(TC02) Redefining Treatment Outcomes on Condemned “Unfavorable” Teeth

Dentists face the challenge of determining the prognosis of a tooth prior to initiating care. The determinants of such a prognosis are multifactorial and founded on evidence-based guidelines within each dental discipline. In 2017, the American Association of Endodontists published an evidence-based prognosis guide titled “Treatment Options for the Compromised Tooth: A Decision Guide.” This guide outlines how various pre-treatment and post-treatment conditions can affect outcomes of endodontic treatment. The prognosis is important for the dentist and patient as they attempt to articulate goals of treatment, thus affecting the treatment planning process in which the patient will decide whether to pursue endodontic treatment. The purpose of this table clinic is two-fold. One, it is to discuss the phenomenon of how seemingly “unfavorable” endodontic cases can have successful results, despite compromised treatment. Two, it is to propose endodontic tooth prognosis as the risks involved in treatment rather than likelihood of successful outcomes from treatment. This approach will be illustrated in a case that initially had an “unfavorable” prognosis. Despite every reason for this tooth to fail due to pre-treatment status and iatrogenic treatment error, both the patient and clinician were invested in saving the tooth, and it healed successfully over a six-year period. The case will illustrate how the best available evidence should be considered when discussing the risks involved in endodontic treatment and inspire endodontists to attempt care on the more questionable to unfavorable case types.