Phase Format Treatment for Endodontic Therapy

[Anonymous]

 PHASE III—Apical Surgery Indications

Phase III of the outcome assessment guideline (Figure 3) involves initiating one or all services involving manipulation of the roots including apical surgery, apical resurgery, perforation repair, root amputation, hemisectioning, intentional reimplantation, exploratory surgery. The patient may demonstrate a radiographic lesion that has not adequately healed or describe persistent symptoms with an associated pathology. The tooth in question may also demonstrate inaccessible areas of the root canal system that could not be instrumented safely due to natural, iatrogenic, or restorative blockage. The goal of radicular surgery is to mechanically remove pathology and optimally seal the defect to promote healing. Phase III relies upon current surgical techniques that address etiological factors beyond initial and retreatment root canal therapy. All teeth treatment planned for surgical intervention should be thoroughly examined for proper preoperative and postoperative prosthetic rehabilitation prior to initiating therapy.

Outcomes/Evaluation
The evaluation of Phase III therapy should include the final evaluation of endodontic therapy success or failure. First, if the tooth displays complete healing following a 6-month recall period with full radiographic resolution of the lesion, with a normal PDL space, asymptomatic, and no associated pathology, then the case can be considered a success. Second, if the tooth presents with a radiographic lesion that is decreasing in size, asymptomatic, functional with no associated pathology then the treatment is in the process of healing and the recall period should be lengthened to one to 4 years and be re-examined for complete healing. Third, if the patient is asymptomatic and the lesion appears smaller but persistent over a lengthened period of time, a scar formation may be considered and the therapy a success. Fourth, if following an appropriate recall period the tooth presents with a lesion that is increasing or the same size, the patient has become symptomatic, or has developed swelling, or a sinus tract, then apical resurgery or extraction should be recommended.
Following this exhaustive process of providing all therapy accessible prior to determining the tooth inoperable, the therapy should now be considered unsuccessful. Each phase of endodontic therapy addressed its specific goals, and if the tooth remains symptomatic or demonstrates increased bony destruction, then the therapy should be considered a failure and an alternative prosthetic replacement should be considered.

SUMMARY
This paper has shown that modern endodontics has progressed significantly in describing and treating pulpal and periradicular pathology. Current knowledge indicates that endodontic therapy should be evaluated as a complete unit and that each phase of treatment is completed to provide a foundation for rehabilitation. The phase format assessment of endodontic therapy success provides an outline for clinicians to objectively provide treatment in effort to conserve natural dentition.