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Conparacao Endodontia Classica X Moderna
Conparacao Endodontia Classica X Moderna
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Abstract
Introduction: Many recent technological advance-
ments have been made in the field of endodontics;
however, comparatively few studies have evaluated
T he goal of endodontic treatment is to eliminate diseased pulpal tissue and to create
an environment that will allow for healing of periapical tissues and prevent the devel-
opment of apical periodontitis. Through the removal of diseased tissue, sealing of the
their impact on tooth survival. This study compared canal system, and subsequent restoration of the coronal tooth structure, affected teeth
the survival rates of endodontic treatment performed are retained. This maintenance of arch integrity, esthetics, and function is what most
by using classic techniques (eg, instrumentation with patients ultimately desire. Yet, there are other treatment options available for pulpally
stainless steel hand files, alternating 5.25% NaOCl and or periapically diseased teeth in addition to endodontic treatment. Extraction fol-
and 3% H2O2 irrigation, mostly multiple treatment visits, lowed by implant or removable/fixed partial denture placement are treatment options
and so on) versus those performed using more contem- that the dentist and patient may consider. Extensive literature has been published on the
porary techniques (eg, instrumentation with hand and success of endodontic treatment, but great variability exists between study protocols as
rotary nickel-titanium files, frequent single-visit treat- well as data obtained. Differences include the length of recall, radiographic interpreta-
ment, NaOCl, EDTA, chlorhexidine, H2O2 irrigation, tion, experience of practitioners, and methods of assessment of treatment outcomes.
warm vertical or lateral condensation obturation, use Thus, treatment outcomes and success rates differ greatly. Some studies define success
of surgical microscopes, electronic apex locators, and based on strict radiographic healing, whereas others consider an endodontically
so on). Methods: Using a retrospective chart review, treated tooth a success if it remains present and functioning in the oral cavity (1–5).
clinical data were obtained for 984 endodontically Inconsistency in the definition of endodontic treatment ‘‘success’’ is confusing to
treated teeth in 857 patients. Survival was defined as patients and practitioners and can cause injudicious treatment decisions. This concept
radiographic evidence of the treated tooth being present has become increasingly problematic in the debate between endodontic treatment and
in the oral cavity 12 months or more after initial treat- implant-supported single-tooth replacement. In order to more effectively compare
ment. A mixed-model Poisson regression analysis was treatment outcomes between endodontically treated teeth and implants, several recent
used to compare failure rates. Results: Of the 459 teeth studies have evaluated endodontic success in terms of tooth survival rather than strict
in the classic group, there was an overall survival rate of radiographic and histologic criteria for healing (6–11).
98% with an average follow-up time of 75.7 months. Of Over the past few decades, huge technological advancements have been made in
525 teeth in the contemporary group, there was an over- the field of endodontics. Microscopes, rotary nickel-titanium files, ultrasonic instru-
all survival rate of 96%, with an average follow-up time mentation, electronic apex locators, digital radiography, new irrigation solutions,
of 34 months. Considerably more treatments in the and innovative obturation techniques have revolutionized the way in which endodontic
classic group were completed in multiple appointments procedures are performed. Despite such advancements, the question exists as to
(91%) than in the contemporary group (39%). More whether these technologies have improved the outcome of endodontic treatment and
teeth in the classic group underwent posttreatment increased the likelihood of tooth survival. The purpose of this retrospective study
interventions (6.7% vs 0.9%, respectively). Conclu- was to evaluate and compare survival rates of endodontic treatment performed by an
sions: No statistically significant difference was noted experienced endodontist performing classic treatment techniques versus a group per-
between the two technique groups or between single forming more contemporary techniques.
or multiple visits in terms of survival. (J Endod
2010;36:414–418) Materials and Methods
This study was approved by the University of Alabama at Birmingham Institutional
Key Words Review Board. Two study groups were selected for analysis: the classic group and the
Endodontics outcomes, multiple-visit endodontics, contemporary group. Patient records from four different treatment locations were iden-
temporary restorations tified, and data were collected by chart review. The classic group consisted of patient
records obtained from the practice of one endodontist who had been trained in the early
1970s. The ‘‘classic techniques’’ performed by this endodontist included
From the Departments of *Endodontics and †Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL.
Address requests for reprints to Dr Paul Eleazer, University of Alabama at Birmingham Department of Endodontics, 1530 3rd Avenue South, SDB 406, Birmingham, AL
35294. E-mail address: eleazer@uab.edu.
0099-2399/$0 - see front matter
Copyright ª 2010 American Association of Endodontists.
doi:10.1016/j.joen.2009.11.013
JOE — Volume 36, Number 3, March 2010 Classic Endodontic Techniques versus Contemporary Techniques on Treatment Success 415
Clinical Research
TABLE 3. Summary of Data
Classic Group (%) Contemporary Group (%)
Treated teeth 459 525
Anteriors 88 (19.2) 106 (20.2)
Premolars 149 (32.5) 129 (24.6)
Molars 222 (48.4) 290 (55.2)
Avg treatment age* 48.9 (SD = 14.1) 53.9 (SD = 15.2) p < 0.0001
Females 267 (58.2) 299 (56.9)
Males 192 (41.8) 226 (43.1)
Ethnicity* White: 98.6% White: 86% p < 0.0001
Black: 1.4% Black: 12.2%
Smoker NA N: 340 of 401 (84.8)
Y: 61 of 401 (15.2)
Diabetes N: 455 (99.1) N: 361 of 401 (90.0)
Y: 4 (0.9) Y: 40 of 401 (10.0)
Avg recall time 75.73 months 34.07 months
Avg number visits 2.2 1.41
1 visit* 39 (8.5) 316 (60.2) p < 0.0001
2 visits 330 (71.9) 204 (38.9)
3+ visits 90 (19.6) 5 (0.95)
Overfills 0 21
Post present N: 402 (87.6) N: 445 (84.8)
Y: 57 (12.4) Y: 80 (15.2)
Preoperative lesion N: 317 (69.1) N: 378 (72.0)
Y: 142 (30.9) Y: 147 (28.0)
Post Tx interventions* 31 (6.7) 5 (0.9) p = 0.0141
Apico: 10 Apico: 3
Retreat- 20 Retreat: 2
Hemisection: 1 NA
Failures (extractions) 9 21
Success 98.03% 96.00
Y, yes; N, no; NA, not applicable; SD, standard deviation.
*Indicates statistical significance.
cresol was placed in many vital cases. Obturation in the classic group the contemporary group were restored with a temporary restoration.
was confined within the tooth in all cases, with lengths ranging from Cotton pellets were more frequently placed.
0 to 5 mm inside the radiographic apex. Most of the obturation lengths A significantly greater number of teeth underwent posttreatment
were confined within 2 mm from the radiographic apex. No gross over- interventions in the classic group (6.7%) than in the contemporary
fills were noted. The contemporary group had more overfills (3.8%); group (0.9%, p = 0.0141). Only one of the teeth that received posttreat-
however, most of the fills were less than 2 mm short of the radiographic ment intervention was subsequently extracted. A summary of data on
apex. A larger percentage of teeth with pretreatment lesions (PAI score posttreatment interventions is presented in Table 4. Most of the post-
of $3) (31.2%) occurred in the classic group versus the contemporary treatment interventions in both groups were performed on molars
group (28.0%) although the difference was not statistically significant and on teeth with pretreatment periapical radiolucencies. The most
(p = 0.3796). Although no specific data were recorded, most of the frequent posttreatment intervention performed in the classic group
access preparations in the classic group were restored by the endodon- was retreatment, whereas apicoectomy was marginally more frequent
tist with a definitive restoration. All teeth that did not require multisur- in the contemporary group. Most of the interventions in the classic
face buildups were restored with amalgam or composite at the group were performed on teeth originally treated in multiple visits.
completion of endodontic treatment. When temporary restorations The average obturation lengths of intervention teeth were similar to
were placed, cotton pellets were seldomly used. Almost all teeth in those of the nonintervention teeth in both groups.
JOE — Volume 36, Number 3, March 2010 Classic Endodontic Techniques versus Contemporary Techniques on Treatment Success 417
Clinical Research
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