.Z. Strindberg

    Dependence of the results of pulp therapy on certain factors. An analytical study based on radiographic and clinical follow-up examinations

    Acta Odont Scand

    (1956)
  • D. Orstavik

    Reliability of the periapical index scoring system

    Scand J Dent Res

    (1988)
  • A. Byström et al.

    Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis

    Endod Dent Traumatol

    (1987)
  • U. Sjögren et al.

    Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis

    Int Endod J

    (1997)
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