Endodontic

Problem Solving In The Assessment Of
Treatment Outcomes, Quality Assurance,
And Their Integration Into Endodontic
Treatment Planning

A few moment’s consideration of the original cause of trouble at the apex of roots enable us to realize what is required to be accomplished in the way of successful treatment. If the original cause is admitted to be imitation from decomposing pulp, it’s removal will in most cases affect a cure.

PROBLEM – SOLVING LIST

Problem – solving issues addressed in the chapter:

What are the historical and contemporary views on treatment outcomes?
What is meant by success or failure? Are these term appropriate for the clinician’s needs?
What factors may influence the outcome of treatment under specific circumstance?
What factor will definitely influence the outcome of treatment?
What clinical and radiographic parameters are used to determine treatment outcomes?
Should the clinician be concerned with histopathology out comes of treatment?
How can treatment outcomes be determined in the patient who is symptom free?
How long should treated case be evaluated to ensure favorable treatment outcomes?
Can treated case revert from an acceptable outcome to an unacceptable outcome-or vice versa?
What are the significant signs or symptoms that should alert the clinician to such changes?
How is the integration of factors accomplished in the assessment of treatment outcomes (clinical decision making)? How can these factors be used in the establishment of new treatment plan (case studies)?


The concepts of success and failure or treatment outcomes in endodontics are often relegate to a position of secondary importance. This position is evident in textbooks in which chapters on these issues, if present, are situated deep in the written material, whereas those chapter that deal with canal cleaning and shaping, obturation, and surgery are in the forefront. Dental school lectures are conducted in a similar manner, and those curricula that are limited in time also overlook these issues. Many aspiring professionals never face the need to determine treatment outcomes in didactic courses and certainly not in clinical training. In requirement – driven curriculum, successful outcomes are erroneously assumed once treatment is completed. This approach undermines the entire process of treatment planning because the clinician is never able to learn from the choice made in providing treatment. When faced with future compromised situation, the clinician is unable to apply and integrate the concepts of assessing treatment outcomes into the treatment plant of choice. Under these circumstances, quality assurance is impossible. This deficit frequently leads to the provision of no treatment, poor treatment, or wrong treatment. In the medical profession the common phrase, “Take two aspirin and call me in the morning,” is often an indictment of the treatment provided (or lack thereof). Similar phrase characterize the clinician’s dilemma: “ I don’t see any thing on the radiograph,” “I’ll give you some antibiotics and pain medication, and we’ll see what happens.” “ I’m not sure what’s wrong, but you don’t need that tooth, and I can make you a bridge.” “I’m going to grind your tooth down a little further to make it feel better.”

Automatically identifying an implant as being a far better treatment plan than retaining the natural tooth appears to be in vogue in contemporary dental practice. This practice has resulted in a wholesale and radical removal of teeth, as opposed to spending the time to determine the cause that may be linked with the negative outcomes at hand and devising a treatment plan that is both reasonable and in the best interest of the patient to eliminate these cause and retain sound tooth structure whenever possible.

The dental professional is faced with a daily continuum of clinical situation that require an integration of facts, experiences, interpretations, and analyses. The ability to confront these situations in a systematic and successful manner characterizes the problem – solving approach to treatment and evaluation.
The purpose of this chapter is to emphasize the importance of determining treatment outcomes and to encourage the problem – solving approach in this endeavor. Once these concepts are grasped, quality assurance is routinely achievable. Integration of these concepts into realistic and thoughtful treatment planning of endodontic problems is demonstrated with specific case scenarios in this chapter and throughout this text. Hopefully, information gleaned from this chapter will be integrated into the problem – solving concepts advocated throughout subsequent chapter. Similarly, a review of this chapter during assimilation of the information in the remainder of this text is highly recommended to ensure the daily performance of all dental treatment at or above the standard level of care.