Prognosis/Outcome

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Author:
Aleksbaron
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253136
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Prognosis/Outcome
Updated:
2014-05-04 20:25:29
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ABE Prep
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ABE Prep
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  1. Prognosis / Outcomes Overview
  2. When should pts be recalled?
    • Orstavik – 1 yr; peak incidence of healing / CAP occurred @ 1 yr; may take 4 yrs
    • Andreasen – 1 yr; wait 4 yrs for uncertain healing cases
  3. How long doe it take a lesion to heal?
    Murphy – Avg. rate is 3.2mm/mo.; >70% require >12mo
  4. What factors may be detrimental to a successful outcome?
    • Crump – (POOR PAST): Perforation, Obturation; Overfill, Root canal missed, Perio disease, Another tooth, Split tooth, Trauma
    • Friedman – Toronto study: NSRCT – Pre-op lesion
    • RETX – Pre-op lesion, perforation, fill quality, restoration
    • S RCT – lesion > 5mm quadrupled risk
  5. Do the radiographic healing correlate to histologic healing?
    • Byrnolf – No; only 7% demonstrated no inflammation
    • Walton – Yes; 74%
  6. Is bacterial culturing indicated? Does it influence healing?
    • Sjogren & Sundqvist – 94% success w/ -culture; 68% w/ +culture; regardless, they state modern anaerobic culturing techniques are not readily available, nor are they required
    • Peters & Wesselink – found NSD between 1 or 2 visit, or between + and – cultures
  7. What are reasons for failure of NS RCT?
    • Intraradicular infection – Nair – main reason for failure is microbes persist in canals
    • Extraradicular infection – Siqueira –rare / Nair – Actinomycosis
    • Foreign body rxn – Nair – root filling materials
    • Cysts – Nair – possibly with cholesterol crystals
  8. Does the level of root canal fill influence success/failure?
    • Seltzer & Bender – Overfill decreased success; underfill had no influence
    • Ng – meta-anaylsis shows w/in 2mm of apex improved success
  9. Is 1 or 2-visit treatment more successful?
    • Peters & Wesselink – NSD
    • Weiger, Rosendahl & Lost – NSD for teeth with AP treated in 1 visit or with 1 wk Ca(OH)2
  10. OUTCOME STUDIES
  11. NSRCT
    • Toronto (Friedman) 85% healed; 95% functional
    • Washington Study (Ingle) 92%
  12. Perforation Repair
    Kvinnsland 92%
  13. RE-TX
    • Toronto (Friedman) 81% healed; 93% functional (with Perforation - 42%)
    • Allen, Newton , Brown 73%
  14. 2nd RE-TX
    Allen, Newton , Brown 47%
  15. S RCT
    • Toronto (Friedman) 74% healed; 91% functional
    • Rubinstein, Kim 97% (3-12 mo.); 92% (5-7yrs.)
    • Allen, Newton , Brown 60%
  16. 2nd S RCT
    Peterson & Gutmann 36% healed; 26% uncertain
  17. Root AMP
    Blomlof 68%
  18. Int Replant
    Bender & Rossman 81%
  19. IPC
    Jordan, Suzuki & Skinner <50% (11/24 cases)
  20. DPC
    • Ravn 80% (uninflammed pulps)
    • Tronstad <50% (carious exposure - consider IP)
  21. Cvek Pulpotomy
    • Cvek 96% (young incisors)
    • Mass 91% (young molars)
  22. Apexification
    • Cvek 96% -Ca(OH)2 long term
    • Whitherspoon 91-94% -MTA
  23. Pulpotomy (primary teeth)
    Fuks

    Formo -84%; FeSO4 -93%; MTA -97%
  24. Implants vs. RCT
    • Doyle NSD - 94%
    • Kim Meta analysis – NSD
  25. Internal Bleaching
    Glockner 98% -pt. subjective success
  26. Who discussed the criteria for success in 1956?
    • Strindberg 1956
    • Success

    §  The contours, width and structure of the periodontal margin are normal

    §  The periodontal contours are widened mainly around the excess filling

    Failure

    §  A decrease in the periradicular infection

    §  Unchanged periradicular rarefaction

    §  An appearance of new rarefaction or an increase in the initial
  27. Who introduced the PAI?
    • Orstavik 1986 – developed the Periapical Index (PAI) which is an ordinal scale of five scores ranging from healthy to severe periodontitis with exacerbating features; the
    • PAI is based on reference radiographs verified histologically by Brynolf 1967; 1=healthy; 2-5=disease

    (1) normal PA structures

    (2) small changes in bone structure

    (3) changes in bone structure w/ some mineral loss

    (4) periodontitis w/ well-defined radiolucent area

    (5) severe periodontitis w/ exacerbating features
  28. Are endodontic teeth more brittle?
    Sedgley - Endo treated teeth are NOT
  29. Does the presence of PARL reduce success of NSRCT?
    Friedman – Presence of PARL decreases success by 10-25%
  30. If a tooth is perforated, what factors affect outcome?
    Trope–3 factors affect outcome of perfs

    • o   
    • Size

    • o   
    • Location

    • o   
    • Time since perf
  31. Does radiographic healing correlate to histo?
    Brynolf – only 7% histo healing despite 100% radiographic healing

    Walton –100% radiographic healing had 74% histo healing (disputes Brynolf’s findings)

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