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Modern endodontic planning part 1: assessing complexity and predicting success Sarra Jawad Carly Taylor Reza Vahid Roudsari James Darcey Alison Qualtrough Dental Update 2024 42:7, 707-709.
Authors
SarraJawad
BDS, BSc, MFDS
Specialty Registrar/Honorary Clinical Lecturer in Restorative Dentistry, University Dental Hospital of Manchester
Following a diagnosis of irreversible pulpal disease, periapical disease or failed endodontic therapy, the options for the tooth are extraction or root canal treatment. There is increasing evidence that certain factors may allow the clinician to predict the likely outcome of root canal therapy (RCT) and thus better inform the patient of the possible success rates. Should the patient choose root canal treatment, the clinician must also be able to gauge the potential difficulties that may be encountered and consequently determine whether it is within their competency.
CPD/Clinical Relevance: Assessing outcomes and complexity of care is an essential part of informed consent. Knowing when to refer is an essential component of best clinical practice.
Article
The primary goal of endodontics is to preserve the health of the pulp. When the pulp is irreversibly damaged, the goal is to prevent infection and periapical disease. When there is bacterial contamination of the root canal system, the clinician must be aware that success is more intimately tied to the decontamination of the root canal system. The intricate anatomy of the root canal system, the challenging oral environment and a plethora of patient factors can present challenges to achieving these goals. There are a multitude of reasons as to why root canal treatment may be difficult to achieve or more likely to fail. This ability to predict outcomes is critical to the decision to treat. All clinicians must be able to assess the prognosis of endodontic treatment, make a sensible decision about its complexity and decide whether it is within their capabilities if they are to obtain informed consent.
Dentists are often asked by patients, ‘Will it work?’ and it falls to the dentist to give an indication as to the projected success rate of their treatment. The definition of success has been a topic of much debate in the endodontic literature in recent years. The European Society of Endodontology definition of success is (Figure 1):1
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