Clinical and radiological analysis of the causes for endodontic treatment failure

Introduction Development of inflammatory lesions or their persistence after primary treatment is considered endodontic failure. The reason for failure can be complex anatomy of the canal system and numerous iatrogenic factors. The objective of this study was to analyze, clinically and radiographically, the causes of primary endodontic treatment failure and assess possibilities for retreatment of teeth with failed endodontic treatment. Method The study included 79 teeth (36 multirooted and 43 singlerooted tooth) indicated for repeated endodontic treatment. Based on the radiographic assessment of the status of periapical structures, teeth were divided into two groups. The first group included teeth without periapical lesions, i.e. the healthy periodontal tissues (PAI score of 1 and 2) in which retreatment was required for prosthodontic reason due to the poor quality of obturation (28 teeth), and the second group included teeth with visible signs of periapical tissue damage (PAI scores 3, 4 and 5) (51 teeth). In both groups, quality of obturation, coronal sealing and the presence or absence of clinical symptoms was analyzed. Results The most common radiographic finding of definitive obturation was short filling (65.8% of cases); “forgotten” canals (25.3%); non-homogeneous obturation with correct length (5.1%) and fractured instrument (3.8%). There was significant difference between healthy periodontal ligament and adequate restoration (P lt 0.001). In 95% of patients with symptoms, changes in the periapical tissue were observed. Also, there was significant difference in the presence of symptoms after primary treatments, between the teeth with healthy apical periodontal tissue and teeth with periapical lesions (P = 0.019). Conclusion The outcome of the root canal treatment is significantly affected by the quality (density) of obturation and the presence and quality of coronal restoration. In patients with symptoms there were changes in the periapical tissue.
Uvod Neuspehom endodontskog lečenja smatra se pojava radiografskog nalaza inflamatorne lezije, odnosno njeno perzistiranje ili uvećanje posle preduzete primarne endodontske terapije. Razlog za neuspeh mogu biti kompleksna anatomija kanalnog sistema, ali i brojni jatrogeni faktori. Cilj ovog rada je bio da se kod zuba sa neuspelim endodontskim lečenjem klinički i radiografski analizira uzrok neuspeha primarnog endodontskog tretmana i procene mogućnosti za ponovni endodontski zahvat. Metod rada U ovo istraživanje je uključeno 79 zuba (36 višekorenih i 43 jednokorena zuba) indikovanih za ponovljeni endodontski tretman. Na osnovu radiografske ocene stanja periapikalnih struktura zubi su podeljeni u dve grupe: prvu grupu su činili zubi bez periapikalnih promena, tj. sa zdravim parodoncijumom (PAI skor 1 i 2) kod kojih je retretman bio neophodan iz protetskih razloga – zbog lošeg kvaliteta definitivne opturacije (28 zuba), a drugu zubi sa vidljivim znacima oštećenja apeksnog parodoncijuma (PAI skor 3, 4 i 5) (51 zub). U obe grupe analiziran je kvalitet opturacije, kvalitet kruničnog zaptivanja i prisustvo ili odsustvo kliničkih simptoma. Rezultati Najčešći radiografski nalazi kvaliteta definitivne opturacije kanala bili su: kratko punjenje (65,8% slučajeva), “zaboravljeni” kanali (25,3%), klinički nehomogeno punjenje uz korektnu dužinu definitivnog punjenja (5,1%) i frakturiran instrument (3,8%). Nađe- na je statistički visoko značajna razlika između adekvatne restauracije i zdravog parodoncijuma, odnosno pojave mikrocurenja zbog neadekvatne restauracije i periapikalnih promena (p lt 0,001). Kod 95% pacijenata sa simptomima uočene su promene u apeksnom parodoncijumu. Takođe, nađena je statistički značajna razlika u prisustvu simptoma nakon primarne endodontske terapije između zuba sa zdravim parodoncijumom i zuba sa periapikalnim lezijama (p = 0,019) Zaključak Na ishod endodontskog lečenja značajno utiču kvalitet (hermetičnost) opturacije kanala korena, odnosno prisusutvo