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ePaper created 2016-09-05, 09:33:59 | version 1.38.0
| study non-surgical treatment 26 roots 3 2016 Long-term analysis of primary, non-surgical root canal treatments– A retrospective study Author: Dr Robert Teeuwen, Germany Abstract The aim of this study was to exam more than 8,000 primary, non-surgical root canal treatments in the author’s general practice during 1985–1999 and fol- lowed-up for 25 years. Factorsthathaveinfluenceonfailureandextraction rate were evaluated. Statistically, the data were anal- ysedbylog-ranktestandCoxregression.Theestimated survivalrateswereshowninKaplan-Meiercurves. With regard to the multivariat Cox regression the significant factors were: overfilled root canal, poor root filling quality, restoration, and fractured canal instrument, via falsa. Further on failure was influ- enced by the operator and the preoperative status of the pulp. Insurance conditions, patient age and type of tooth influenced the extraction risk. After 20 years, 82.3 % were not subject to failure and 51.5 % were saved from extraction. Introduction Studies feature the evaluation of factors with the treatment aim of healing and retention in a symp- tom-free environment. Evaluation of success/failure is partly based on X-rays only, and partly on X-rays plus clinical situation. According to Schmalz1 , X-rays arenotanabsolutelyreliableparameter.Furthermore, studies2, 3 show that the bias of the reviewer influ- ences the interpretation of the X-ray. Finally, various improbabilities affect evaluation. Ng et al.4 evaluated 76 studies from 1922–2002 in a systematic review. Various studies showed an aver- age success of 74.7 % based on strict criteria, and a success rate of 85.2 % based on loose criteria. When using strict criteria, the success rate increased with duration of follow-up period—from 67.3 % after 24 months to 85.4 % after 48 months. In a follow-up publication based on 63 studies5 , the authors anal- ysedparametersregardingtheirinfluenceonthesuc- cess of the root canal treatment (RCT). Using strict criteria, they determined four main factors: apical periodontitis(AP),qualityofrootcanalfilling(RF)ho- mogeneous versus nonhomogeneous, length of RF, and quality of restoration. They ascribed a success of 82.5 % to vital teeth, and a success of 73.1 % to non-vitalteeth.Thelowestsuccessratescouldbeob- served in mandible molars, patient age > 50. In a sys- tematicreviewof14survivalstudiesNgetal.6 showed that survival rates concerning extractions showed better results than success rates. The study of Lee et al.7 featuresaclearcomparisonoftheevaluatedcom- parison parameters success/survival. Materials and methods The author, who started as a dental practitioner in 1969, used the 9,988 non-surgical endodontic treat- mentcasesregisteredinhispatientfilesfrom1985to 1999.Ofthese,X-rayswerenolongeravailablein518 cases. Five teeth were extracted immediately upon noticing of via falsa. Eight hundred and twenty-one caseshadnotreturnedtothepracticeafterRCT,how- ever they were included in the dropout rate without furtheranalysis.Thus,8,644casesofvitalandnon-vi- 32016