#D3/S2/W6
#Endo

Monitoring of Endodontic Treatment

why do we need to monitor it?

• because endodontic treatment outcome is not immediately evident
• can see radiographically and histologically, but radiolucency takes time to resolve

what is monitoring

• complete clinical and radiographic exam

when do we monitor

• healing on majority of initial endo cases (curve flattens at 4 years)
• size and severity assumption is very debatable but fair ()
• big lesion doesnt always mean case is less likely to heal
• but, likelihood of reverse course of event is rare, therefore fair to assumption shrinkage will progress
  • 

how do we monitor

• change of lesions size at 1 year
  • disappear
    • perfect
  • smaller
    • favourable
    • review again at 4 years
      • if persisted, intervene
      • late healing-rare (molven 2002)
  • same, large
    • unfavourable, intervention necessary
• 

Patient centred outcome

• whats important to us?
  • radiographic healing
• whats important to patient
  • painfree tooth retention

Treatment Outcome (Success Rates)

• when root canal treatment doesn't work, what do we do?

Why do we need to know about treatment outcome

• using word success -> makes it seem as if operator is completely in control of failure vs success
• better terminology
  • healed
  • healing
  • disease
• disease focus
• implicity
  • biological entity and processes which may be beyond clinicians control

what is treatment outcome

• outcome of interest differs on who you are
• for patients
  • pain/swelling
  • what treatment they'd prefer - less pain during treatment
  • satisfaction
  • value
  • quality of life HRQL
• for clinician
  • pain free
  • treatment works
    • better or worse than no trt
    • one better than another
    • how much better

how do we measure treatment outcome

policymaker/epidemiologist POV

• number need to treat NNT
  • relative benefit of treatment and background risk
  • inverse of absolute risk reduction
  • compare to standard treatment, how many people need to receive treatment for 1 to benefit from treatment
• hazard ratio
  • chance of untoward events occurring in treatment arm as a ratio of that occurring in control arm
• consider increasing benefit vs minimising harm

patient

• symptoms
• functional
• survival
• healing

levels of evidence

• power to infer causality between studied factors and event of interest

healing rates of initial treatment

Endo tooth survival rate

healing rates of retreatment

low vs high technical quality persistent lesion healing

healing rate for anatomy respected vs altered

Modern endodontic microsurgery

• incision, raise flap, remove granulation tissue via curettage
• ultrasonic cleaning of apex
• copious irrigation
• MTA delivery into apex, pack
• suture close