Inconsistencies in the Assessment of Endodontic Outcomes in Patients with Special Health Care Needs: A Novel Proposal

Conventional: Endodontic outcome criteria established by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE) rely heavily on radiographic, clinical, and functional parameters. These criteria may not be applicable to patients with special health care needs, who often present with limited cooperation, communication impairments, and altered pain perception. Objective: This study aims to propose an adapted classification system for evaluating non-surgical root canal treatment outcomes in this underserved population. Methods: Based primarily on the criteria established by the ESE and our clinical experience, a novel classification system was developed, delineating three outcome categories grounded in both clinical and radiographic parameters. This framework deliberately excludes the "functional" criterion and introduces a "not assessable" category. It was retrospectively applied to 217 non-surgical root canal treatments performed in 137 patients with special health care needs, each with a minimum one-year follow-up. Outcomes were categorized as "favorable," "uncertain," or "unfavorable." Results: Using the proposed criteria, 87 treatments (40.0%) were classified as "favorable," 88 (40.5%) as "uncertain," and 42 (19.3%) as "unfavorable." By contrast, the application of AAE/ESE standards resulted in a 71.9% "favorable" classification. Most "uncertain" outcomes occurred in patients with neurodevelopmental disorders, where clinical or radiographic evaluation was not feasible. Conclusions: We propose adapted clinical and radiographic criteria for assessing non-surgical root canal treatment outcomes in patients with special health care needs, though broader validation is required. The findings suggest that this procedure remains advisable in this population, with fewer than 20% showing an "unfavorable" long-term outcome.