When making the decision whether to retain a tooth using endodontic therapy versus extraction and implant placement, the long-term predictability of restored endodontically treated teeth is an important factor. A study by Dr. Frank Setzer, et al searched a clinical database of endodontic treatment of molar teeth with crown placement with a minimum follow-up period of 4 years. The purpose was to determine if preoperative factors could predict the long-term prognosis of these teeth. The authors randomly selected charts of 42 patients with 50 individual treatments and recorded information concerning the following factors: crown lengthening; periodontal diagnosis; attachment loss; furcation involvement; mobility; and internal, external, or periradicular resorption. Radiographs from treatment initiation and followup were digitalized, and the presence of apical periodontitis was evaluated. Available ferrule was calculated from bite-wing radiographs using computer-aided design software. The resulting data, age, sex, and times of restoration and follow-up were analyzed for correlation with the presence of apical radiolucency at follow-up and the following 4 possible outcome scenarios: no event, nonsurgical retreatment, surgical retreatment, or extraction using Spearman rank order correlation analysis. Patients’ ages ranged from 19 to 87 years and 48 teeth (96.0%) were retained at follow-up. Of those, 44 (88.0%) were no event; 4 (8.0%) underwent surgical or nonsurgical retreatment; and 2 teeth (4.0%) had been extracted. Significant positive correlations existed between untoward events (any form of retreatment or extraction) and prognostic value according to periodontal status (P = .047) and attachment loss (P = .042).
The study concluded that the only preoperative factors significant for the prognosis of restored endodontically treated molars were related to periodontal prognostic value and attachment loss. It can be concluded that it may be difficult to predict the prognosis of molars in need of endodontic treatment and restoration from prognostic factors not related to periodontal disease.
(Source: Journal of Endodontics, January 2011, Volume 37, Issue 1)