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ePaper created 2016-09-05, 09:33:59 | version 1.38.0
| study non-surgical treatment 34 roots 3 2016 conforms to literature data indicating a better RCT success result4, 21 although Eckerbom et al.22 noted an increase of apical lesions from 17.3 % to 21.4 % within 20 years. The own, relatively high success rate might be based on a bias with a too positive evaluation of the cases or an over-representation of the VitEs. It might also be due to the used RCT methodasobservedinepidemiologicalstudies23 in countries with extensive application of formalde- hyde-containing materials despite poor technical RF-quality. Socially advantaged patients were represented with approx. 40 % in the examined patient popula- tion. They carried a 24 % lower extraction risk than social weak patients. A different failure risk did not existbetweentheindividualsocialstatusesofthepa- tients. According to Hujoel et al.24 , decision for ex- traction is determined by sociodemographic factors. Alowincomestatusandalowlevelofeducationfavor the decision for extraction. The authors Jafarian and Etebarian25 concluded from an analysis of 2,620 ex- tracted teeth that the level of education is of signifi- cantimportancefortoothpreservation.Inacompany health insurance study26 representing the working class, 8.3 % of the endodontic cases were extracted within 2 years. After 5 years, 28 % of reinterventions intheformofextractionsandRTRsbecamenecessary. In my own practice, the cumulative survival quote of all reinterventions increased to 16 % after 5 years. According to Lee et al.7 , the median survival limit regardingextractionhadbeenreachedafter21years, thus approximately corresponding to my own. The medianfailurelimitofLeeetal.wasafter119months (about 10 years). It has to be added that the authors scheduled their study 2 weeks after RCT only, so very earlyextractionsandfailuresmighthavebeenskipped from the study. Torabinejad et al.14 pointed out that in their study they categorically assigned pain after RCT to the fail- ures. The same principle is valid for the present study. Allacuteexacerbations(clinicalfailures)weretreated. 10.5 % of the failures accompanied by X-ray did not undergo therapy. The postoperative pain sensations amounted to 1.7 % after vital, after completion of a non-vitaltreatmentto11 %.Alittlemorethanathird could be contributed to overfilling: 30.9 %afteroverfillingofvitaland41.7 %afterover- filling of non-vital teeth. The Gesi et al.27 study on vi- tally extracted teeth mentions a pain rate of 13.3 % within the first week after VitE. 30.7 % of the pain aroseinoverfilledteeth.Intheownstudy,69overfill- ings (34.2 %) were responsible for 199 postoperative pain sensations. Neither the sex, nor the preoperative pathology or the number of appointments were decisive for ex- tractions or failure. However, the failure risk of vital teeth only amounted to 30.9 % of non-vital teeth. The multivariate analysis emphasised the results of theunivariate analysis regarding the extraction risk subject to age and kind of tooth. The two older age classesattainedhigherextractionratescomparedto the age class of <30. With increasing age, tooth loss rises even in non-root canal treated teeth by carious destruction and periodontal diseases. According to Eriksenetal.23 ,epidemiologicstudiesreflecttheend- odontic performance of general dentists with suc- cessratesof60–75 %.Inhisownpractice,theauthor achievedafailurerateof10.3 %invitaland28.7 %in non-vital teeth. It is also to be expected that different levels of ex- perience are responsible for different success rates. The cases treated by assistant doctors had a statisti- callysignificantlyhigherfailureratecomparedtothe practiceseniorwhiletheextractionratesofassistants and practice senior were on the same level. Cox re- gression proved that RF-degree and RF-quality do hardly play a role for the extraction risk the more howeverforthefailurerisk.AnRFwith‘voids’andin- complete canal wall adhesion allows a bacterial aug- mentation/invasion, an overfilling at least a periapi- calirritationcausedbycanalcontentflowingoverthe apex and root canal filling material. AccordingtoNgetal.6 ,themostsignificantcrite- ria for survival were: crown, two proximal contacts, Case 3 Fig.12: Pre-op X-ray (1989). Fig.13: Post-op X-ray (1989). Fig.14: Control X-ray (2007). Fig.12 Fig.13 Fig.14 32016