ENDODONTIC SUCCESS CAN BE DIFFICULT TO DEFINE
What’s an Endodontist ?
… a doctor further trained in root canal treatment and surgery
Post-treatment success might be based on the appearance of a radiograph or the clinical findings (symptoms/signs) related to the tooth treated, or it may be based on the patient’s history of signs and symptoms.
Regardless, defining success versus defining survival (of treatment outcomes) after treatment is rendered becomes challenging.
No matter what presents itself during diagnosis, treatment or following treatment, know that I have your best interests at heart.
However, please realize that after extensive experience with endodontic care outcomes (root canal treatment, retreatment and/or surgery), I’ve found that it is not uncommon for a number of patients to experience symptoms after root canal therapy is complete.
Examples of symptoms may include continual sensitivity, tenderness, pain or other feelings that could be considered as survival, but perhaps may not be definable as success.
I provide an approach very different from most endodontists in that more often, surgery in conjunction with nonsurgical endodontic care, is combined for many reasons. A combined approach to care offers many advantages that weigh against the minimal surgical risks associated with minor intra-oral surgery.
First, it allows for interior and exterior tooth exploration to check for problems that may not present with inspecting and treating the interior confines of the root canal only. This includes looking for fractures, looking for bone loss in places that provide a poorer prognosis, decay on roots or other problems.
Second, a combined approach to care (surgery in conjunction with nonsurgical care) does indeed improve success rates (based on experience). Although data and higher levels of evidence studies are lacking and/or are not clear, it is clear to me (after roughly 10,000 cases) that offering nonsurgical with surgical care improves success.
And success is defined here as having none, to very minimal, sensitivity after treatment.
Survival may be thought of as having had root canal treatment; but the tooth still hurts or becomes uncomfortable in the future.
That being said, having a surgical view along with a nonsurgical “root canal only” view provides a plethora of information beyond that of a root canal only approach. Also, it allows for clinical removal of inflammation, infection, pathology, and problems that may not be possible to achieve with an approach that employs only nonsurgical root canal access.
This method of care defines how our team-centered approach to care varies as compared to how other clinicians may practice.
My goals are to determine if endodontic therapy makes sense in your case, to emphasize a combined approach to care (offering the best chance for success), and to make every attempt possible to minimize follow-up appointments (due to symptoms/sensitivity/or complaints related to rendering care on your tooth/jaw).
At times, your care is planned in advance (during consultation). But sometimes care changes as your case develops (during treatment), due to complexity or issues that require us to shift to techniques/methods that will produce the best possible outcome.
And I may discover, via clinical or microscopic assessment, that removing your tooth is a better choice (or the only choice) than proceeding with root canal therapy methods or surgery.
All cases planned and treated in this practice are well thought through; but due to extemporaneous findings, a different surgical technique may be required from the one originally planned. It may be that the removal of your tooth is the only option.
Today, because of other advanced technologies (such as implantology as a second option if you lose your tooth), it may be advisable to graft or augment your jaw or bone socket to make it most suitable for future implantation.
Obviously, because we want your care to occur comfortably, and because we want to completely care for you in one clinical visit (regardless of difficulty), IV sedation is recommended and encouraged for most patients.
If anything is not clear, please ask Dr. Kiser.
Goals of Care:
- Successful Outcomes with Endodontic Therapy
- A Comfortable Experience
- Being Prepared to Extract & Preferably Shift Towards Pre-Implant Care (if endodontics is not indicated)