AAE and Foundation Approve Definition of Endodontic Outcomes
There has been little agreement within the scientific community about what constitutes endodontic success. Throughout the years, endodontics have used a number of terms and criteria to determine the outcome of root canal treatment. Clinical and/or radiographic indices, the periapical index or a combination of these are examples of the various benchmarks. Recently the AAE Board of Directors approved new definitions of endodontic outcomes.
The definition is the product of several years or work and deliberation from a number of groups within the Association, and incorporated results of a survey of graduate endodontic program directors.
In addition to addressing the variety of opinions within the specialty, the AAE an AAE Foundation representatives charged with this task considered how the criteria that they identified might compare to standards used by other specialties. To familiarize themselves with systems of evaluation, particularly those used in implant dentistry, they reviewed key articles and concluded that it would be extremely difficult to compare endodontic outcomes with other treatment methodologies that are so different. The group concluded that endodontists must judge their results using standards that provide a valid measure for endodontics.
The definitions are constructed on the premise that the commonly used terms of “success” and “failure” are too vague. Success or failure can be attributed to a variety of factors. On the other hand, terms such as “healed”, “nonhealed” and “healing” focus on the tooth, its surrounding structures and the host response. These are also words that patients can understand more easily. Function is one of the primary determinates for successful outcomes as it reflects clinical conditions with or without radiographic evidence of pathosis. Not all cases can be definitively categorized as healed, nonhealed or healing. When the outcome is uncertain, the clinician must use intuition and proper clinical judgement to ascertain the status of the tooth at that point in time.
The definitions were approved by the Foundation’s Board of Trustees at its 2004 interim meeting and by the AAE Board of Directors at its 2005 annual meeting in Dallas.
“We realize that this is an area of significant controversy,” said Foundation President Charles L. Siroky. “There is great divergence of philosophical and clinical opinion throughout the membership. Crafting a definition that satisfies every endodontist would be northing short of a miracle. However, if 50 percent plus one of the members accepts these criteria, we will have done our job.
Approved Definitions of Endodontic Outcomes
Healed – Functional*, asymptomatic teeth with no or minimal radiographic periradicular pathosis.
Nonhealed – Nonfunctional, symptomatic teeth with or without radiographic periradicular pathosis.
Healing – Teeth with periradicular pathosis, which are asystomatic and functional, or teeth with or without radiographic periradicular pathosis, which are symptomatic but whose intended function is not altered.
Functional – A treated tooth or root that is serving its intended purpose in the dentition.