Quality of Life of Endodontically Treated versus Implant Treated Patients: A University-based Qualitative Research Study

Survival, complications, and patient-reported outcomes of endodontically treated teeth versus dental implant-supported prostheses: A systematic review

STATEMENT OF PROBLEM

Decision making for compromised teeth involving the choice between endodontic treatment and tooth extraction followed by an implant-supported prosthesis is challenging. However, systematic reviews examining studies using the same patients or clinical settings to provide conclusive evidence regarding the best approach are lacking.

PURPOSE

The purpose of this systematic review was to compare the survival rate, complications, failure, and patient-reported outcomes of endodontically treated teeth and implant-supported prostheses.

MATERIAL AND METHODS

After the protocol had been registered at the International Prospective Register of Systematic Reviews (PROSPERO), PubMed, Scopus, and the Cochrane Database of Systematic Reviews were searched from database inception to July 2023 with no language restriction. A manual literature search was performed. The review protocol was based on the population, intervention, comparator, outcome, and study design (PICOS) criteria and included all observational and experimental human studies that directly compared the survival, complications, and patient-reported outcomes of teeth with pulpal and periapical disease after all types of endodontic treatment and subsequent restoration and tooth extraction followed by an implant-supported prosthesis. The risk of bias of the included studies was assessed by using the modified Newcastle-Ottawa scale.

RESULTS

Eight observational studies were included in this systematic review: 3 retrospective cohort and 5 case-control studies. Three included studies revealed no difference in survival rate between endodontically treated teeth and implant-supported prostheses during the first 3 years, but the survival of endodontically treated teeth declined over time with a higher failure rate than implant-supported prostheses. In contrast, the other 3 included studies reported lower survival rate for implant-supported prostheses and more complications. In terms of patient-reported outcomes, patients were generally satisfied with both treatment modalities, with notable improvements in oral health-related quality of life in those receiving endodontic treatment.

CONCLUSIONS

Whether implant-supported prostheses or endodontically treated teeth are better in terms of survival outcome is unclear. Improved oral health-related quality of life was found after endodontic treatment.

Evaluation of quality of root canal therapy performed by predoctoral students on endodontic outcome and quality of life of patients

This study evaluated the technical quality (TQ) of root canal therapy (RCT) performed by predoctoral students and its impact on endodontic outcome (EO) and patients' quality of life (QoL). The TQ of RCT done by predoctoral students was evaluated and follow-up visits were conducted to determine the clinical, radiographic outcome of RCT and patients' QoL. Frequency distribution, multiple regression, independent-samples t test and one-way anova were performed. A total of 226 teeth of 164 patients were clinically and radiographically examined. A satisfactory TQ was observed in 130 (57.5%), successful clinical outcomes in 155 (68.6%), successful radiographical outcomes in 206 (91%) and overall successful EO in 150 teeth (66.4%) with 80% of patients reporting a favourable QoL. A significant positive correlation was noted between EO and QoL (p = 0.002) with no significant correlation in between TQ-RCT and EO (p = 0.07) and TQ-RCT and QoL (p = 0.316). Successful EO had a positive impact on patients' QoL.

Oral health-related quality of life and perceptions of patients following primary root canal treatment or non-surgical retreatment

This retrospective cohort study compared the effect of primary root canal treatment (RCT) with root canal retreatment (Re-RCT) on patient-reported outcomes in Kuala Lumpur, Malaysia. Forty randomly selected adults participated (RCT n = 20; Re-RCT n = 20). The impact their dentition had on the Oral Health Impact Profile-14 (OHIP-14) was assessed by calculating the prevalence of oral health impact, and the severity score. Focus group discussions using a semi-structured guide were arranged through an online meeting platform. Qualitative content analysis identified common themes, and relevant quotes gathered. The impact on OHIP-14 was limited for both RCT and Re-RCT groups with no significant differences in the prevalence of oral health impact. Significant differences were found for functional limitation (RCT higher) and psychological discomfort (Re-RCT higher). Common themes from the discussions include the importance of retaining teeth, the significance of effective communication between clinicians and patients and that the respondents were satisfied with the treatment.

Quality of Life in Patients with Endodontically Treated Teeth: A Retrospective Study at an Educational Hospital

BACKGROUND/OBJECTIVES

Root canal treatment (RCT) is a crucial procedure for preserving dental health. While its clinical success rates are well documented, patient-reported outcomes regarding quality of life remain less explored. This study aimed to assess the long-term impact of RCT performed in an educational hospital on patients' oral-health-related quality of life (OHRQoL) using the Oral Health Impact Profile-14 (OHIP-14).

METHODS

A total of 1500 patients who underwent non-surgical RCT between April 2018 and February 2023 were called and invited for a follow-up visit. During the visit, all teeth that had undergone RCT were assessed clinically and radiographically by two calibrated examiners to evaluate RCT quality and pre- and post-treatment periapical index (PAI) scores. Demographic information and OHIP-14 responses were collected, and the data were recorded.

RESULTS

Patients reported high levels of satisfaction (95%) and no negative impact on their OHRQoL. Statistical analysis revealed that post-operative periapical index (PAI) scores (p < 0.001), patient gender (p = 0.003) and nationality (p = 0.029) significantly influenced OHRQoL perceptions; Conclusion: These findings emphasize the effectiveness of RCT in enhancing patients' quality of life and highlight the impact of demographic factors-such as gender and whether the patient is a resident or a national of the country, along with post-treatment severity of the disease-on patient-reported outcomes.

A comparison of oral health-related quality of life and satisfaction among patients undergoing root canal treatment or tooth extraction - A prospective controlled cohort study

OBJECTIVE

This study aimed to evaluate the impact of root canal treatment on Oral Health-Related Quality of Life (OHRQoL) in general dental practice and compare it with tooth extraction. Additionally, patient satisfaction following tooth-preserving treatment was assessed.

MATERIAL AND METHODS

In all, 65 patients were recruited from 6 general dental clinics in Västra Götaland over 8 weeks, with 37 starting root canal treatment and 28 having extractions. Questionnaires, including Oral Health Impact Profile-14 (OHIP-14) and 9 questions assessing patient satisfaction, were administered at treatment initiation, and at 1, 6, and 12 months. The responses from both modalities were analysed using descriptive and analytical statistical methods.  Results: The response rate ranged from 73.8% to 92.3%. Regarding OHRQoL, differences between the groups were few compared to baseline. However, significant improvements were observed in the extraction group at the 6- and 12-month follow-ups, in the 'total score', and the dimensions 'pain', 'discomfort', and 'handicap'. Patient satisfaction was generally high, with cost being the least satisfactory item. Pain intensity remained consistently low.

CONCLUSIONS

In this prospective cohort study few differences were found between the two treatment modalities. However, significant improvements were observed in the extraction group in several dimensions. The patient satisfaction regarding root canal treatment was considered high.

Oral Health-Related Quality of Life Following Root Canal Treatment of First Permanent Molars Among Children. A Cross-Sectional Study

Aim

This study aimed to assess the Oral Health-Related Quality of Life (OHRQoL) of pediatric patients (9-18 years old) who underwent root canal treatment (RCT) on first permanent molars (FPMs).

Methods

A cross-sectional study was conducted at three healthcare centers in Jeddah, Saudi Arabia. Participants (n = 482) completed the validated OHIP5-Ar questionnaire to assess OHRQoL. Responses were classified as "optimal" (no problems) or "less than optimal" (any reported problems). Logistic regression analyzed the relationship between OHRQoL and sociodemographic factors.

Results

There were 66.8% children reported optimal OHRQoL after RCT. Logistic regression showed no significant association between optimal OHRQoL and gender, family income, or location of treated tooth. However, although not statistically significant. Treating only one FPM with RCT (compared to multiple teeth) and lower family income (compared to higher income) were more likely to have decreased or increased odds of optimal OHRQoL (AOR = 0.684 or 1.424; respectively).

Conclusion

RCT on FPMs can be a successful treatment option for pediatric patients, offering optimal oral health-related quality of life.

Retrospective Assessment of Endodontically Treated Teeth Replaced by Dental Implants

INTRODUCTION

This study investigated endodontically treated teeth that were replaced by dental implants at the University of North Carolina (UNC) at Chapel Hill School of Dentistry. The primary objective of this study was to determine the reasons leading to the extraction of endodontically treated teeth and their subsequent replacement with dental implants. The secondary objective was to evaluate the proportion of these teeth that, according to experienced endodontists, could have been preserved.

METHODS

The UNC-Chapel Hill's dental electronic health records between 2004 and 2019 were probed for implant placement that replaced root canal-treated teeth. Preextraction radiographs and clinical charts were examined to ascertain the primary reason related to the extraction and to compile a profile for each case. In cases in which endodontic failure was the primary reason for extraction, radiographs and clinical findings were evaluated by 2experienced endodontists to assess potential treatment options.

RESULTS

Between 2004 and 2019, 29.3% (1564 of 5229) of teeth replaced by dental implants at UNC School of Dentistry had undergone root canal treatment, with the mandibular first molar being the most commonly replaced tooth. The leading reasons for extraction were recurrent caries associated with defective restoration (26.6%), fracture of coronal structure (21.5%), vertical root fracture (20.9%), compromised periodontal condition (13.8%), and endodontic failure (2.4%). Two experienced endodontists evaluated extractions due to endodontic failure and concluded that 61.7% of them could have been candidates for endodontic retreatment.

CONCLUSION

Substantial loss of tooth structure was the leading cause of extraction of root canal-treated teeth, followed by vertical root fracture and periodontal disease. Although endodontic failure constituted a minor portion of the reasons for extraction, a considerable number of teeth were extracted due to vertical root fractures following root canal treatment. A significant proportion of the extracted teeth due to endodontic failure could have been considered as potential candidates for endodontic retreatment.

Patient-related outcomes and Oral Health-Related Quality of Life in endodontics

There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient-centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient-reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health-related quality of life, and patient-reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient-related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3-level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health-Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter-related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.

DENTAL PATIENT-REPORTED OUTCOMES IN ENDODONTICS - A NARRATIVE REVIEW

Recently in oral health care settings, the focus of assessing treatment outcomes has shifted from the perspective of the clinician towards that of the patient. Endodontology is a specialty of dentistry concerned with the prevention and treatment of pulp and periapical diseases. Research in endodontology and its associated treatment outcomes have focused mainly on clinician-reported outcomes (CROs) and not dental patient-reported outcomes (dPROs). As a result, there is a need to emphasize the importance and relevance of dPROs to researchers and clinicians. The aim of this review is to present an overview of dPROs and dPROMs within endodontics in an attempt to create a better understanding of the patient experience, highlight the need to place the patient at the center of treatment, enhance patient care and encourage more research into dPROs. The key dPROs following endodontic treatment include pain, tenderness, tooth function, need for further intervention, adverse effects (exacerbation of symptoms, tooth discoloration) and Oral Health-Related Quality of Life. dPROs are important following endodontic treatment because they assist clinicians and patients when they discuss and select the most appropriate management options, help clinicians make decisions on pre-operative assessment, prevention and treatment, and improve the methodology and design of future clinical studies. Clinicians and researchers in endodontology should prioritize patient welfare and undertake routine analyses of dPROs using appropriate and robust measures. Due to the lack of agreement over the reporting and definition of endodontic treatment outcomes, a comprehensive project to define a ``Core Outcome Set for Endodontic Treatment Methods (COSET)'' is currently ongoing. In the future, a new and exclusive assessment tool should be developed to reflect the viewpoints of patients receiving endodontic treatment more accurately.

Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review

Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.

Impact of Case Difficulty, Endodontic Mishaps, and Instrumentation Method on Endodontic Treatment Outcome and Quality of Life: A Four-Year Follow-up Study

INTRODUCTION

Root canal treatment (RCT) is often considered a difficult procedure for both the patient and treatment provider. The American Association of Endodontists case difficulty assessment form categorizes cases as minimal, moderate, and high difficulty level. We recently showed that endodontic mishaps occur frequently during treatment of teeth in high difficulty category. The aims were to investigate the clinical and radiographic outcome at least 4 years after RCT and to evaluate patients' perceived oral health-related quality of life (OHRQoL).

METHODS

Two hundred thirty-four patients (257 endodontically treated teeth) who were previously included in a quality assurance study were offered a recall appointment at the Department of Clinical Dentistry, University of Bergen, Norway. Patients were given a thorough clinical, radiographic examination and asked to fill out the Oral Health Impact Profile-14 questionnaire.

RESULTS

A total of 149 patients (160 teeth) attended the 4-year (range, 4-6 years) recall appointment. An unchanged or lower Periapical Index (PAI) score at recall visit was registered on 153 teeth (95.6%) (P < .001). Radiographic success rate (PAI score ≤ 2) was 87.5%, and clinical success (absence of clinical signs and symptoms) was 88.8%. Both radiographic and clinical success was observed in 78.8% of teeth. Teeth in high difficulty category, instrumented with engine-driven files, and molars presented with significantly more clinical signs and symptoms but not high PAI score (PAI score ≥ 3) (P < .05). Endodontic mishaps such as overinstrumentation and overfill with gutta-percha resulted in significantly high PAI score (P < .05). Patients with no clinical signs and symptoms after RCT and elderly had a significantly better OHRQoL (P < .05).

CONCLUSIONS

Presence of clinical signs and symptoms rather than PAI score affected patients' OHRQoL.

Quality of life and satisfaction of patients two years after endodontic and dental implant treatments performed by experienced practitioners

OBJECTIVES

To compare oral health related quality of life (OHRQoL) and patients´ satisfaction with root canal treatment (RCT) and dental implant (DI) therapy performed by experienced practitioners.

METHODS

Patients with both an RCT and a DI performed respectively by an endodontist and an oral surgeon with more than 15 years of experience two years prior to the study were included. The survival and satisfactory outcome of both treatments were verified with clinical and radiographic data. Participants completed two constructed questionnaire (one for each treatment). OHRQoL assessment included 24 items (OHIP-14 plus other relevant 10 items from the original OHIP-49 questionnaire). Satisfaction regarding duration, cost and pain (both during and after treatment) of treatment was assessed with a 0-10 scale and perceptions with true/false questions. Weighted sums for each dimension, total OHIP scores, prevalence of impact and general satisfaction of patients were then calculated for DI and RCT and compared using the Wilcoxon test for related samples. Patients´ perceptions were compared with Chi-square test.

RESULTS

Total OHIP scores were low for both treatments (8.82 and 7.87, respectively for RCT and DI). No significant differences were detected in OHIP total score or any dimension, except for physical pain (significantly higher for RCT than DI (p=0.044)). All patients were satisfied with both treatments; however, patients recalled that pain during treatment was significantly worse for RCT than DI (p=0.003).

CONCLUSIONS

High long-term OHRQoL and satisfaction is expected with either DI or RCT performed by experienced practitioners; however, physical pain dimension is higher for RCT.

CLINICAL SIGNIFICANCE

This study demonstrated a high satisfaction and long-term quality of life of patients undergoing both DI and RCT if treatments provide a functional balance and are performed by experienced practitioners. Very importantly, all participants had received both treatment modalities and being their own control eliminates individual variability.

PROMs Following Root Canal Treatment and Surgical Endodontic Treatment

The FDI is currently working on developing a tool to encompass patient-reported outcome measures (PROMs) within the overall assessment of outcomes of endodontic treatment. The outcome of endodontic treatment has traditionally been determined by various clinical and radiographic criteria. However, these parameters do not address the impact of treatment on a patient's oral health-related quality of life (OHRQoL). OHRQoL, a crucial PROM, can be used to understand treatment outcome from a patient-centred perspective, thus improving clinician-patient communication whilst guiding decision-making. This focussed review aims to recount the OHRQoL of patients following nonsurgical root canal treatment and surgical endodontic treatment, with a specific focus on the minimal important difference (MID; the minimum score changes of an outcome instrument for a patient to register a clinically significant change in their OHRQoL and/or oral condition) and the methods used to determine it. The current evidence indicates that the OHRQoL of patients requiring root canal treatment is poorer than those without such need. Accordingly, the literature suggests that OHRQoL improves following nonsurgical or surgical endodontic treatment. However, study methodologies vary widely, and conclusions cannot be drawn with high confidence, nor can MID recommendations be provided. Well-designed clinical studies with baseline measurements and appropriate follow-up time frames are therefore needed. Despite that the literature is rife with outcome studies, research on PROMs is an area that deserves greater attention, particularly in relation to the MID. Determining the MID will facilitate the understanding of changes in outcome scores from the patients' perspective, thus allowing for more informed decision-making in clinical practice.

Psycho-social perspectives of nonsurgical versus surgical endodontic interventions in persistent endodontic disease

INTRODUCTION

Patients' experiences related to dental treatment could influence care-seeking behaviour and engender personal bias. Although endodontic retreatment and apical surgery are procedures often performed to manage previously treated teeth with persistent disease, there is lack of information regarding psycho-social perspectives of patients who undergo these treatments. Our aim was to compare experiences of patients who received these two treatment modalities using a qualitative approach.

METHODS

A purposive sample of patients was taken from our previous study utilizing the Oral Health Impact Profile to compare oral health-related quality of life of 150 patients who received retreatment and apical surgery. Patients who reported impact and no impact were invited to participate in focus group discussions (FGDs). Eighteen patients from the retreatment group and 15 patients from the surgical group participated in six FGDs. Thematic analysis was conducted to identify key themes.

RESULTS

Four themes emerged: (1) psycho-social disability associated with dental procedures, (2) physical disability associated with dental problems, (3) reliance on dentist's advice for treatment and (4) self-management to preserve treated teeth. Patients undergoing endodontic retreatment reported significant time loss from work and were less informed of alternative treatment options. However, they were pleased with the aesthetics of their teeth, especially if new crowns were made. Patients undergoing surgery experienced anxiety related to loss of control during surgery and apprehension on visualizing the wound post-surgery. They reported more impact on their diet, social interaction and sleep quality and some felt self-conscious due to post-treatment gingival recession. Patients in both groups placed great trust in professional advice and expressed a clear desire to maintain their natural dentition. There was low awareness regarding long-term care and future sequelae of their treated tooth.

CONCLUSIONS

Patients reported different psycho-social and physical impacts following endodontic retreatment and apical surgery. Patients undergoing endodontic retreatment were more satisfied with aesthetic outcomes but experienced greater impact related to complexities and length of time taken for treatment. Patients undergoing surgery were better informed of treatment options but experienced greater physical and psycho-social disability during the recovery phase. Clinicians could consider incorporating findings from this study into the patient-dentist discussion.

Patient satisfaction with root canal treatment and outcomes in the Swedish public dental health service. A prospective cohort study

AIM

To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics.

METHOD

The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT-completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow-up questionnaire. Both descriptive and analytical statistics were used to compare respondents and non-respondents and tooth groups.

RESULTS

One hundred and fifty-nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for non-respondents (P<0.001). A completed root filling was registered for the majority of the teeth (n = 112, 70.9%), but significantly fewer molars had been completed (n = 46, 59.7%, P = 0.02). Fifty percent (n = 59) of the patients reported current pain, mostly mild in intensity (n = 45, 38.1%). One hundred and twenty-three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item 'chewing ability' (mean = 1.6, SD = 1.9). The majority of patients (n = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present, or had not experienced much discomfort during or after RCT. Forty-four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients' responses was considered to be good.

CONCLUSIONS

The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient-centred outcomes.

A critical review of qualitative research publications in dental implants from 2006 to 2020

OBJECTIVES

This critical review is aimed to investigate the current status of qualitative research in dental implant research and to explore the quality of available information.

MATERIAL AND METHODS

A systematic search was done on the journal databases to identify dental implant research articles that used qualitative methodology during 2006 and 2020. The resulting articles were appraised against the checklist offered by the Critical Appraisal Skills programme (CASP) tool. Also, the theories evolved from the research were reviewed to understand the value of this methodology in dental implant research.

RESULTS

Twenty-five (25) articles out of the 8,421 original results were identified as using qualitative methodology. The researchers have sought to identify the views of patients about tooth loss, dental implants, and the information they receive from dental professionals, and views of the dentists about dental implant practice. The review found that there were few inconsistencies in the quality of such research especially the qualitative data analysis.

CONCLUSIONS

The quantity of qualitative research in dental implants remains low; however, the quality has improved in the past two decades. Despite these improvements, there is still a lack of research in understanding both patients' and dentists' views on dental implant procedures and management.

Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years

Background: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT). Methods: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed (α = 0.05). A Cox regression model was made. Results: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan–Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1–98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68–56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03–23.38)), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205–1.61)). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively). Conclusions: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.

Comparing Quality of Life of Patients Undergoing Root Canal Treatment or Tooth Extraction

INTRODUCTION

The knowledge of patient-centered outcomes concerning the consequences of root canal treatment in daily life is limited. The treatment option is often tooth extraction with possible prosthetic replacement. This study aimed to achieve a greater understanding of the patient perspective by evaluating the effect of root canal treatment in terms of quality of life and quality-adjusted life year (QALY) weights in comparison with patients who underwent tooth extraction.

METHODS

Patients with either root canal treatment or extraction were recruited from 6 clinics in the general public dental service during a predetermined period of 8 weeks. Three different instruments were used: the Oral Health Impact Profile evaluating the oral health-related quality of life (OHRQOL), the EQ-5D-5L evaluating health-related quality of life (HRQOL) and QALY weights, and a disease-specific questionnaire evaluating satisfaction regarding the root canal treatment. The evaluation was assessed at the initiation of treatment and after 1 month. Patient-based and tooth-specific characteristics were obtained from the dental records.

RESULTS

Eighty-five patients were included. The distribution between sexes was even, with 43 women and 42 men. The mean age was 51.1 years. Forty-eight patients (56.5%) had a tooth extraction, and 37 patients (43.5%) initiated root canal treatment. The response rate for the questionnaire at baseline was 95.3%, and at the 1-month follow-up, it was 74.1%. Two relevant and comparable groups were obtained after exclusion of the extracted third molars (n = 20), resulting in 65 patients for further analyses. At follow-up, the patients who initiated root canal treatment registered a significant improvement in perceived HRQOL according to the QALY weights (P = .02 and P < .01, respectively). Patients initiating root canal treatment reported generally high satisfaction.

CONCLUSIONS

A cohort of patients either initiating root canal treatment or tooth extraction as a control group was established. Initiating root canal treatment had a positive impact on perceived HRQOL. The included patients in general dental practice registered overall high satisfaction regarding root canal treatment.

Oral health-related quality of life (OHRQoL) before and after endodontic treatment: a systematic review

OBJECTIVES

This systematic review was undertaken to determine the oral health-related quality of life (OHRQoL) before and after endodontic treatment.

MATERIALS AND METHODS

Based on the PRISMA guidelines, electronic databases (n = 7) were searched and from 1038 citations, 16 papers were included in this review. Information on study design, sample size, intervention/treatment modality, methods of assessing OHRQoL, and the key findings were extracted and analyzed.

RESULTS

Among the 16 studies, 3 were cross-sectional surveys, 9 were longitudinal studies, and 4 were randomized clinical trials. The cross-sectional studies reported improvements in OHRQoL following root canal treatment. Comparative longitudinal studies did not identify a significant association between improvements in OHRQoL and the method of root canal instrumentation or number of instruments used. Clinical trials found that improvements in OHRQoL were significantly associated with instrumentation technique, surgical-incision approach, and the application of platelet-concentrate during surgery. Several methods of assessing OHRQoL were employed with the most common being the Oral Health Impact Profile (OHIP), albeit using different versions.

CONCLUSIONS

The results of this systematic review indicate that the QoL of patients improved after endodontic treatment. Nevertheless, these results are limited to patients who seek endodontic treatment and cannot be generalized. The lack of well-designed observational studies with standardized assessment approaches, coupled with heterogeneity of study design and interventions, precluded quantitative synthesis.

CLINICAL RELEVANCE

Pragmatic clinical trials are more meaningful to understand patient-centered outcomes of treatment. This review shows that endodontic treatment does improve the QoL. However, future studies should use standardized tools and data reporting, which are critical to make meta-analyses possible.

Comparative Longitudinal Study on the Impact Root Canal Treatment and Other Dental Services Have on Oral Health-related Quality of Life Using Self-reported Health Measures (Oral Health Impact Profile-14 and Global Health Measures)

INTRODUCTION

The literature assessing quality of life for subjects who have undergone root canal treatment (RCT) is scarce. The aim of this study was to compare the effect of RCT with other dental services (exodontia, restorative, prosthodontics, periodontics, and negative controls [preventative and scale and clean]) on oral health-related quality of life.

METHODS

A random sample of 3000 adults aged 30-61 years was obtained from the Australian electoral roll in 2009. Data were collected through questionnaires, dental service logbooks, and treatment receipts. The impact their dentition had at baseline and the 2-year follow-up for the Oral Health Impact Profile-14 and the self-rated dental health score followed by "global transition statement of change" (GTSC) was assessed. Binary regression models were used to compare the outcomes.

RESULTS

Responses were collected from 1096 respondents (response rate = 36.5%). After adjustment (for age, sex, household income, and reason for visit), the RCT group had significant differences (P ≤ .05) to other dental services at the 2-year follow-up using the Oral Health Impact Profile-14 (odds ratio = 0.34; 95% confidence interval, 0.12-0.96) and GTSC (odds ratio = 0.29; 95% confidence interval, 0.09-0.88) but not with individual treatment groups. Using the self-rated dental health score/GTSC, only the prosthodontic treatment group had a significant difference to the RCT group at baseline, whereas the negative controls (P ≤ .01) had significant differences to the RCT group with the odds for improved health 5 times higher, at 2-year follow-up.

CONCLUSIONS

The RCT group presented with similar oral health-related quality of life when compared with the other individual treatment groups; however, they consistently reported poorer oral health outcomes when the negative controls were included.

Assessing a training programme for primary care dental practitioners in endodontics of moderate complexity: Pilot data on skills enhancement and treatment outcomes

Aims

To explore the impact of dedicated training to extend the skills of primary care practitioners on the quality of endodontic care, using clinical, radiographic and patient-related outcomes.

Methods

The quality of endodontic treatment performed at the beginning and end of training to become dentists with extended skills (DES) in endodontics was assessed in vitro and in vivo from endo-training blocks and self-reported logbooks containing clinical notes and radiographs respectively. The quality of endodontic care delivered by DES post-training was measured using clinical and radiographic outcomes. Patient-related outcomes were assessed using a self-report questionnaire, including the Oral Health Impact Profile – Endodontic Outcome Measure (OHIP-EOM).

Results

Data on eight dentists were examined pre-and post-training, five of whom participated in further follow-up investigations on the quality of endodontic care delivered to their patients. Significant improvements in skills were seen for all domains in vitro (p <0.05), and for all domains of the clinical treatment process, and achieving the correct working length of the root filling as seen by radiography in vivo (p <0.05). The quality of the clinical process was maintained following training. Positive patient outcome (OHIP-EOM) scores were recorded (mean score of 34.72, SD = 10.74, n = 120 pre-treatment and 25.85, SD = 7.74, n = 47 representing reduced impact at follow-up). The majority of patients reported being satisfied, or very satisfied, with the service they received (72.5%, n = 98); would use the service again (68.1%, n = 92); and would recommend the service to friends and family (74.8%, n = 101).

Conclusions

Findings suggest that training for dentists working in practice can be successful in enhancing skills and changing practice, with evidence of high patient satisfaction and good clinical and patient-related outcomes. Pilot results must be interpreted with caution and further research is required.

Impact of root canal preparation performed by ProTaper Next or Reciproc on the quality of life of patients: a randomized clinical trial

AIM

To compare the impact of the two different root canal preparation systems on the quality of life of patients and correlate postoperative pain with the impact on quality of life.

METHODOLOGY

A randomized clinical trial was conducted with 58 patients allocated into two groups based on the root canal preparation system employed: ProTaper Next (PN) or Reciproc (R). Data collection involved the administration of a questionnaire addressing demographic and clinical characteristics, the OHIP-14 (quality of life) and a visual analog scale (pain). The latter two were the outcomes of interest and were administered in the first 24 h after root canal treatment. The data were submitted to descriptive analysis, bivariate analysis, Poisson univariate and multiple regression, and Spearman's correlation test, with a 5% significance level.

RESULTS

A greater frequency of impact after treatment was found for the items 'uncomfortable to eat food' and 'felt self-conscious'. No significant difference between groups was found regarding the severity of impact for total OHIP-14 score or any of the domain scores.

CONCLUSIONS

The two root canal preparation systems exerted a similar impact on quality of life. Postoperative pain was correlated with impact on quality of life, affecting chewing function, self-consciousness and stress. Thus, it is important for dentists to provide care capable of preventing or treating the negative consequences of such therapy.

Eight-year follow-up of autogenous tooth transplantation involving multidisciplinary treatment

Although autogenous tooth transplantation is a widely reported procedure, its success is dependent on a number of factors. Here we describe the surgical technique, endodontic treatment and rehabilitation employed for a patient in whom a lower right third molar was transplanted to substitute an adjacent second molar with extensive caries. During an 8-year follow-up period, normal periodontal healing was observed and no infection, ankylosis or progressive resorption occurred. It may be concluded that transplantation of a third molar is a practicable approach for replacement of a lost permanent tooth, with restoration of esthetics and function.

Long-term Clinical Outcomes of Endodontically Treated Teeth Restored with or without Fiber Post-retained Single-unit Restorations

INTRODUCTION

The aim of the present study was to evaluate both survival and failure rates of endodontically treated teeth restored with or without fiber post-retained restorations after a mean observation period of at least 5 years.

METHODS

A total of 144 single-rooted and multirooted teeth in 100 subjects were endodontically treated following a predetermined aseptic protocol and restored with either a fiber post and a composite core or a composite filling without intraradicular retention. A fiber post was cemented when the teeth presented with only 1 wall and/or less than one third of the remaining height of the clinical crown. After a comprehensive treatment plan, the teeth were restored with either a direct composite restoration or a single-unit crown. Endodontically treated teeth supporting fixed and removable dental prostheses and telescopic crowns were excluded from the analysis. Success was defined as tooth survival without any treatment of biological and/or technical complications.

RESULTS

The overall tooth survival rate was 89.6% after a mean observation time of 8.8 ± 2.3 years. The survival rate of teeth with a fiber post amounted to 94.3%, and for teeth without a post, it was 76.3% (P < .001). The main reason for tooth loss was root fracture (9.7%). No loss of post retention was observed. Successfully treated teeth without any biological and/or technical complications and requiring no additional treatment during the entire observation period amounted to 79.9%.

CONCLUSIONS

Endodontically treated teeth restored with fiber posts and either a direct composite restoration or a single-unit crown yielded higher survival and success rates compared with teeth restored without fiber posts. Vertical fractures of roots not containing a post represented a frequently encountered and serious problem.

Multiple-file vs. single-file endodontics in dental practice: a study in routine care

BACKGROUND

Little is known about the differences of rotary multiple file endodontic therapy and single-file reciprocating endodontic treatment under routine care conditions in dental practice. This multicenter study was performed to compare the outcome of multiple-file (MF) and single-file (SF) systems for primary root canal treatment under conditions of general dental practice regarding reduction of pain with a visual analogue scale (VAS 100), improvement of oral-health-related quality of life (OHRQoL) with the german short version of the oral health impact profile (OHIP-G-14) and the speed of root canal preparation.

MATERIALS AND METHODS

Ten general dental practitioners (GDPs) participated in the study as practitioner-investigators (PI). In the first five-month period of the study, the GDPs treated patients with MF systems. After that, the GDPs treated the patients in the second five-month period with a SF system (WaveOne). The GDPs documented the clinical findings at the beginning and on completion of treatment. The patients documented their pain and OHRQoL before the beginning and before completion of treatment.

RESULTS

A total of 599 patients were included in the evaluation. 280 patients were in the MF group, 319 were in the SF WaveOne group. In terms of pain reduction and improvement in OHIP-G-14, the improvement in both study groups (MF and SF) was very similar based on univariate analysis methods. Pain reduction was 34.4 (SD 33.7) VAS (MF) vs. 35.0 (SD 35.4) VAS (SF) (p = 0.840) and the improvement in OHIP-G-14 score was 9.4 (SD 10.3) (MF) vs. 8.5 (SD 10.2) (SF) (p = 0.365). The treatment time per root canal was 238.9 s (SD 206.2 s) (MF) vs. 146.8 sec. (SD 452.8 sec) (SF) (p = 0.003).

DISCUSSION

Regarding improvement of endodontic pain and OHRQoL measure with OHIP-G-14, there were no statistical significant differences between the SF und the MF systems. WaveOne-prepared root canals significantly faster than MF systems.

Treatment of Necrotic Teeth Using Two Engine-Driven Systems and Patient's Postoperative Pain: A Double-Blind Clinical Trial

INTRODUCTION

One of the most important reasons for postoperative pain is the extrusion of debris from the apical foramen during preparation and shaping of root canals. The aim of this clinical trial was to evaluate the severity of postoperative pain with the use of two different engine-driven NiTi systems.

METHODS AND MATERIALS

Ninety mandibular molars were randomly divided into two groups (n=45), and root canal cleaning and shaping was done using either RaCe or Reciproc instruments. The severity of postoperative pain was determined with visual analogue scale (VAS) at 4-, 12-, 24-, 48- and 72 h and 1-week intervals and postoperative pain was compared between the two groups. The chi-squared test and repeated-measures analysis were used to compare the data between the two groups.

RESULTS

Based on the results of the statistical analyses, the two groups were matched regarding the age and gender, with no significant differences. In addition, except for 4- and 24-h and 1-week intervals, postoperative pain was significantly less in the RaCe group compared to the Reciproc group (P<0.001).

CONCLUSION

Based on the results of the present study, use of RaCe files for cleaning and shaping of root canals in necrotic mandibular molars resulted in less severe postoperative pain compared to Reciproc files.

Current status of implant prosthetics in Japan: a survey among certified dental lab technicians

Background

There are many implant cases in which dental technicians take initiative with regard to the design of implant prostheses, and to a certain extent, this area of care is one in which dentists do not necessarily play the leading role. Moreover, inadequate communication between dental technicians and dentists and insufficient instructions for technicians has been highlighted as issues in the past. The purpose of this questionnaire is to improve the quality of implant prostheses and thereby contribute to patient service by clarifying, among other aspects of treatment, problem areas and considerations in the fabrication of implant prostheses, conceptual-level knowledge, and awareness of prosthodontics on the part of the dentists in charge of treatment and methods for preventing prosthetic complications.

Methods

A cross-sectional survey was given to 120 certified dental technicians. To facilitate coverage of a broad range of topics, we classified the survey content into the following four categories and included detailed questions for (1) the conditions under which implant technicians work, (2) implant fixed prostheses, (3) implant overdentures, and (4) prosthetic complications.

Results

Out of 120 surveys sent, 74 technicians responded resulting in a response rate of 61.6%.

Conclusions

This survey served to clarify the current state of implant prosthodontics, issues, and considerations in the fabrication of implant prostheses, and the state of prosthetic complications and preventive initiatives, all from a laboratory perspective. The results of this survey suggested that, to fabricate prostheses with a high level of predictability, functional utility, and aesthetic satisfaction, it is necessary to reaffirm the importance for dentists to increase their prosthetic knowledge and work together with dental technicians to develop comprehensive treatment plans, implement an organized approach to prosthesis design, and accomplish occlusal reconstruction.

Translational opportunities in stem cell-based endodontic therapy: where are we and what are we missing?

Pulp regeneration is a biologic process occurring under specific circumstances. An endodontic treatment modality to accomplish pulp regeneration has emerged based on the response of undifferentiated cells that are often referred to as stem cells. The treatment itself is currently empirical based on clinicians' thoughts and observations. The demonstration of a variety of dental stem cells initiated basic research detailing the properties and behavior of these cells. Attempts are made to bridge gaps in knowledge regarding treatment strategies by translating basic stem cell research into practice. However, neither the patient population likely to benefit from pulp regeneration nor most clinical parameters are well described. Classic topics in endodontics (eg, indication/clinical diagnosis, disinfection/irrigation, and root canal preparation/pretreatment) have to be revisited under the premises of pulp regeneration. Furthermore, new topics like the development of new diagnostic tools or new clinical success criteria will emerge, and the translational research itself will generate new insight into pulp regeneration mechanisms.

Reciproc vs. hand instrumentation in dental practice: a study in routine care

Background. Little is known about the clinical impact of new root canal preparation systems in general dental practice under routine care conditions. Therefore, we compared hand instrumentation (H) with Reciproc (R) (VDW, Munich, Germany) preparation. The outcomes were endodontic related pain and oral health related quality of life (OHRQoL), evaluation of the procedures by the patients and the strain felt by the dentists during root canal therapy. Methods. Six dentists participated in the trial as practitioner-investigators. In the first phase of the trial they prepared root canals with H and in the second phase with R. The patients documented their pain felt with a visual analogue scale (VAS 100) and OHRQoL with the German short version of the oral health impact profile (OHIP-G-14) before treatment and before the completion of therapy and answered questions about how they experienced the treatment. The dentists documented their physical strain during treatment. Results. A total of 137 patients were included in the evaluation. 66 patients were treated with H, 71 with R. Pain reduction was 32.6 (SD 32.9) VAS (H) vs. 29.4 (SD 26.9) VAS (R) (p = 0.550), and the improvement of the OHIP-14 score was 5.5 (SD 9.2) (H) vs. 6.7 (SD 7.4) (R) (p = 0.383). There were no statistical differences in both groups. Significantly fewer patients felt stressed by the duration of treatment with R as with H (p = 0.018). Significantly more dentists reported that their general physical strain and the strain on their fingers were less severe with R than with H (p = 0.013 and p < 0.001). Discussion. H as well as R effectively reduced endodontic related pain and OHRQoL without statistical differences. R has advantages in terms of how patients experience the treatment and regarding the physical strain felt by the dentists.

Assessment and Evaluation of Quality of Life (OHRQoL) of Patients with Dental Implants Using the Oral Health Impact Profile (OHIP-14) - A Clinical Study

INTRODUCTION

Peri-implant tissue health is a requisite for success of dental implant therapy. Plaque accumulation leads to initiation of gingivitis around natural teeth and peri-implantitis around dental implants. Peri-implantitis around dental implants may result in implant placement failure. For obtaining long-term success, timely assessment of dental implant site is mandatory.

AIM

To assess and evaluate Quality of Life (OHRQoL) of individuals with dental implants using the Oral Health Impact Profile (OHIP-14).

MATERIALS AND METHODS

Total 92 patients were evaluated for assessment of the health of peri-implant tissues by recording, Plaque Index (PI), Probing Pocket Depth (PD), Bleeding On Probing (BOP) and Probing Attachment Level (PAL) as compared to contra-lateral natural teeth (control). In the same patients Quality of Life Assessment was done by utilizing Oral Health Impact Profile Index (OHIP-14).

RESULTS

The mean plaque index around natural teeth was more compared to implants and it was statistically significant. Other three dimensions mean bleeding on probing; mean probing attachment level and mean pocket depth around both natural teeth and implant surfaces was found to be not statistically significant. OHIP-14 revealed that patients with dental implants were satisfied with their Oral Health-Related Quality of Life (OHRQoL).

CONCLUSION

Similar inflammatory conditions are present around both natural teeth and implant prostheses as suggested by results of mean plaque index, mean bleeding on probing, mean pocket depth and mean probing attachment level, hence reinforcing the periodontal health maintenance both prior to and after incorporation of dental implants. Influence of implant prostheses on patient's oral health related quality of life (as depicted by OHIP-14) and patients' perceptions and expectations may guide the clinician in providing the best implant services.

Choice of Treatment Plan Based on Root Canal Therapy versus Extraction and Implant Placement: A Mini Review

Case selection and treatment plan are important aspects of endodontic treatment. Dentists should organize the treatment plan based on their knowledge, abilities, skills and more importantly the patients’ preference and dentition. Indubitably, the treatment plan for each patient is exclusive and “tailor-made” and cannot be used for all patients. Dentists’ selfestimation of their abilities opens up treatment options; however, in difficult or complicated cases it is advisable to refer to a specialist. Currently, one of the most challenging aspects in dentistry is the choice between extraction and placement of implant (EPI) instead of a complicated root canal treatment (RCT). Overemphasis on one treatment plan while neglecting other options, not only mislead the dentist but also impose unnecessary charges to the patients. This mini-review compares RCT to EPI from various aspects to help practitioners in routine decision making.

Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings

INTRODUCTION

The frequency of persistent pain 3-5 years after primary root canal therapy and its impact on the patient's perceived oral health-related quality of life was determined in a practice-based research network.

METHODS

All patients presenting to participating network practices who received primary root canal therapy and restoration for a permanent tooth 3-5 years previously were invited to enroll. Persistent pain was defined as pain occurring spontaneously or elicited by percussion, palpation, or biting. The patient also completed an oral health-related quality of life questionnaire (Oral Health Impact Profile-14).

RESULTS

Sixty-four network practices enrolled 1323 patients; 13 were ineligible, 12 did not receive a final restoration, and 41 were extracted, leaving 1257 for analysis. The average time to follow-up was 3.9 ± 0.6 years. Five percent (63/1257) of the patients reported persistent pain, whereas 24 of 63 (38%) exhibited periapical pathosis and/or root fracture (odontogenic pain). No obvious odontogenic cause for persistent pain was found for 39 of 63 (62%). Teeth treated by specialists had a greater frequency of persistent pain than teeth treated by generalists (9.3% vs 3.0%, respectively; P < .0001). Sex, age, tooth type, type of dentist, and arch were not found to be associated with nonodontogenic persistent pain; however, ethnicity and a preoperative diagnosis of pulpitis without periapical pathosis were. Patients reporting pain with percussion tended to experience pain with other stimuli that negatively impacted quality of life including oral function and psychological discomfort and disability.

CONCLUSIONS

These results suggest that a small percentage (3.1%) of patients experience persistent pain not attributable to odontogenic causes 3-5 years after primary root canal therapy that may adversely impact their quality of life.

Root canal therapy reduces multiple dimensions of pain: a national dental practice-based research network study

INTRODUCTION

Initial orthograde root canal therapy (RCT) is used to treat dentoalveolar pathosis. The effect RCT has on pain intensity has been frequently reported, but the effect on other dimensions of pain has not. Also, the lack of large prospective studies involving diverse groups of patients and practitioners who are not involved in data collection suggest that there are multiple opportunities for bias to be introduced when these data are systematically aggregated.

METHODS

This prospective observational study assessed pain intensity, duration, and its interference with daily activities among RCT patients. Sixty-two practitioners (46 general dentists and 16 endodontists) in the National Dental Practice-Based Research Network enrolled patients requiring RCT. Patient-reported data were collected before, immediately after, and 1 week after treatment using the Graded Chronic Pain Scale.

RESULTS

The enrollment of 708 patients was completed over 6 months with 655 patients (93%) providing 1-week follow-up data. Before treatment, patients reported a mean (± standard deviation) worst pain intensity of 5.3 ± 3.8 (0-10 scale), 50% had "severe" pain (≥ 7), and mean days in pain and days pain interfered with activities were 3.6 ± 2.7 and 0.5 ± 1.2, respectively. After treatment, patients reported a mean worst pain intensity of 3.0 ± 3.2, 19% had "severe" pain, and mean days in pain and days with pain interference were 2.1 ± 2.4 and 0.4 ± 1.1, respectively. All changes were statistically significant (P < .0001).

CONCLUSIONS

RCT is an effective treatment for patients experiencing pain, significantly reducing pain intensity, duration, and related interference. Further research is needed to reduce the proportion of patients experiencing "severe" postoperative pain.

Treatment planning the endodontic-implant interface

One of the most challenging treatment planning decisions in restorative dentistry is the retention of a root filled tooth or its extraction and replacement with an implant. Making an informed judgement relies upon not only clinical experience and expertise but also interpretation of the published clinical evidence. In the last few years, more robust data and closer scrutiny of the evidence has helped to understand the advantages and disadvantages of each of these treatment modalities. The purpose of this paper is to provide a narrative review of some of the factors that may influence treatment planning for root canal treated teeth and indications for whether these teeth would be better replaced by an implant. From the evidence presented it is clear that both treatments have a place in contemporary restorative dental treatment and that survival for both root filled teeth and implants are similar. Unsurprisingly, both these treatment choices require high standards of clinical expertise and careful planning to ensure the best outcome.

Long-term survival rate of teeth receiving multidisciplinary endodontic, periodontal and prosthodontic treatments

Deciding whether to replace or preserve a compromised tooth, even with emerging trends in implant dentistry, is still a common dilemma for practitioners. This study sought to determine the 3- to more than 10-year survival rate of teeth that had undergone endodontic, periodontal and prosthodontic treatments. A total of 245 teeth in 87 patients were clinically and radiographically evaluated. All the teeth had received crown lengthening surgery by a single periodontist. Root canal therapy and prosthodontic procedures were rendered either by specialists or by experienced general dentists. Numbers of lost teeth were recorded and the criteria for hopeless teeth were defined. Survival rate was determined using the Kaplan-Meier estimator. Clinical indices including pocket depth (PD), bleeding index (BI), C/R ratio, position of the restoration margin relative to the gingival margin (RM-GM) and the presence of intra-canal post were compared between different survival groups (<3, 3-5, 5-10 and >10 years) using one-way analysis of variance (anova). Potential predictors of failure were determined using the Cox regression model. The mean ± s.d. of 3-, 5-, 10- and 13-year survival rates was 98 ± 1%, 96 ± 1·6%, 83·1 ± 4·5% and 51·9 ± 14·5%, respectively. The mean PD (P < 0·013), as well as C/R ratio in the mesial (P = 0·003) and distal (P = 0·007) surfaces, was significantly higher in the >10-year-survived teeth. Bleeding index and RM-GM showed no significant differences between the groups. C/R ratio and RM-GM position appeared to be the major determinants of tooth loss. The long-term survival rate of multidisciplinary-treated teeth was 83-98% in this specific sample.

Comparison of long-term survival of implants and endodontically treated teeth

The outcomes of both dental implants and endodontically treated teeth have been extensively studied. However, there is still a great controversy over when to keep a natural tooth and when to extract it for a dental implant. This article reviews the benefits and disadvantages of both treatment options and discusses success vs. survival outcomes, as well as the impact of technical advances for modern endodontics and endodontic microsurgery on the long-term prognosis of tooth retention.

A practice-based study on the survival of restored endodontically treated teeth

INTRODUCTION

This retrospective study evaluated the survival of endodontically treated teeth (ETTs) and investigated factors influencing restoration and tooth survival.

METHODS

Data from 795 ETTs were recorded, and success (restoration still intact) and survival (restoration intact or failed/repaired/replaced and tooth still in situ) were analyzed using Kaplan-Meier statistics. A multivariate Cox regression analysis was performed to assess the variables influencing success and survival.

RESULTS

At the end of the observation period (mean observation time = 4.48 years), 45 teeth had been extracted (annual failure rate for survival = 1.9% at 9.6 years) and 114 restorations had received a restorative follow-up treatment (annual failure rate for success = 4.9% at 9.6 years).

CONCLUSIONS

ETTs showed acceptable survival and success in the long-term. Variables showing significant influence on survival were the number of teeth in the dentition and the presence of decay at the moment the patient entered the practice.

Contemporary issues in the provision of restorative dentistry

This review highlights current issues in the provision of restorative dentistry both in primary and secondary care settings. Current challenges in the provision of restorative procedures are reviewed and methods in improving care and efficiency are proposed. Possible changes to the infrastructure and delivery of care are suggested in order to improve effectiveness and the patient pathway.

Patient-centered endodontic outcomes: a narrative review

INTRODUCTION

Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults.

MATERIALS AND METHODS

Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis.

RESULTS

Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is "fair" to "very much" prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses.

CONCLUSION

Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT.