Successfully Root Canal Treatment

04-03-2017

By: Brazilian Dental Journal

Success is the expected outcome after root canal treatment (RCT), regardless of the clinical conditions.

However, predicting success usually requires adopting a referential or criteria, and presupposes that the patient is healthy. It is estimated that RCT should be considered completed when the tooth is permanently restored and in function.

RCT clinical success can be analyzed based on different points of view, with specific values that involve the dentist, the patient or the tooth itself. References for the dentist are the value of symptom (clinical silence - absence of pain), the value of image (root canal space completely filled with no evidence of periapical inflammation), and the value of clinical condition (a well-restored and functioning tooth).

The dentist's skills are crucial to interpret correctly the radiographic features and establish a diagnostic hypothesis. For the patient, the value of symptom (no pain) is essential. Apart from this, RCT success is associated with predictive aspects that eliminate the need of interventions and establishes treatment conclusion. The success for the tooth itself is associated with absence of disease (root canal infection or periapical inflammation).

The life of an endodontically treated tooth implies understanding that biological and mechanical events have a multifactorial nature and cannot be viewed separately. Ideally, it is expected to preserve the largest possible number of teeth until the end of life. Successful RCT prevents pain, apical periodontitis (AP) and tooth loss, but it is a real challenge because several clinical conditions can contribute, alone or in combination, for a poor prognosis, namely root canal perforation, overfilling, endodontic and periodontal lesion, root fracture, periapical biofilm, traumatic dental injury, fracture of instrument, AP, root resorption, etc.

Systemic and periodontal conditions should be carefully examined before RCT. Preoperative diagnosis of dental pulp and/or periapical tissues is an important reference to establish case prognosis. The dentist's health represents a human aspect that is frequently neglected and can also be a risk factor for the occurrence of intraoperative procedural errors. Human error may be associated with stress, working conditions, and lack of attention, adequate planning and sufficient knowledge of new technologies. Renouard and Charrier (2) discussed some human factors that could induce accidents and reported that as far as the interactions between the individual and the working environment, errors could be related to other people (life ware), technology (hardware), documentation (software) and environment.