Characterization of Successful Root Canal Treatment

Abstract

Knowing the outcome of root canal treatment (RCT) is determinant to substantiate the clinical decision making process, especially when RCT is weighed against the extraction of natural teeth or replacement by prosthetic elements. The ideal scenario in all clinical situations should combine healing/prevention of disease (apical periodontitis) and the functional retention of the tooth. Understanding the risk factors associated with endodontic failure is a key factor to increase the chances of success. The logical action is to reverse the existing disease, which requires intervention to neutralize the bacterial invasion and disrupt the bacterial biofilm within the complex anatomy. Success is more predictable when the immune host defenses are favorable. However, success has different meanings to the dentist, to the patient and to the tooth itself. The life of an endodontically treated tooth depends on the accuracy of the diagnosis and planning, excellence of disinfection, instrumentation and filling procedures (antimicrobial strategies, root canal shaping and coronal and apical seal) and finally the rehabilitation management. The interpretation of constant or intermittent pain and/or discomfort associated with apical periodontitis (AP) in endodontically treated tooth may be suggestive of endodontic failure. The success features of RCT, namely absence of pain, regression of AP, tight seal of canal and coronal spaces, and recovery of tooth function, must be reevaluated over time. In case of doubt between success and failure, cone beam computed tomography (CBCT) could be indicated for detection and precise localization of AP. The possibility of map reading on CBCT images characterizes the real multidimensional structure, providing accurate information on the presence, absence or regression of AP. The survival of an endodontically treated tooth implies understanding the biological and mechanical outcomes as multifactorial events over the individual's life span. The objective of this review of literature is to discuss relevant factors associated with patient's health, tooth and dentist that could account for a successful RCT.

Antibacterial action of red and green propolis extract in infected root canal

“…Several studies have considered sodium hypochlorite as the substance that agglutinates the largest number of characteristics for its use as irrigant in infected root canals [4,5,8,9]. Bhardwaj et al [34] reported that passive ultrasonic irrigation with1% sodium hypochlorite was effective to completely remove E. faecalis biofilms compared to natural substances (Aloe Vera, Nona juice and propolis).…”

“…Bacterial growth is enhanced by complex anatomy of root canal system, inaccessible areas to endodontic instruments, which represent an ideal environment for bacterial biofilm structuring [2,3]. Bacterial biofilm is structured from microorganisms attachment on a solid surface embedded in an extracellular matrix, resistant to antimicrobial agents, what favors the maintenance of infection process and represents a special challenge for successful root canal treatment [4,5].…”

“…The ability to invade the dentinal tubules, be resistant to antimicrobial agents and interfere with host defenses reveals its pathogenic role [6][7][8]. The use of antibacterial strategies that can promote the disruption of the biofilm is essential to the success of the endodontic therapy [3,5]. Sodium hypochlorite is extensively used in endodontics as irrigating solution due to its antimicrobial effect.…”

Analysis of reasons for retreatment and extraction of endodontically treated teeth: A transversal study

“…Despite the presence of high rates of success in endodontic therapy, mainly due to knowledge of internal dental anatomy and advancements in science and technology, failures in root canal treatment have been described [7]. Once diagnosed as a failure of primary endodontic therapy, the tooth may be submitted to a new intervention, which is the usual procedure in endodontics in order to correct the failures of the previous treatment.…”

Presence of Metallic Microfragments on Dentinal Walls and Instrument Defects following Root Canal Preparation

“…1 Several instrumentation techniques, with different kinematics and types of instruments, have been introduced into the market with this goal in mind. 2,3 Traditional stainless steel files and nickel-titanium (NiTi) files used in rotary and reciprocating systems are universally employed.…”