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Endodontic treatment and tooth loss
structures preoperatively is the most common risk factor for these injuries.
Clinical Significance.—If the patient suffers a perioperative dental injury, it is essential that prompt dental assessment be done by a specialist who can provide adequate therapeutic management and avoid the need to seek dental care after hospitalization. Any preexisting structural defects or problems should be noted preoperatively and documented in the patient’s record. It is important to be aware of the problem, institute good interdisciplinary communication and cooperation, and document
everything so that adequate management can begin as quickly as possible.
Adolphs N, Kessler B, von Heymann C, et al: Dentoalveolar injury related to general anaesthesia: A 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital. Dent Traumatol 27:10-14, 2011 Reprints available from N Adolphs, Dept of Oral and Maxillofacial Surgery, Centrum 9 f€ ur Unfall- und Wiederherstellungschirurgie, Charit e Universit€atsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Mittelallee 2, 13353 Berlin, Germany; fax: þ4930450555901; e-mail: [email protected]
Endodontics Endodontic treatment and tooth loss Background.—Few studies have examined the role of endodontic involvement in tooth loss. Studies have noted that root canal filled (RCF) teeth are lost significantly more often than teeth not receiving root canal treatment (RCT). In addition, periapical involvement has been linked to a higher risk of tooth loss. However, it is rarely considered a separate cause of tooth loss, but rather is usually classified as a sequel to dental caries. The relationships between endodontic involvement and tooth loss, with consideration of periapical lesions, were investigated. Methods.—Data on 18,798 teeth were collected from 791 participants in the Veterans Affairs Dental Longitudinal Study. The potential tooth-level and person-level covariates were fit into marginal proportional hazards models that included both apical radiolucencies (AR) and RCT status as time-dependent variables. AR and RCT status were used to develop survival curves for the teeth. Results.—The presence of either RCT or AR correlated with a significantly increased risk for tooth loss. Both were significant risk factors for time to tooth loss after significant baseline covariates were controlled for. The risk of loss for any tooth having current RCTwas 1.39 times that of a tooth with no current RCT. The hazard ratio of tooth loss for any tooth without current AR was 6.95 for teeth with current AR of at least 4 mm and 4.11 for teeth with current AR of 1 to 3 mm. All of these analyses included controlling for other factors in the model. RCF teeth with AR had better survival
264
Dental Abstracts
than non-RCF teeth with AR but worse survival than nonRCF teeth without AR. Discussion.—When other potential risk factors were controlled for, endodontic involvement, as assessed by AR and RCT status, was significantly associated with tooth loss. The baseline effects of other factors did not alter this relationship.
Clinical Significance.—If endodontic treatment is consistently associated with subsequent loss of the tooth, especially if the evidence comes from longitudinal studies that accurately identify exposure variables and potential confounding factors, this could influence the choice of treatment approach. Further prospective studies are needed to provide a better evidentiary base for understanding the impact of endodontic involvement on tooth loss.
Zhong Y, Garcia R, Kaye EK, et al: Association of endodontic involvement with tooth loss in the Veterans Affairs Dental Longitudinal Study. J Endod 36:1943-1949, 2010 Reprints available from Y Zhong, 1441 Shoal Dr, San Mateo, CA 94404; e-mail: [email protected]
Clinical Significance.—If the patient suffers a perioperative dental injury, it is essential that prompt dental assessment be done by a specialist who can provide adequate therapeutic management and avoid the need to seek dental care after hospitalization. Any preexisting structural defects or problems should be noted preoperatively and documented in the patient’s record. It is important to be aware of the problem, institute good interdisciplinary communication and cooperation, and document
everything so that adequate management can begin as quickly as possible.
Adolphs N, Kessler B, von Heymann C, et al: Dentoalveolar injury related to general anaesthesia: A 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital. Dent Traumatol 27:10-14, 2011 Reprints available from N Adolphs, Dept of Oral and Maxillofacial Surgery, Centrum 9 f€ ur Unfall- und Wiederherstellungschirurgie, Charit e Universit€atsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Mittelallee 2, 13353 Berlin, Germany; fax: þ4930450555901; e-mail: [email protected]
Endodontics Endodontic treatment and tooth loss Background.—Few studies have examined the role of endodontic involvement in tooth loss. Studies have noted that root canal filled (RCF) teeth are lost significantly more often than teeth not receiving root canal treatment (RCT). In addition, periapical involvement has been linked to a higher risk of tooth loss. However, it is rarely considered a separate cause of tooth loss, but rather is usually classified as a sequel to dental caries. The relationships between endodontic involvement and tooth loss, with consideration of periapical lesions, were investigated. Methods.—Data on 18,798 teeth were collected from 791 participants in the Veterans Affairs Dental Longitudinal Study. The potential tooth-level and person-level covariates were fit into marginal proportional hazards models that included both apical radiolucencies (AR) and RCT status as time-dependent variables. AR and RCT status were used to develop survival curves for the teeth. Results.—The presence of either RCT or AR correlated with a significantly increased risk for tooth loss. Both were significant risk factors for time to tooth loss after significant baseline covariates were controlled for. The risk of loss for any tooth having current RCTwas 1.39 times that of a tooth with no current RCT. The hazard ratio of tooth loss for any tooth without current AR was 6.95 for teeth with current AR of at least 4 mm and 4.11 for teeth with current AR of 1 to 3 mm. All of these analyses included controlling for other factors in the model. RCF teeth with AR had better survival
264
Dental Abstracts
than non-RCF teeth with AR but worse survival than nonRCF teeth without AR. Discussion.—When other potential risk factors were controlled for, endodontic involvement, as assessed by AR and RCT status, was significantly associated with tooth loss. The baseline effects of other factors did not alter this relationship.
Clinical Significance.—If endodontic treatment is consistently associated with subsequent loss of the tooth, especially if the evidence comes from longitudinal studies that accurately identify exposure variables and potential confounding factors, this could influence the choice of treatment approach. Further prospective studies are needed to provide a better evidentiary base for understanding the impact of endodontic involvement on tooth loss.
Zhong Y, Garcia R, Kaye EK, et al: Association of endodontic involvement with tooth loss in the Veterans Affairs Dental Longitudinal Study. J Endod 36:1943-1949, 2010 Reprints available from Y Zhong, 1441 Shoal Dr, San Mateo, CA 94404; e-mail: [email protected]