Outcomes of endodontic therapy in general practice

Abstract

Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis.

Restorative outcomes for endodontically treated teeth in the Practitioners Engaged in Applied Research and Learning Network

“…We also acknowledge the possibility of patient selection bias by the P-Is in the participating practices in that they may have tended to enroll patients who were likely to have favorable outcomes. However, the 19.1 percent endodontic failure rate reported earlier, 6 coupled with the 13.9 percent restorative failure rate reported here, tends not to support the possibility of gross patient selection bias. Finally, we should acknowledge that the study was conducted in a PBRN by general practitioners who volunteered to participate and who enrolled patients actively treated in their practices.…”

“…However, the 13.9 percent restorative failure rate reported here, when combined with the 19.1 percent endodontic failure rate for primary endodontic therapy we 6 reported earlier, underscore the need for the practitioner to give careful consideration to all treatment options when planning treatment for teeth with an irreversible pulpitis or a necrotic pulp. To this end, we sent “benchmarking” reports to PEARL Network P-Is who participated in this study so they could see the outcome of endodontic and restorative treatment in their offices compared with the average across all participating practices.…”

“…We 6 have published details of the study design. In brief, practitioner-investigators (P-Is) in participating PEARL Network practices invited the study enrollment of patients in those practices who had undergone primary endodontic therapy and subsequent restoration in a permanent tooth three to five years previously.…”

“…5 One of the PBRNs, the Practitioners Engaged in Applied Research and Learning (PEARL) Network, conducted a retrospective study of the three- to five-year outcomes of primary endodontic therapy and restoration in general dental private practices. We 6 previously published a report regarding the outcomes of more than 1,300 primary endodontic therapies and factors associated with endodontic success and failure. Our objective in this article is to present the outcome of the definitive restoration placed after the completion of endodontic therapy.…”

Outcomes of implants and restorations placed in general dental practices

“…After a mean follow-up of 3.9 years, 3.3 percent of all primary endodontically treated teeth were extracted, 2.2 percent underwent re-treatment, 3.6 percent elicited pain on percussion and 10.6 percent exhibited periapical radiolucencies, for a combined failure rate of 19.1 percent. 2 An additional 13.9 percent of teeth experienced restorative failures. 3 These results are in stark contrast to the failure rate of less than 5 percent five years after endodontic therapy reported in academic studies 4,5 and in studies involving the use of insurance databases.…”