Endodontic Prognosis 1,2 of 8 Apical Periodontitis
Apical Periodontitis
A clear majority of teeth presenting with apical periodontitis can be expected to heal following nonsurgical or surgical endodontic treatment. The presence of a periapical lesion prior to treatment only decreases the prognosis slightly.
Favorable: Pulp necrosis with or without a lesion that responds to nonsurgical treatment
Questionable: Pulp necrosis with a periapical lesion that does not respond to nonsurgical root canal treatment but may be treated surgically
Unfavorable: Pulp necrosis with a periapical lesion present that does not respond to nonsurgical root canal treatment or subsequent surgical intervention
Complications
Nonsurgical Root Canal Retreatment
Favorable: Missed Canal The etiology for failure of the initial treatment can be identified Nonsurgical endodontic retreatment will correct the deficiency
Questionable: The etiology for failure of the initial treatment cannot be identified Nonsurgical endodontic retreatment may not correct the deficiency
Unfavorable: The etiology for failure of the initial treatment cannot be identified and corrected with nonsurgical retreatment and surgical treatment is not an option
Questionable: The etiology for failure of the initial treatment cannot be identified Nonsurgical endodontic retreatment may not correct the deficiency
Unfavorable: The etiology for failure of the initial treatment cannot be identified and corrected with nonsurgical retreatment and surgical treatment is not an option
Surgical Root Canal Treatment
Altered Anatomy (e.g., loss of length, ledges, apical transportation)
Favorable: The procedural complication can be corrected with nonsurgical treatment, retreatment or apical surgery
Questionable: Canals debrided and obturated to the procedural complication, there is no apical pathosis and the patient is followed on recall examination
Unfavorable: The patient is symptomatic or a lesion persists and the procedural complication cannot be corrected and the tooth is not amenable to surgery (apicoectomy/ intentional replantation)
Questionable: Canals debrided and obturated to the procedural complication, there is no apical pathosis and the patient is followed on recall examination
Unfavorable: The patient is symptomatic or a lesion persists and the procedural complication cannot be corrected and the tooth is not amenable to surgery (apicoectomy/ intentional replantation)
Separated Instruments
Favorable: No periapical periodontitis In general, cases that have a separated instrument in the apical one-third of the root have favorable outcomes Able to retrieve nonsurgically or surgically if periapical pathosis is present Defect correctable with apical surgery
Questionable: Instruments fractured in the coronal or mid-root portion of the canal and cannot be retrieved Patient asymptomatic No periapical periodontitis
Unfavorable: The patient is symptomatic or a lesion persists requiring extensive procedures in order to retrieve instrument that would ultimately compromise long-term survival of the tooth and surgical treatment is not an option (apicoectomy/ intentional replantation)
Questionable: Instruments fractured in the coronal or mid-root portion of the canal and cannot be retrieved Patient asymptomatic No periapical periodontitis
Unfavorable: The patient is symptomatic or a lesion persists requiring extensive procedures in order to retrieve instrument that would ultimately compromise long-term survival of the tooth and surgical treatment is not an option (apicoectomy/ intentional replantation)
Perforations
Location
Favorable: Apical with no sulcular communication or osseous defect
Questionable: Mid-root or furcal with no sulcular communication or osseous defect
Unfavorable: Apical, crestal or furcal with sulcular communication and a probing defect with osseous destruction
Questionable: Mid-root or furcal with no sulcular communication or osseous defect
Unfavorable: Apical, crestal or furcal with sulcular communication and a probing defect with osseous destruction
Time of Repair
Favorable: Immediate repair
Questionable: Delayed repair
Unfavorable: No repair or gross extrusion of the repair materials
Questionable: Delayed repair
Unfavorable: No repair or gross extrusion of the repair materials
Size
Favorable: Small (relative to tooth and location)
Questionable: Medium
Unfavorable: Large
Questionable: Medium
Unfavorable: Large
Post Perforation
Favorable: No sulcular communication or osseous destruction No sulcular communication but osseous destruction is evident The perforation can be repaired surgically
Questionable: Long standing with sulcular communication, a probing defect and osseous destruction Strip Perforation Small with no sulcular communication No sulcular communication and osseous destruction that can be managed with internal repair or surgical intervention
Unfavorable: Sulcular communication and osseous destruction that cannot be managed with internal repair or surgical intervention
Questionable: Long standing with sulcular communication, a probing defect and osseous destruction Strip Perforation Small with no sulcular communication No sulcular communication and osseous destruction that can be managed with internal repair or surgical intervention
Unfavorable: Sulcular communication and osseous destruction that cannot be managed with internal repair or surgical intervention
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