Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.
Aim: To devise measurement instruments for 'quality' of root canal treatment to assess training and outcome of general dental practitioners working within primary care settings.Method: Scoring systems relating to quality of root canal treatment were developed using expert consensus and published literature. Domains scored included the Treatment Process, Quality of the Obturation, Clinical Healing, Radiographic Healing and Tooth Complexity.Scoring systems were applied to 10 clinical cases treated by each dentist at the beginning and 10 cases treated at the end of their clinical training and 135 cases treated after completion of training. The dentists recorded the treatment process and clinical healing in clinical logs. Two examiners independently scored the radiographs after undertaking calibration and training. Inter-and intra-examiner reliability of scoring radiographic outcomes was tested.Results: Instrument created with 4 domains to assess quality (2 process and 2 outcome), and a measure of case complexity (structure). One domain of process (n=240 teeth), one domain of outcome (n=32 teeth) and the complexity (n=215 teeth) were scored using radiographs. The Kappa scores for intra-examiner reliability between 0.22 and 1, whilst interexaminer reliability ranged between 0.18 and 0.99. Conclusion: Evidence based scores for assessment of the quality (process and outcome) and complexity (structure) of root canal treatment were devised. They are reliable, provided that clinicians are trained in record keeping and examiners have in depth training and calibration in the use of the instruments.
This paper reviews the assessment of success and failure following endodontic treatment and highlights the fact that many referrals for specialist management of endodontic failure do not take into consideration established guidelines in this important area.
This survey revealed that the practice of leaving teeth on open drainage is still present in general dental practice. Current guidelines do not comment on the use of this treatment modality. There is a need to ascertain further information about practices throughout the United Kingdom in order to provide clear evidence-based guidelines.
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