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ePaper created 2016-01-20, 13:53:08 | version 1.38.0
I 07 studies _ comparison of three methods of therapy I roots1_2015 have more than halved. Based on a scientific report,4 the prognosis of success for nsRCT is as follows: _vital extirpation and pulp necrosis of teeth without associated AP: 85–95% _retreatment or revision treatment (RV) of teeth without AP: 89–95% _pulp necrosis of teeth with AP: 70–85% _RV of teeth with associated AP: 50–70%. Thedefinitionofsuccessisessentialforevaluating thesuccessoftreatment.Thisisdefinedbasedonthe radiograph and the clinical findings (pain, fistula, swelling), and possibly on the examined teeth re- maining in asymptomatic function regardless of the radiographic findings. A benchmark regarding strict or loose criteria is determined radiographically. Strict criteria imply complete AP healing, whereas classifi- cation according to loose criteria means that the re- ductionofAPissufficientforconfirmationofsuccess. Ngetal.5 evaluatedindividualfactorsforsuccessand classified these into strict or loose criteria; for exam- ple, regarding vitality before RCT: a vital success rate of 82.5% and 89.6%, respectively; and a non-vital successrateof73.1%and84.7%,respectively;orre- gardingevaluationofthetechnicalqualityofanRCF: ahomogeneoussuccessrateof82.9%and87.0%,re- spectively; and an inhomogeneous success rate of 61.1%and64.2%,respectively.Usinginsurancedata, Lazarski et al.6 checked the data of 110,000 insurants over an average observation time of 22 months. A negative incident (extraction [EX], RER, RV) occurred after an average of 14.7 months. During this time, 3.56% of the teeth treated with RCF were extracted, 1.84% underwent RV and 1.00% underwent RER. Chen et al.7 looked at more than 1.5 million non- surgical endodontic treatments covering a period of five years. During this time, 6.70% of the teeth were extracted, 0.29% underwent RER and 3.20% under- wentRV.Afterfiveyears,thesurvivalrateforanterior teeth was 95.4% and 93.6% for premolars. The EX rateremainedconstantwith20%p.a.,and81%ofall RERs and 40% of all RVs were performed in the first year post-RCT. During a ten-year observation period inLumleyetal.,8 74%ofallteeththathadundergone RCF remained without re-intervention (EX, RER, RV). Afteroneyear,thepercentageofteethwithoutre-in- tervention was 96%; after five years, it was 84%. Of those that failed 70% ended up in EX. The central in- cisorsandthefirstpremolarshadthelongestsurvival time;thelateralincisorsandthecaninestheshortest. SalehrabiandRotstein9 evaluated4,744casesofnon- surgical RV. During a five-year observation period post-RCT, 11.0% were extracted and 5.2% under- went RER. Ngetal.10 evaluatedsurvivalratebasedon14stud- ies. The observation time ranged from one to 11.5 years,and74–85%oftheteethtreatedwithRCFsur- vived to the end of observation time without re-in- tervention.Intheirreviewof63studiespublishedbe- tween1922and2002,Ngetal.11 foundasuccessrate inthestudiesof31–96%(apooledandweightedrate of74.7%)accordingtostrictcriteriaandof60–100% (a pooled and weighted rate of 85.2%) according to loose criteria. In the same study, they analysed the practitioner’s influence on the treatment result dif- ferentiated according to strict and loose criteria. General practitioners achieved a success rate of 65.7–86.2%, postgraduate students 77.2–93.1%, and specialists 84.8–87.6%. Cross-sectionalstudiesandepidemiologicalstud- ies permit a survey of the quality of practitioners’ en- dodontic treatment results. Eriksen12 compared the successandfailureof14clinicalstudies—withRCTby specialistsandsupervisedstudents—and28epidemi- ological studies—with RCT by general practitioners. The success rate of the clinical studies varied from 77 to94%(average:86%weresuccessful,6%wereun- certain and 8% failed) and of the epidemiological studiesfrom35to78%(average:63%weresuccess- ful and 37% failed). Friedman13 consolidated data from 39 cross-sec- tionalstudiesperformedbetween1976and2006.The rate of AP was 20–65%. RCFs were found to be inad- equatein48–87%.Alleyetal.14 foundafive-yearsur- vival rate of 89.7% for endodontically treated teeth for cases treated by general practitioners and of 98.1% by endodontists. The figures mentioned prove that there is a dis- crepancy between learning and success in practice. Hülsmann and Snezna15 conclude that an optimal success rate cannot be achieved under practice con- Fig. 2_Success with respect to the total failure rate by therapy type. The initial Diagnosis 1, 2 (n = 757) showed 6.1% (n = 46) flare-ups, the initial Diagnosis 3, 4, 5 (n = 963) 4.3% (n = 41) flare-ups thus influencing the total failure rate. Fig. 2 inLumleyetal.,874%ofallteeththathadundergone