Root-filled teeth extracted within 12 months in a hospital setting

Objectives: To quantify the reasons for the extraction within 12 months of root filled tooth in a teaching hospital setting. Methods: Over an eighteen month period patients' files from a large teaching hospital were examined where the item number for a root filling was followed by that for an extraction within one year of the placement of the root filling Twenty five patient files were examined. Results: Twenty two teeth (12 anterior teeth, 6 premolars and 4 molars) were extracted between 2 and 12 months post root filling. Reasons for extraction were constant pain and swelling, root or coronal fracture or periodontal involvement. Reasons for failure and the influence of the operator were looked at. Five cases treated by a specialist compared to 19 cases treated by generalists had failed. The reasons for failure of the cases treated by specialists were found to be crown fracture (with the treatment being prolonged by patient factors) and crown or root fracture due to inappropriate restoration. In those cases treated by generalists reasons for failure included procedural errors, failure of the restoration, periodontal reasons, and poor treatment planning. Radiographically poor seal, perforation, root fracture, crown/root fracture, crown fracture, difficult root canal anatomy, incomplete canal preparation and gross overfill were seen. Continuous pain cases were associated with overfilling, overpreparation and inappropriate apical preparation. Retreatment cases were a high percentage of failing cases for those specialist-treated cases. Twenty seven teeth were extracted within 12 months of root filling out of a total of 1,171 teeth root filled. Conclusion: Patient compliance may be maximized by one appointment endodontics Endodontic treatment must meet the restorative needs of the tooth. The placement of orthodontic bands should be mandatory. Continuation training in endodontics is essential.