Criteria for Outcome Assessment of Nonsurgical Endodontic Treatment
Robust criteria for outcome assessment of nonsurgical endodontic treatment are essential determinants for any measure of success. Strindberg (1956) established strict criteria for clinical and radiographic evaluation of the endodontically-treated tooth at
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Nadia Chugal, Sanjay M. Mallya, and Bill Kahler What’s in a name? That which we call a rose by any other name would smell as sweet. William Shakespeare
Abstract
Robust criteria for outcome assessment of nonsurgical endodontic treatment are essential determinants for any measure of success. Strindberg (1956) established strict criteria for clinical and radiographic evaluation of the endodontically-treated tooth at follow-up examinations. The absence of clinical symptoms, and the presence or absence of periapical radiolucency became the principal outcome measures of endodontic treatment. Subsequent studies have considered additional parameters that influence outcome such as microbiologic status prior to obturation, histopathologic data, and the effects of different techniques and materials. The “periapical index” (PAI) introduced the concept of a “continuum” that exists between success and failure where lesions could be considered as “healing.” The Toronto study introduced a novel outcome category of “functional” for teeth that were asymptomatic regardless of the PAI score. The American Association of Endodontists (AAE) has proposed that
N. Chugal (*) Section of Endodontics, UCLA School of Dentistry, Los Angeles, CA, USA e-mail: [email protected] S.M. Mallya Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, Los Angeles, CA, USA e-mail: [email protected] B. Kahler School of Dentistry, University of Queensland, Brisbane, QLD, Australia e-mail: [email protected] © Springer International Publishing Switzerland 2017 N. Chugal, L.M. Lin (eds.), Endodontic Prognosis, DOI 10.1007/978-3-319-42412-5_12
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endodontically-treated teeth are considered (1) healed, (2) nonhealed, (3) healing, or (4) functional. More recently, technological advances in radiology and the application of high-resolution cone beam computed tomography (CBCT) have increased diagnostic accuracy of radiographic changes in the apical periodontium. However, the use of this technology has been limited in outcome studies. Microbiological studies indicate the importance of disinfection of the root canal system on endodontic outcome. Therefore, the absence of clinical symptoms and presence or absence of radiographic apical periodontitis, as determined by periapical radiography, remain the principal outcome measures of endodontic treatment. The aim of this chapter is to discuss the development of the criterion for outcome for nonsurgical endodontic treatment from the strict view of success and failure while adequately considering newer concepts of healing and functionality.
12.1 Introduction With completion of endodontic treatment and placement of permanent restoration, the professional obligation to our patients does not end. One of the most exciting aspects of endodontics is actually following up the patients and evaluating how the treatment performed affected the end result, i.e., the resolution of patient symptoms, restoration of normal periradicular structures, function, and ultimately tooth
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