Comparison of Classic Endodontic Techniques
Contemporary Techniques on Endodontic Treatment Success
Chris H. Fleming, DMD,* Mark S. Litaker, PhD,
Larry W. Alley, DMD,* and Paul D. Eleazer, DDS, MS *
Many recent technological advance-ments have been made in the ﬁeld of endodontics;however, comparatively few studies have evaluatedtheir impact on tooth survival. This study comparedthe survival rates of endodontic treatment performedby using classic techniques (eg, instrumentation withstainless steel hand ﬁles, alternating 5.25% NaOCland3%H
irrigation,mostlymultipletreatmentvisits,and so on) versus those performed using more contem-porary techniques (eg, instrumentation with hand androtary nickel-titanium ﬁles, frequent single-visit treat-ment, NaOCl, EDTA, chlorhexidine, H
irrigation,warm vertical or lateral condensation obturation, useof surgical microscopes, electronic apex locators, andso on).
Using a retrospective chart review,clinical data were obtained for 984 endodonticallytreated teeth in 857 patients. Survival was deﬁned asradiographic evidence ofthetreated toothbeing presentin the oral cavity 12 months or more after initial treat-ment. A mixed-model Poisson regression analysis wasused to compare failure rates.
Of the 459 teethin the classic group, there was an overall survival rate of 98% with an average follow-up time of 75.7 months. Of 525teethinthe contemporarygroup,therewas anover-all survival rate of 96%, with an average follow-up timeof 34 months. Considerably more treatments in theclassic group were completed in multiple appointments(91%) than in the contemporary group (39%). Moreteeth in the classic group underwent posttreatmentinterventions (6.7% vs 0.9%, respectively).
No statistically signiﬁcant difference was notedbetween the two technique groups or between singleor multiple visits in terms of survival.
(J Endod 2010;36:414–418)
Endodontics outcomes, multiple-visit endodontics,temporary restorations
he goal of endodontic treatment is to eliminate diseased pulpal tissue and to createanenvironmentthatwillallowforhealingofperiapicaltissuesandpreventthedevel-opment of apical periodontitis. Through the removal of diseased tissue, sealing of thecanal system, and subsequent restoration of the coronal tooth structure, affected teethare retained. This maintenance of arch integrity, esthetics, and function is what most patients ultimately desire. Yet, there are other treatment options available for pulpally and or periapically diseased teeth in addition to endodontic treatment. Extraction fol-lowed by implant or removable/ﬁxed partial denture placement are treatment optionsthatthedentistandpatientmayconsider.Extensiveliteraturehasbeenpublishedonthesuccess of endodontic treatment, but great variability exists between study protocols as well as data obtained. Differences include the length of recall, radiographic interpreta-tion, experience of practitioners, and methods of assessment of treatment outcomes.Thus, treatment outcomes and success rates differ greatly. Some studies deﬁne successbased on strict radiographic healing, whereas others consider an endodontically treated tooth a success if it remains present and functioning in the oral cavity (1–5).Inconsistency in the deﬁnition of endodontic treatment ‘‘success’’ is confusing topatients and practitioners and can cause injudicious treatment decisions. This concept has become increasingly problematic in the debate between endodontic treatment andimplant-supported single-tooth replacement. In order to more effectively comparetreatment outcomes between endodontically treated teeth and implants, several recent studies have evaluated endodontic success in terms of tooth survival rather than strict radiographic and histologic criteria for healing(6–11).Over the past few decades, huge technological advancements have been made inthe ﬁeld of endodontics. Microscopes, rotary nickel-titanium ﬁles, ultrasonic instru-mentation, electronic apex locators, digital radiography, new irrigation solutions,and innovative obturation techniques have revolutionized the way in which endodonticprocedures are performed. Despite such advancements, the question exists as to whether these technologies have improved the outcome of endodontic treatment andincreased the likelihood of tooth survival. The purpose of this retrospective study was to evaluate and compare survival rates of endodontic treatment performed by anexperienced endodontist performing classic treatment techniques versus a group per-forming more contemporary techniques.
Materials and Methods
This study was approved by the University of Alabama at Birmingham Institutional Review Board. Two study groups were selected for analysis: the classic group and thecontemporarygroup.Patientrecordsfromfourdifferenttreatmentlocationswereiden-tiﬁed, and data were collected by chart review. The classic group consisted of patient recordsobtainedfromthepracticeofoneendodontistwhohadbeentrainedintheearly 1970s. The ‘‘classic techniques’’ performed by this endodontist included
From the Departments of *Endodontics and
Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL.AddressrequestsforreprintstoDrPaulEleazer,UniversityofAlabamaatBirminghamDepartmentofEndodontics,15303rdAvenueSouth,SDB406,Birmingham,AL35294. E-mail address:email@example.com/$0 - see front matterCopyright
2010 American Association of Endodontists.doi:10.1016/j.joen.2009.11.013
Fleming et al.
Volume 36, Number 3, March 2010