Transcript Document

Tooth survival of endodontically treated molars
A total of 220 endodontically treated permanent molar teeth in 203 subjects on a waiting list for fixed
prosthodontic treatment at the Faculty of Dentistry-Mahidol University, Thailand.
Three levels of remaining tooth structure:
Type I remaining tooth structure denoted maximum remaining tooth
structure. The amount of remaining coronal tooth structure was
approximately that of a Class I cavity preparation with at least 2 mm of
surrounding wall thickness.
Type II denoted moderate remaining tooth structure. The amount of
remaining coronal tooth structure was approximately a Class II cavity
preparation with no less than 2 walls with at least 2 mm thickness.
Type III denoted minimum remaining tooth structure as the remaining
coronal tooth structure had less than 2 walls with at least 2 mm
thickness, ..
Nagasiri R, Chitmongkolsuk S. Long-term survival of endodontically treated molars without crown coverage: a
retrospective cohort study. J Prosthet Dent. 2005 Feb;93(2):164-70.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Tooth survival of endodontically treated molars
A total of 220 endodontically treated permanent molar teeth in 203 subjects on a waiting list for fixed
prosthodontic treatment at the Faculty of Dentistry-Mahidol University, Thailand.
Per cent tooth survival
100
80
60
40
20
Cuspal coverage of molars!
0
1
2
Class I
MOD
5
No safe wall
Nagasiri R, Chitmongkolsuk S. Long-term survival of endodontically treated molars without crown coverage: a
retrospective cohort study. J Prosthet Dent. 2005 Feb;93(2):164-70.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Apical regeneration after endodontic surgery
Wang Q, Cheung GS, Ng RP.
Survival of surgical endodontic
treatment performed in a dental
teaching hospital: a cohort study.
Int Endod J. 2004
Nov;37(11):764-75.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Apical regeneration after endodontic surgery
Wang Q, Cheung GS, Ng RP.
Survival of surgical endodontic
treatment performed in a dental
teaching hospital: a cohort study.
Int Endod J. 2004
Nov;37(11):764-75.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Apical regeneration after endodontic surgery
Wang Q, Cheung GS, Ng RP.
Survival of surgical endodontic
treatment performed in a dental
teaching hospital: a cohort study.
Int Endod J. 2004
Nov;37(11):764-75.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Apical regeneration after endodontic surgery:
material effect?
35
30
No of teeth
25
20
IRM
MTA
15
10
5
0
Complete
Incomplete
Uncertain
Unsatisfactory
Outcome
Chong BS, Pitt Ford TR, Hudson MB. A prospective clinical study of Mineral Trioxide Aggregate and IRM when
used as root-end filling materials in endodontic surgery. Int Endod J. 2003 Aug;36(8):520-6.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Apical regeneration after endodontic surgery:
material effect?
IRM 1y (n = 58)
MTA 1y (n = 64)
45
40
35
No of teeth
30
25
20
15
10
5
0
Complete
Incomplete
Uncertain
Unsatisfactory
Lindeboom JA, Frenken JW, Kroon FH, van den Akker HP. A comparative prospective randomized clinical study
of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 2005 Oct;100(4):495-500.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Apical regeneration after endodontic surgery:
material effect?
IRM 2y (n = 47)
MTA 2y (n = 61)
50
45
40
No of teeth
35
30
25
20
15
10
5
0
Complete
Incomplete
Uncertain
Unsatisfactory
Lindeboom JA, Frenken JW, Kroon FH, van den Akker HP. A comparative prospective randomized clinical study
of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 2005 Oct;100(4):495-500.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Endodontics vs implantat
Apples and oranges
Comparing case-selected, low-risk implants with
heroic salvation efforts by endodontics is biased
Comparing case-selected, low-risk endodontics with
high-risk, money- or patient-driven implants is biased
True comparisons difficult, may be impossible
The accumulation and presentation of individual cases
give information of the individual possibilities of each
method: endodontists need to knbow what
implantologists can do, and vice versa
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Endodontics vs implant
100
80
60
Prosent
40
20
0
Endo
Success
Survival
Impl
Repair
Failure
Doyle SL, Hodges JS, Pesun IJ, Law AS, Bowles WR. Retrospective cross sectional comparison of initial nonsurgical
endodontic treatment and single-tooth implants. J Endod. 2006 Sep;32(9):822-7. NSRCT outcomes were affected by
periradicular periodontitis (p = 0.001), post placement (p = 0.013), and overfilling (p = 0.003).
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Comparison of success of implants
versus endodontically treated teeth.
• A chart review was carried out in 2 group
specialty practices in the same city. Implant data
were collected from a periodontic practice and
endodontic data from patients presenting for
routine recall or treatment of another tooth at an
endodontic practice. Charts were selected in
alphabetical sequence, with no exclusions made
for systemic disorders, time of implant loading,
or tooth implant position in the mouth, and were
reviewed on patients with clinical and
radiographic follow-ups more than 1 year after
treatment.
Hannahan JP, Eleazer PD. J Endod. 2008 Nov;34(11):1302-5.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Endodontics vs implant
• Success was defined as radiographic
evidence that the implant or treated tooth
was still present in the mouth, and that
there was no notation of signs or
symptoms requiring intervention during the
follow-up period in the chart notes.
Hannahan JP, Eleazer PD. Commparison of success of implants versus endodontically treated teeth. J Endod. 2008
Nov;34(11):1302-5.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Endodontics vs implant
• Uncertain findings were defined for implants as
charted mobility greater than class I,
radiographically detectable bone loss, or
additional surgical procedure required. Uncertain
findings for endodontic treatments were defined
as charted mobility greater than class I,
radiograph judged as periapical index score of 3
or greater (Table 2), or orthograde endodontic
procedure or apical surgery required (22).
Hannahan JP, Eleazer PD. Commparison of success of implants versus endodontically treated teeth. J Endod. 2008
Nov;34(11):1302-5.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Endodontics vs implant
• Typical surgical interventions for implants were
flap exposures for debridement, with or without
grafting osseous material. Uncertain findings for
endodontic treatments were defined as charted
mobility greater than class I, radiograph judged
as periapical index score of 3 or greater (Table
2), or orthograde endodontic procedure or apical
surgery required (22). Preoperative values were
not considered.
Hannahan JP, Eleazer PD. Commparison of success of implants versus endodontically treated teeth. J Endod. 2008
Nov;34(11):1302-5.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Endodontics vs implant
140
120
100
80
Implants 129
60
Endo 143
40
20
0
Success
Uncertain
Failures
Hannahan JP, Eleazer PD. Commparison of success of implants versus endodontically treated teeth. J Endod. 2008
Nov;34(11):1302-5.
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Optimizing Prognosis
• Case selection: If in doubt, do not wait: prevention
is easier than cure
• Asepsis for vital pulps; antisepsis for infected pulps
• Bacteria-free canals: adopting procedures known
to provide a high probability of no growth
• Conventional fillings of high quality
• Coronal filling and molar coverage
• Judicious inclusion in prosthetic restorations
Dr. Dag Ørstavik
7. Jahrestagung DGEndo
Thank you for your endurance
and kind attention!
Let us all improve!
Dr. Dag Ørstavik
7. Jahrestagung DGEndo