2TheApex: A functional, asymptomatic tooth with no clinical signs of pathosis can be considered successful even without complete healing of the ligament.
Endodontic success has traditionally been defined as the prevention or elimination of periapical disease following root canal treatment, meaning both complete healing of the PDL radiographically and absence of symptoms clinically. However, utilizing CBCT to evaluate PDL healing Patel showed a 25% reduction in “success” compared to periapical radiographs. Many of these teeth are still in function, asymptomatic, free of active disease, and esthetic; yet fail to meet the above, very stringent, definition of endodontic success. Has treatment been unsuccessful in these cases? How do we measure success clinically? Does it really even matter what definition we use for “success”? Having a clear definition of success is important because treatment plans are be based largely on the prognosis of treatment options. Endodontic treatment and implant placement will frequently be compared, however most implant studies define success as simply survival of the implant. (Iqbal) Helping patients maintain their natural dentition is a primary goal of endodontics, and a definition of success that emphasizes survival more closely aligns with both patient goals and allows for the most accurate comparison of treatment options. Doyle addressed this discrepancy directly by analyzing both the success and survival of implant and endodontic treatment, which resulted in almost identical success and survival rates. A financial evaluation, however, shows that in most circumstances endodontic treatment is the most cost effective option. (Pennington)