Characterization of successful root canal treatment
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Data
2014
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Resumo
Knowing the outcome of root canal treatment (RCT) is determinant to substantiate the
clinical decision making process, especially when RCT is weighed against the extraction
of natural teeth or replacement by prosthetic elements. The ideal scenario in all clinical
situations should combine healing/prevention of disease (apical periodontitis) and the
functional retention of the tooth. Understanding the risk factors associated with endodontic
failure is a key factor to increase the chances of success. The logical action is to reverse
the existing disease, which requires intervention to neutralize the bacterial invasion and
disrupt the bacterial biofilm within the complex anatomy. Success is more predictable
when the immune host defenses are favorable. However, success has different meanings
to the dentist, to the patient and to the tooth itself. The life of an endodontically treated
tooth depends on the accuracy of the diagnosis and planning, excellence of disinfection,
instrumentation and filling procedures (antimicrobial strategies, root canal shaping and
coronal and apical seal) and finally the rehabilitation management. The interpretation
of constant or intermittent pain and/or discomfort associated with apical periodontitis
(AP) in endodontically treated tooth may be suggestive of endodontic failure. The success
features of RCT, namely absence of pain, regression of AP, tight seal of canal and coronal
spaces, and recovery of tooth function, must be reevaluated over time. In case of doubt
between success and failure, cone beam computed tomography (CBCT) could be indicated
for detection and precise localization of AP. The possibility of map reading on CBCT
images characterizes the real multidimensional structure, providing accurate information
on the presence, absence or regression of AP. The survival of an endodontically treated
tooth implies understanding the biological and mechanical outcomes as multifactorial
events over the individual’s life span. The objective of this review of literature is to discuss
relevant factors associated with patient’s health, tooth and dentist that could account
for a successful RCT.
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Palavras-chave
Success, Failure, Outcome, Apical periodontitis, Healing
Citação
ESTRELA, Carlos et al. Characterization of successful root canal treatment. Brazilian Dental Journal, Ribeirão Preto, v. 25, n. 1, p. 3-11, 2014.