The success of endodontic therapy--healing and functionality

Area of Science:

• Endodontics
• Dental Public Health
• Restorative Dentistry

Background:

• Evaluating endodontic therapy outcomes is crucial for treatment decisions, especially when comparing endodontics to tooth extraction and replacement.
• Defining "success" in endodontic therapy requires considering patient-specific goals, such as disease healing or functional tooth retention.

Purpose of the Study:

• To review the outcome of endodontic therapy, assessing both healing of apical periodontitis and functional tooth retention.
• To compare the success rates of initial endodontic treatment, orthograde retreatment, and apical surgery.

Main Methods:

• Systematic review of selected follow-up studies providing the best available evidence on endodontic treatment outcomes.
• Analysis of success rates based on the presence or absence of apical periodontitis and the type of endodontic procedure.

Main Results:

• Teeth without apical periodontitis have a 92-98% chance of remaining disease-free after non-surgical treatment or retreatment.
• Teeth with apical periodontitis show a 74-86% chance of complete healing and a 91-97% chance of functionality after non-surgical treatment or retreatment.
• Apical surgery outcomes are less consistent, with a 37-85% chance of complete healing (average ~70%) but an 86-92% chance of functionality.

Conclusions:

• Non-surgical endodontic treatment and orthograde retreatment demonstrate comparable and favorable outcomes.
• Conservative endodontic therapy, both surgical and non-surgical, is justified when a good restorative and periodontal prognosis exists.
• Patient motivation is a key factor in the decision to pursue endodontic treatment over extraction.