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roots - international magazine of endodontology

14 I I studies _ comparison of three methods of therapy regulardentalcheck-ups.38 Incross-sectionalstudies, Eriksen12 found a success rate of 35–78% compared withthatofclinicalstudiesof77–94%.Ngetal.11 ob- servedatreatmentsuccessrateamonggeneralprac- titionersof65.7–86.2%.Therefore,theresultsofthe present study are in the mid-range with the follow- ing success rates: 60.8% for nsRCT, 73.9% for RER and 76.4% for TR. These results cannot be compared with the results of cross-sectional studies, as clinical failuresarenotconsideredhere.Theresultsofcross- sectional,longitudinalandsurvivalstudieshavetobe separated. According to Ng et al.,10 survival rates in relation to EXs are always higher than failure rates. A problem was that the number of clinical cases (n = 1,720) outnumbered the cases with a follow-up radiograph (n = 1,162). Numerous endodontic stud- ies do not define the end of RCT being the start of the analysis, but only with a temporal delay, so early fail- uresorinterventionsarenotconsideredintheanaly- sis. Furthermore, cases without a follow-up radi- ograph and patients with health problems affecting the immune system (diabetes, HIV/Aids, steroid ther- apy, chemotherapy) are excluded from evaluation. Moreover, failures are often only based on the evalu- ation of radiographs, on which apical rarefactions cannot always be visualised. The present study is based on 149 radiographs accompanying Failure 2 cases, of which in 11 cases (7.4%) the radiograph showed no AP. In a previous study by the author39 on the EX of 1,160 endodontically treated teeth in his own practice, endodontic failure (n = 245) was the reason for EX. For n = 35 (14.3%), a failure was only discovered after EX. If the teeth without a follow-up radiograph were not considered in this study, the acute exacerbations, which occur anyway under the one-year limit and are decisive for the high failure rateofnsRCT,wouldnotappearasclinicalfailuresand the failure rate would only be based on the radi- ographic findings. Thus, the clinical failures were re- lated to all patients visiting the practice again after undergoing RCT. The file research in this study found 87teethdeemedFailure1(5.1%),70ofwhichhadun- dergonensRCT(12.9%ofallnsRCTs),13ofwhichhad undergoneTR(2.9%ofallTRs)andonlyfourofwhich hadundergoneRER(0.5%ofallRERs).Balabanetal.40 report a 10% incidence of acute exacerbation in 157 asymptomatic teeth with necrotic pulp with existing AP.Tsesisetal.41 foundarangeofacuteexacerbations of 1.5–20.0%. Recall in the author’s practice did not take place. An average observation period of 5.9 years for the 1,720caseswasachievedthough,evenifonly67.6% underwentafollow-upradiograph.Recallmighthave generated a higher patient appearance in observa- tion. In their review of 63 studies, Ng et al.5 describe a recall rate of 52.7% and the lowest of 11.0%. After one year, Orstavik42 achieved a recall rate of 71%, de- creasing to 33% after four years. The success rate in the remaining patients had increased. This raises the question of whether dissatisfaction with the treat- ment may have made patients stay away.43 The au- thors assume that the reason for the drop-out of the concernedpatientswaspostoperativeproblems,pain uptofailure.Afurtherdecreaseofrecallrateoverthe yearswithasimultaneousincreaseinsuccessrateled Wu et al.43 to speculate that only patients satisfied withtreatmentmightattendappointments,whereas patients with poor RCT results might stay away. Ac- cording to Orstavik et al.,44 18% of the patients never visitedthedentalpracticeagainafterRCT.Inthepres- ent study, the percentage was 3.9%. When following up their RER patients, Rud et al.24 realisedthatthepercentageofcaseswithincomplete anduncertainhealingdecreasedwithinthefirstpost- operative years, whereas the percentage of success- fultreatmentsandfailuresincreased.Aftermorethan four years, only insignificant changes were observed. Friedman report a relapse rate after RER of 5–42% after more than four years. Eckerbom et al.19 re-ex- amined their RCT patients after 20 years and found that the AP rate in teeth that had undergone RCT had increased from 17.3% to 21.4%. The Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde [German society for dental and oral medicine]1 has warnedthattheendodonticsuccessoflong-termfol- low-up is being overestimated. The author’s analysis confirmsadecreaseinRCTsuccessrates,aswellasan increase in failure rates after four years. The type of health insurance indicated no greater incidence of failures among individual pa- tient groups. Regarding EX rate, a socio-economic componentcouldnotbeignoredhowever.Thelowest socio-economic group constituted 59.2% of the pa- Table 4_Survival rate in relation to Failures 1 and 2, depending on initial diagnosis and therapy. roots1_2015 Therapy Years Survival rate (%) P-value Diagnosis 1,2 Diagnosis 3,4,5 NsRCT 5 86.1 73.3 0.002 10 78.6 58.3 15 68.9 58.3 RER 5 96.6 91.4 0.016 10 92.5 82.3 15 84.3 76.0 TR 5 94.9 86.9 0.004 10 90.4 79.2 15 87.9 72.0 TOTAL 5 91.9 86.5 0.001 10 86.2 76.9 15 79.3 71.0 Table 4 cording to Orstavik et al.,4418% of the patients never NsRCT 586.173.30.002 1078.658.3 1568.958.3 RER 596.691.40.016 1092.582.3 1584.376.0 TR 594.986.90.004 1090.479.2 1587.972.0 TOTAL 591.986.50.001 1086.276.9 1579.371.0

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