Endodontic treatment of molars

OBJECTIVE: Commissioned by the German Institute of Medical Documentation and Information (DIMDI) the Austrian Health Institute (ÖBIG) prepared a HTA report on the long-term effectiveness of endodontic treatment (root canal treatment, RCT) of molars. The focus is to examine factors influencing the outcome of endodontic treatment and showing their impact on long-term results. Additionally, economic aspects of root canal treatment in Germany are discussed. METHODOLOGY: By performing a systematic literature search in 29 databases (e.g. MEDLINE), the Cochrane Library and by hand searching two peer-reviewed endodontic journals the authors could identify 750 relevant articles, of which finally 18 qualified for assessment. RESULTS: The findings show that the most relevant factor influencing the long-term outcome of endodontic treatment is the preoperative status of a tooth. The lowest success rates are reported for molars with a preoperative devital or necrotic pulp and persisting periapical lesions (so called periapical disease). DISCUSSION: Even if there is no positive selection of patients and the RCT is performed by a normal dentist rather than an endodontist - a fact which is very common - long-term success rates of more then 90% are possible. The overall success rates for endodontic treatment of molars therefore seem to be similar to those of other tooth-types. CONCLUSIONS: Especially primary, conventional (i.e. non-surgical) root canal treatment is an effective and efficient therapy for endodontically ill molars, especially if no large periapical lesion persists. Nonetheless, a long term successful endodontic therapy requires a thorough assessment of the pre-operative status of the molar and treatment according to established guidelines.