Endodontic Outcomes
According to Dr. Carlos Nemkovsky, the goal of dentistry is to provide the patient with a long-term aesthetic functional solution (Evidence Based Decision Making in Dentistry, 2017). The role of endodontics towards that goal is to provide an asymptomatic, functional tooth for a timeframe that is acceptable to the patient.
In endodontics, there are two outcome measures. The proximal outcome, the first outcome marker, measures the initial response to endodontic therapy and includes both the immediate resolution of the patient’s symptoms and the short-term goal of restoration of the tooth’s function. The second measure involves the long-term survival of the tooth.
Endodontic outcome studies have shown that endodontics is very successful at achieving the proximal outcome, eliminating the patient’s symptoms while restoring the treated tooth to normal function. The second goal, long-term tooth survival, is dependent on a number of factors including the health of the surrounding periodontium, the amount of remaining tooth structure, the patient’s occlusion, the patient’s ability to maintain the tooth. Multiple studies have shown that tooth loss associated with endodontically treated teeth tends to be associated with factors that the endodontist has little control over. However, long-term tooth survival of endodontically treated teeth has been associated with minimizing tooth removal during endodontic treatment (Zang et al JOE 2019, Jiang et al JOE 2018, Plotino et al JOE 2017, Kishen et al 2014), with the immediate restoration of endodontically treated teeth (Swanson and Madison JOE 1987, Willershausen et al Eurp Jour Med Res, 2005), and managed occlusion (Pradeepkomar et al JOE 2016, Caplan and Weintraub Jour Public Dent Health 1997). The challenge for the endodontist is then how to address the disease while managing the remaining tooth structure.
Traditionally, eradication of pulpal and periapical disease required the removal of a significant amount of tooth structure which may be associated with an increased chance of tooth fracture. However, recent advancements in endodontics such as the use of the surgical operating microscope, CBCT imaging, heat treated (flexible) rotary files, and enhanced irrigation devices such as laser activated irrigation and Sonendo’s Gentle Wave, has allowed addressing the disease while maximizing remaining tooth structure to become more achievable.
Dr. Grover, like many endodontists, was interested in seeking answers to questions such as what causes endodontic tooth loss and do minimally shaped endodontically teeth heal? There are a limited number of studies investigating these issues so, under the guidance of endodontic stalwarts such as Dr. Gary Carr, Dr. John Khademi, and Dr. Richard Schwartz, Dr. Grover began an in-depth review of his patients in an attempt to determine 1) the common characteristics of surviving endodontically treated teeth, 2) the causes of the loss of endodontically treated teeth, and 3) does attempting to remove less tooth structure during endodontic treatment reduce tooth survival?
Over an eight-year period, Dr. Grover followed over 4,040 teeth that he had treated with endodontic therapy over the previous 26 years.
He found that on the whole, surviving teeth shared the following characteristics:
- the teeth started with more tooth structure
- the endodontic shapes tended to more conservative, especially in the coronal third
- the tooth’s occlusion within the context of the patient’s overall occlusion was significant
- the timing and quality of the post-treatment restoration was important
- the primary cause of loss of endodontically treated teeth was structural failure
- minimally shaped teeth healed at the same rate as traditionally treated teeth.
The following are some cases illustrating Both traditional and more minimally shaped treatment.
Cases
Traditionally Treated Teeth
External Tooth Repair After 17 Years
When the body’s immune system compromises the tooth, such as after a tooth infection the condition is called Invasive Cervical Resorption (ICR). It has no external symptoms during early stages, unless discovered during a radiographic exam (x-ray or gamma ray). The following X-ray was taken in 2015.
Internal Resorptive Defect
A patient presented with history of pain and swelling associated with maxillary anterior tooth #10. The CBCT images revealed a non-perforating internal resorptive defect. The defect was accessed and the resorptive tissue was removed. The canal was cleaned and shaped and Ca(OH)2 was placed.
After two changes of Ca(OH)2, the defect was dry and gutta percha was placed in the canal. A fiber post was placed. The one-year recall indicated that the resorptive defect was in remission. The patient reported that the tooth was asymptomatic and functioning well.
Minimally Treated Teeth with Traditional Irrigation Techniques
Laser Activated Irrigation
Laser-activated irrigation (LAI) or laser-activated therapy significantly improves the removal of debris, pulp tissues, and bacteria by activating the liquid designed to do the job. This irrigation method flows to areas that traditional tools cannot reach.
Fotona lasers are used for root canal therapy, endodontic surgery, and other treatments related to the interior of the tooth.
Laser Activated Short-term Interval Healing
Witness the healing process after root canal treatment. Certain settings on the laser can promote healing and tissue regeneration, enhancing recovery after endodontic procedures.
Sonendo's GentleWave® Short-term Interval Healing
Short-term interval healing refers to the accelerated healing process that patients may experience after treatment. Notice the improvement of tooth health, as seen by the strength of the innermost layer of the tooth, from the first picture to the last.
Sonendo's GentleWave®
This modern approach to root canal therapy offers improved success rates, including risk of infection, preservation of the tooth structure, and reduced need for retreatment compared to traditional methods.
