Endodontic Prognosis: Clinical Guide for Optimal Treatment Outcome

IntroductionMultifactorial Nature of Endodontic OutcomePreoperative FactorsIntraoperative FactorsPostoperative FactorsEffect of Root Canal Infection on Treatment OutcomeOutcomes in Endodontic TherapyConclusionReferencesMicrobiology and Immunology of Endodontic InfectionsThe Oral and Root Canal EnvironmentsThe Oral EcosystemMicrobial Colonization of Tooth SurfacesOral Health and DiseaseThe Root Canal EcosystemRoot Canal InfectionsPathways of Microbial EntryPulp Inflammatory ReactionPrimary InvadersProgression of the InfectionThe Endodontic PathogenPolymicrobial Nature of Root Canal InfectionsThe Biofilm LifestyleHow Bacteria Build BiofilmsBiofilms Formed in Root CanalsWhy Bacteria Form BiofilmsBiofilm Resistance to AntimicrobialsMicrobiological Methods Used in EndodonticsMicrobial Identification by Culture and Molecular MethodsDifferences in Microbial CompositionIn Situ MicroscopyPrognosis of Root Canal InfectionsWhere Are Bacteria Located After TreatmentHow Bacteria Survive Root Canal TreatmentMost Resistant SpeciesThe Chronic Inflammatory ResponseConcluding RemarksReferencesDiagnosis of Pulpal and Periradicular DiseaseIntroductionDiagnosis of Pulpal DiseaseChief Complaint (CC)Medical HistoryDental HistoryClinical ExaminationExtraoral ExaminationIntraoral ExaminationDiagnostic Pulp TestsTest SiteThermal Tests InterpretationElectric Pulp Test (EPT) InterpretationReliability of Pulp TestsCorrelation of Clinical Signs/Symptoms, Diagnostic Data, and Actual Histological Status of the PulpRadiographic ExaminationConventional Intraoral RadiographyCone Beam Computed Tomography (CBCT)Clinical Diagnostic Terminology of Pulpal DiseaseDiagnosis of Periapical DiseasePulp TestsPeriapical TestsPercussionPalpationSwelling or Draining Sinus TrackRadiographic ExaminationConventional Intraoral RadiographyCone Beam Computed TomographyClinical Diagnostic Terminology of Periapical DiseaseEndodontic Prognosis and Pulpal-Periapical DiseaseReferencesEndodontic Treatment of Mature Teeth IntroductionPathosis of the Pulpal-Periapical Tissue ComplexBiological Considerations of Treatment of Endodontically Involved Mature Teeth Without Apical PeriodontitisBiological Considerations of Treatment of Endodontically Involved Mature Teeth with Apical PeriodontitisHealing of the Apical and Periradicular Tissues Following Endodontic TreatmentManagement of Emergency of Endodontically Involved Mature TeethSymptomatic Irreversible PulpitisPretreatment or Inter-treatment of Symptomatic Apical Periodontitis Without SwellingPretreatment or Inter-treatment of Apical Periodontitis with Swelling (Localized or Diffuse)Posttreatment Endodontic Pain or SwellingPrognosis of Mature Teeth with and Without Apical Periodontitis After Nonsurgical Endodontic TreatmentQuality of Root Fillings and Coronal Restorations in Endodontic PrognosisReferencesRegenerative Approaches in Endodontic Therapies of Immature TeethIntroductionTreatment of Teeth with Vital Pulp and Open ApicesVital Pulp TherapyDirect Pulp CappingIndirect Pulp CappingPartial and Complete PulpotomyTissue Engineering in Endodontic Therapies: Rationale and Progress to DateRevascularizationPulp-Dentin RegenerationTreatment Recommendations for Regenerative Endodontic TherapiesVital Pulp TherapyRoot Canal Obturation (Apical Barrier Formation) with CSCsPulp RevascularizationConclusionsReferencesEndodontic Pharmacotherapeutics Pain Is a Complex Sensory ExperienceMechanisms of Pain of Endodontic OriginNociceptive PainInflammatory Dental PainDentinal PainNeuropathic PainEndodontic Pain ManagementIntraoperative Pain Management: Local AnestheticsInflammation Reduces the Efficacy of Local AnestheticsSodium Channel SubtypesPulpal Anesthesia Versus Soft Tissue AnesthesiaSupplementary Injections/Adjunctive TherapiesOn Choosing a Local AnestheticPreemptive Analgesics for Improving the Efficacy of Local AnestheticsPostoperative Pain ManagementPrognostic Factors Related to Endodontic Postoperative PainNonsteroidal Anti-inflammatory DrugsCombination Ibuprofen and AcetaminophenOpioids and Combination Opioid DrugsSteroidsPersistent Posttreatment PainInfection ManagementThe Role of Bacteria in Endodontic PathologyAntibiotics in the Management of Endodontic InfectionsEndodontic DressingsReferencesAnatomy, Access, and Length DeterminationIntroductionRoot Canal AnatomyAccess PreparationPrinciples of Access PreparationConservative vs. Traditional Access PreparationPulp Chamber Anatomy and Canal LocationWorking Length DeterminationConcluding RemarksReferencesInstrumentation and Disinfection of Root CanalsIntroductionBiologic and Technical Goals of Root Canal Preparation to Achieve Optimal Clinical Outcomes Challenges in Root Canal Preparation Working Length (WL) and Working Width (WW)Root Canal DisinfectionIrrigantsMain IrrigantsSodium Hypochlorite (NaOCI)Chlorhexidine (CHX)Intracanal Antibacterial Effectiveness of IrrigantsIrrigants for Smear Layer RemovalIntracanal MedicationCalcium HydroxideOutcome Studies: Intracanal MedicationConcluding RemarksReferencesObturation of Root Canals IntroductionIndications for Endodontic Obturating MaterialsEvidence-Based Practice and Endodontic PrognosisTypes of Material and Their Rationale for UseResearch Basis for Material Selection in Endodontic ObturationCore MaterialsSealersMaterials for Root-End Filling and Perforation RepairModes of PlacementThe Radiograph of the Final Root Filling: Factors of Prognostic SignificanceConcluding CommentsReferencesRestoration of Endodontically Treated TeethIntroductionInterim RestorationsRestoration of Mature TeethRestoration of Immature Teeth with Open ApicesPrognostic Factors and Treatment OutcomeConclusionsReferencesLocal, Systemic, and Genetic Considerations of Endodontic Treatment PrognosisLocal FactorsAnatomical FactorsTooth TypeNumber of RootsProximal ContactsPreoperative FactorsPulp StatusClinical SymptomsPeriapical StatusSize of the Periapical LesionFactors Related to Previous TreatmentPeriodontal StatusInter-/Intraoperative FactorsThe Use of Rubber DamFactors Related to Cleaning and ShapingProcedural ErrorsIntracanal Irrigants and MedicationsNumber of VisitsFlare-UpObturationPostoperative FactorsType and Quality of RestorationSystemic FactorsDemographic FactorsGenetic FactorsSystemic Diseases and MedicationsGeriatric PatientsSummaryReferencesCriteria for Outcome Assessment of Nonsurgical Endodontic TreatmentIntroductionStrindberg's CriteriaRadiographic Evaluations Have Been InconsistentThe Periapical Index (PAI) Scoring SystemOutcome Definitions Have Been InconsistentThe American Association of Endodontists Outcome CriteriaThe AAE-Approved Definitions of Endodontic OutcomesCone Beam Computed Tomography-Based Outcome AssessmentOutcome Rates for Orthograde Endodontic TreatmentConclusionReferencesFrom Tooth Retention Through Root Canal Treatment to Extraction and ReplacementIntroductionHigh Survival Rates of NSRCT TeethPatient-Centered Outcomes of NSRCTPrognostic Indicators of NSRCT PerformanceEndodontic Treatments Following Non-healing Initial NSRCTExtraction and Tooth Replacement DecisionsFixed and Removable Dental Prostheses and Implant AlternativesConclusionsReferences
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