SIGNIFICANCE OF PRELIMINARY ENDODONTIC CASE DIFFICULTY ASSESSMENT AS AN APPROACH FOR POTENTIAL PROGNOSTIC DIFFERENTIATION OF COMPLICATIONS PREVALENCE
DOI:
https://doi.org/10.35220/2523-420X/2025.2.9Keywords:
root canal treatment, endodontics, tooth, complications, complication, assessment criteria, prognosisAbstract
Purpose of the study. To verify the feasibility of using specific criteria for preliminary assessment of the endodontic treatment case complexity and to establish differences in the complications prevalence among different categories of the studied criterion. Research methods. The clinical phase was organized as a prospective study, in the structure of which dentists provided a subjective assessment of the complexity of the clinical case before endodontic treatment without using any specific-oriented criteria. The retrospective phase of the study involved randomization of anonymized radiographs of clinical cases obtained before and after the intervention, while maintaining their affiliation with each specific doctor, with the assessment of such according to standardized specific criteria according to the AAE Case Difficulty Assessment Standards, and noting the data obtained for each case. The comparative-analytical stage of the study was conducted by an independent expert, who compared the differences in the assessments of the complexity of endodontic treatment noted by dentists without and with the use of specific criteria, as well as assessed the prevalence of radiologically verified complications and obturation defects. Scientific novelty. The distribution of complications in cases of mild, moderate and high complexity of endodontic treatment was characterized by a statistically confirmed pattern of changes when reassessment of clinical cases using specific criteria was provided in comparison to situation of the initial classification of clinical cases based only on the subjective judgments of dentists (p < 0,05). Compared with the distribution of cases of different treatment complexity based on the subjective assessment of dentists, the prevalence of complications and obturation defects after reassessment according to specific criteria remained the same only for cases with mild treatment complexity (p > 0,05), but was statistically lower for cases with moderate treatment complexity (p < 0,05) and statistically higher for cases with high treatment complexity (p < 0.05). The correlation level of changes in the frequency of registered complications with increasing complexity of endodontic treatment, when latter was verified on the basis of the initial subjective assessments of dentists, was r=-0,43, while after reassessment of the complexity of treatment taking into account specific criteria, this indicator was r=0,83. Conclusions. The complexity of endodontic treatment, objectified by the use of specific criteria, is characterized by a higher level of correlation with the frequency of complications and obturation defects in clinical cases that met the parameters of moderate and high complexity, while the results of the subjective assessment of the complexity of root canal treatment demonstrated the presence of interdependencies with the frequency of complications only in cases categorized as high complexity. The initial assessment of the potential complexity of endodontic treatment does not allow to directly influence the risk of complications during the intervention, however, it allows to identify cases that are characterized by a higher probability of complications, and therefore require more attention during planning, as well as potential adaptation of the used therapeutic approaches, techniques and manipulations to the conditions of the clinical situation, which in turn will allow to reduce the risk of associated complications.
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