Root canal treatment –patient age not a prognostic factor

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Non-surgical root canal treatment (NSRCT) is a well-established highly treatment that preserves teeth following pulp death or infection. Anecdotally it has been considered that NSRCT in older adults is less successful.

The aim of this review was to evaluate the influence of increased patient age on longitudinal outcomes of NSRCT.

Methods

Searches were conducted in the Medline and Cochrane CENTRAL databases supplemented by hand searches in the most recent 2 years of the journals; Acta Odontologica Scandinavica, Community Dentistry and Oral Epidemiology, Gerodontology, International Endodontic Journal, Journal of Endodontics, Journal of Oral Rehabilitation, and Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, and Endodontics.

Studies published in English that provided longitudinal data on outcomes of NSRCT in adult patient populations, including segregated data on elders were considered. Two reviewers screened studies for inclusion and study and assessed for quality using the Wong Scale–Revised (WSR)- a points based system ranging from 9-27 with scores >18 considered to be good. A narrative summary of the findings was presented.

Results

  • 24 studies (9 prospective, 15 retrospective) involving a total of 17430 teeth were included
  • All studies were performed in countries with very high development indices
  • Overall study quality was considered good (mean WSR score ,24)
  • 8 prospective studies reported no difference in outcomes, principally success, with age, and 1 reported that success improved with increasing patient age.
  • 14 retrospective studies found that age was not related to endodontic outcome, principally success, and 1 reported that success improved with increasing patient age.

Conclusions

The authors concluded

All of the included studies in this systematic review of longitudinal non-surgical root canal treatment outcomes demonstrated that increased patient age does not decrease the success of non- surgical root canal treatment. Patient age is not a prognostic factor for non-surgical root canal treatment. Age should not be considered by dentists or patients when making non-surgical root canal treatment decisions. Elders’ non-surgical root canal treatment outcomes are at least as favour- able as for other adults.

Comments

Only two major databases were searched for this review and studies were restricted to those published in English so it is possible that some relevant studies were not included. The use of these databases and restrictions may also have contributed to the fact that all the included studies were from high development index countries. The authors could also have considered using the validated Newcastle Ottawa Scale for the assessment of study quality rather than the WSR.

The authors noted major heterogeneity in relation to reporting units (patients, teeth, root or canals), outcome criteria, treatment methods, provider duration of follow-up, year of publication, sample selection, geographical location, sample size, differing age groupings and differing analytical methods so chose note to conduct a meta-analysis. However, none of the included studies demonstrated a negative impact of increased age on NSRCT outcome. With a generally ageing world population this is a welcome finding although more high quality prospective studies with common core outcome sets in order to better compare and combine data in the future would be welcome.

Links

Primary paper

Shakiba B, Hamedy R, Pak JG, Barbizam JV, Ogawa R, White SN. Influence of increased patient age on longitudinal outcomes of root canal treatment: a systematic review. Gerodontology. 2016 May 16. doi: 10.1111/ger.12231. [Epub ahead of print] PubMed PMID: 27198169.

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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