Success and failure of endodontic treatment: predictability, complications, challenges and maintenance

Abstract

The fundamentals of successful endodontic treatment are an awareness of the aetiology of the disease process and an understanding of factors that affect outcome. This paper aims to outline the prognostic factors found in the endodontic outcome literature to facilitate options appraisal and predictable treatment delivery. We will discuss pre-treatment, treatment and post-treatment factors. In summary, the significance of infection control throughout treatment, provision of an adequate coronal seal and appropriate restoration of the root-filled tooth are highlighted.

Fig. 1

Complete periapical healing. a) Pre-operative radiograph. b) Post-obturation radiograph. c) Two-year review

Fig. 2

Periapical radiographs with differing PA lesion size. a) Lower left first molar with periapical radiolucencies. b) Upper right lateral incisor with a large periapical radiolucency

Fig. 3

Clinical and radiographic appearance of a sinus tract. a) Upper right first molar with a preoperative palatal sinus tract. b) CBCT scan showing perforation of the palatal cortical plate. c) Postoperative sinus healing

Fig. 4

Presentations of cracked teeth. a) Narrow deep pocket adjacent to mid-lingual crack on the lower left second molar tooth. b) Debris housing crack affecting the distal marginal ridge of the lower right second molar tooth. c) Crack along the mesial wall of an upper left first molar

Fig. 5

Pre- and post-operative radiographs of teeth with complex anatomy. a, b) Upper right first molar with severe curvature. c, d) Lower left second molar with acute distal curve. e, f) Three-rooted upper left second premolar. g, h) Four-rooted upper left second molar with five canals

Fig. 6

Radiographs showing obturation errors. a) Upper left first molar with a poorly compacted short root filling. b) Upper left first molar with an overextended root filling

Fig. 7

a, b) Radiographs showing fractured instruments in lower molars