Multi-state outcome analysis of treatment interventions after failure of non-surgical root canal treatment: a 13-year retrospective study

Abstract

Multi-state outcome analysis of treatment interventions after failure of non-surgical root canal treatment: a 13-year retrospective study Objective: To examine the factors affecting the transitions through treatment interventions after failure of non-surgical root canal treatment (NS-RCT). Methodology: Insurance enrollment and claim information for enrollees of Delta Dental of Wisconsin (DDWI), USA were analyzed for 438,487 initial NS-RCT procedures to determine the effect of initial provider type and other covariates on additional treatments (no additional treatment, nonsurgical retreatment, surgical retreatment and extraction). A multi-state model was created using the "mstate" R package. Transitions between the four states identified by Code on Dental Procedures and Nomenclature were analyzed. Cox proportional Hazards regression stratified by transition type was used to estimate the effect of provider type on the risk of each transition, adjusting for covariates. Results: The overall survival rates for all teeth that were treated by NS-RCT was 82.8% [95% CI 82.57%, 83.11%]at 10 years. Approximately, 7% of cases changed from the first state of initial NS-RCT during the 13-year study period with ultimately 0.9%, 0.4% and 5% of cases receiving non-surgical retreatment, surgical retreatment or extraction, respectively. Teeth are more likely to be retreated non-surgically than surgically, and to be extracted than retreated. In general, the probability of a tooth having non-surgical retreatment was higher if the initial provider was not an endodontist (Hazard Ratio (HR)=3.2). Molars were more likely to be non-surgically retreated (HR=2.0) or extracted (HR=2.8) when compared to anterior teeth. The probability of non-surgical retreatment (HR=0.93) or extraction (HR=0.50) was lower when a crown was placed within 90 days after NS-RCT. Conclusion: Most teeth remained in the same state after treatment with no additional treatment transitions. When a transition occurred, it was more likely to be an extraction. Type of provider, age, location of the tooth, gender, and time to placement of final restoration significantly influence treatment transitions.

Tooth survival after endodontic treatment

“…Diabetes mellitus has been shown in a systematic review of longitudinal studies to be associated with a lower tooth survival after root canal treatment (Cabanillas-Balsera et al, 2019;Mindiola, 2006;Ng et al, 2011b;Wang et al, 2011). Coronary artery disease has been studied as a factor affecting tooth extraction after root canal treatment, though in a multivariable analysis, there was no association with tooth extraction (Wang et al, 2011).…”

“…It needs to be stressed that the present narrative review focuses on tooth survival in the sense that the tooth has not been extracted. There is also the possibility to study the survival of the endodontic treatment, in other words, untoward events or that any further treatment of the endodontic conditions such as extraction, retreatment or endodontic surgery has been performed (Bhagavatula et al, 2021; Chen et al, 2008; Dawson et al, 2017; Lumley et al, 2008; Raedel et al, 2015b). As survival of the endodontic treatment includes extractions, reports of survival of the endodontic treatment will be inferior to survival of the tooth.…”

Periradicular surgery: A longitudinal registry study of 10‐year outcomes and factors predictive of post‐surgical extraction

“…Recently, a North American study based on insurance data reported extraction of 14% of teeth during a follow‐up period of 14 years. However, survival curves revealed a cumulative hazard greater than 0.4 after 10 years, though with very broad confidence intervals (CI) (Bhagavatula et al, 2021). In another cohort from the same North American database, the 6‐year retention rate was 88% (Haxhia et al, 2021).…”