Aust Endod J 2019

LITERATURE REVIEW

Quality of life of patients with endodontically treated teeth: A

systematic review
Dephne Jack Xin Leong, BDS (S’pore), Cert (Endodontics), MSc, FRCD (Canada), Am. Board Endo, FAMS (Endodontics) ; and
Adrian U-Jin Yap, BDS (S’pore), MSc (Conservative Dentistry), PhD (S’pore), Grad Dip (Psychotherapy), FAMS (Prosthodontics)
Department of Dentistry, Ng Teng Fong General Hospital, Singapore, Singapore

Keywords Abstract
endodontics, oral health, patient outcome,
quality of life, root canal. This systematic review aimed to appraise the quality of life of patients with
restored endodontically treated teeth. The Preferred Reporting Items for Sys-
Correspondence tematic Reviews and Meta-Analyses guidelines were employed. The specific
Dephne Jack Xin Leong, Department of PEO question was as follows: population: patients who were healthy individu-
Dentistry, Ng Teng Fong General Hospital,
als ≥18 years old and required endodontic treatment; exposure: endodontic
1 Jurong East Street 21, Singapore 609606,
treatment with a coronal restoration with at least 6 months in occlusal func-
Singapore. Email: [email protected]
tion; and outcome: quality of life of patients. Databases were searched in con-
doi: 10.1111/aej.12372 junction with hand searching of reference lists of endodontic textbooks,
endodontic-related journals, and relevant articles from electronic searching.
(Accepted for publication 4 August 2019.) Six articles met the inclusion criteria. Most studies concluded that non-surgical
root canal therapy improved patients’ quality of life. The effect of operator type
yielded conflicting results. Only one paper compared endodontic treatment
with implant placement, and it showed similar patient-centric outcome with a
high level of patient satisfaction. Current research is still limited, and further
studies are warranted.

assessed mainly by three parameters: social indicators, glo-

Introduction
bal self-ratings and multiple item surveys to indicate
Natural dentition should be preserved whenever possi- patients’ oral health (11). The latter is the most exten-
ble because nothing looks, feels or functions like a natu- sively utilised, and common instruments include the Oral
ral tooth (1). Favourable success or survival rates have Health Impact Profile (OHIP) (12), OHIP-14 (13) and the
been reported in numerous studies for endodontic treat- Oral Impacts on Daily Performances (OIDP) (14). By ana-
ment (comprising of root canal treatment, endodontic lysing patients’ perception of the impact of endodontic
retreatment and endodontic surgery) (2–4). These stud- treatment on their well-being, the dental profession will
ies had focused mainly on clinical outcome and are be better able to appreciate pulpal diseases and treatments
measured with instruments such as Strindberg’s Criteria from the patients’ perspective.
or Orstavik’s Periapical Index, and defined by strict cri- Systematic reviews and meta-analysis of randomised
teria comprising of complete healing of radiographic clinical trials have the highest level of evidence (LOE) in
periapical lesion and absence of clinical signs or symp- evidence-based practice (15). However, there is only one
toms (5–7). published systematic review on the impact of endodontic
Nevertheless, clinical parameters alone impart scant treatments on patients’ quality of life in the literature
knowledge of oral health outcomes. There has been a thus far (16). Additionally, there is a current lack of for-
paradigm shift in health care, as well as oral health care, to mal guidance on the conduct of systematic reviews of
patient-centred outcomes of treatment and services (8,9). association except for the one proposed by the Joanna
Oral health-related quality of life (OHRQoL) indices com- Briggs Institute (JBI) (17). Hence, the aim of this system-
plement clinical measures as health is viewed not only as atic review was to appraise the available data on patient-
an absence of disease, but also the presence of physical, centred quality of life outcomes of endodontic treatment
psychological and social well-being (10). OHRQoL is using the JBI approach.

© 2019 Australian Society of Endodontology Inc 1

QoL of Patients with Endo Treated Teeth D. J. X. Leong and A. U-J. Yap

event of a disagreement, consensus was reached by dis-

Methods
cussion. The checklist consists of nine appraisal questions
with an overall appraisal whether to include or exclude
PEO question
the studies, or to seek further information from authors.
The Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) guidelines were employed
Results
for this review. The specific PEO questions were as
follows:
Search findings and study characteristics
P (population): patients who were healthy individuals A total of 112 articles were found. After screening the
≥18 years old and required endodontic titles and the abstracts of the identified studies, six studies
treatment (root canal treatment, endodontic were included in the full-text analysis. No additional rel-
retreatment or endodontic surgery) evant studies were found from hand searching (Fig. 1).
The six studies (Table 1) comprised of three cross-sec-
E (exposure): endodontic treatment with a coronal restoration
tional studies, one case–control study and two cohort
with at least 6 months in occlusal function
studies. The cross-sectional and case–control studies were
O (outcome): quality of life of patients retrospective, while the cohort studies were prospective.
The systematic review seeks to answer the following As the articles were heterogeneous in design/methodol-
question: ogy and contained disparate data types, quantitative
Does endodontic treatment improve the quality of life analysis was not possible and a qualitative systematic
of patients? review was performed.

Search process and selection of studies Quality assessment of risk of bias

Ovid, PubMed and Cochrane databases were searched There was no disagreement between reviewers and both
using the Mesh terms (‘root canal therapy’ OR ‘root canal concurred that the methodological quality of all studies
treatment’ OR ‘endodontic therapy’ OR ‘endodontic was adequate for inclusion into the review. None of the
treatment’, ‘quality of life’ OR ‘patient-centered out- studies fulfilled all bias-free requirements but all studies
come’). Hand searching was performed by screening scored a minimum of five yes responses, with the out-
through reference lists of endodontic textbooks, comes measured in a reliable manner (except for Vena
endodontic-related journals and relevant articles from et al. (22) where details about the reliability of measure-
electronic searching. The searches were last conducted ment were not mentioned) and appropriate statistical
on July 16, 2018. analyses used (Table 2).

Inclusion/exclusion criteria Treatment type

The present review included clinical studies measuring All 6 papers studied non-surgical root canal therapy.
the quality of life of patients who were healthy individu- None of the articles pertaining to endodontic surgery was
als ≥18 years old who received endodontic treatment included because the inclusion criterion ‘at least
(root canal treatment, endodontic retreatment or 6 months in occlusal function’ was not met. Only 4 of
endodontic surgery) with a functional coronal restoration the 6 papers (20–23) specified the type of non-surgical
of at least 6 months (Table 1). Studies that did not meet root canal therapy (primary root canal treatment only,
the above inclusion criteria and non-English articles were non-surgical endodontic retreatment only or both). No
excluded. paper compared primary root canal treatment and non-
surgical endodontic retreatment. Four studies
(18,19,21,23) concluded that non-surgical root canal
Appraisal of the studies selected
therapy improved patients’ quality of life. Two studies
Both authors assessed the quality of methodology based (20,22) looked at the impact of persistent pain post-en-
on the Joanna Briggs Institute (JBI) Critical Appraisal dodontic treatment on patients’ quality of life and found
Checklist for Quasi-Experimental Studies (non-ran- that the latter was deleteriously affected by the presence
domised experimental studies; Table 2) as the studies of persistent pain but generally with minimal impact on
were not randomised controlled clinical trials (24). In the daily activities.

2 © 2019 Australian Society of Endodontology Inc

 Table 1 Characteristics of the six studies included for analysis

OHRQoL
Reference Aim Study type Methodology Patient recruitment and no. outcome Authors’ comments & conclusion

Dugas To assess quality of life and Cross- Patients with radiographically 119 patients aged 25–40 year [238 OHIP-17 Subjects reported preoperative
et al. satisfaction in relation to sectional identifiable endodontic endodontically treated teeth] who (adapted from factors (e.g. pain, sleep
(18) endodontic treatment in two treatment were invited for presented as new patients at the OHIP-49); disturbances) impacting quality of
Canadian populations and the interviews conducted using a University of Toronto Faculty of semantic life, which improved after
association of these outcomes questionnaire that measured Dentistry (n = 83) and the University of differential endodontic treatment, significantly
D. J. X. Leong and A. U-J. Yap

with the treatment providers’ changes in quality of life after Saskatchewan Dental School in scales more in the Toronto than in the
level of training (generalist or endodontic treatment and Saskatoon (n = 36) within the past Saskatoon population. Satisfaction
endodontist) semantic differential scales 2 years from the beginning of the was significantly better when
that measured satisfaction study were randomly selected from endodontic treatment was

© 2019 Australian Society of Endodontology Inc

with endodontic treatment. 610 potential subjects provided by endodontists
After each of the 17 questions
related to the impact of the
disease on the quality of life, a
further question was posed to
explore the impact of ET
Gatten To qualitatively describe and Case– Patients’ charts were randomly Patients treated at either the Graduate OHIP-14; focus All OHIP items had a majority of
et al. compare the quality of life of control selected from the database of Endodontic Clinic or Graduate group individuals who responded that
(19) patients with restored, single the respective departments Periodontic Clinic (University of discussions they never experienced the oral
endodontically treated teeth and screened for eligibility Washington School of Dentistry, recorded for health-related quality of life impact
versus patients with single based on the predetermined Seattle) were considered for this study. subsequent after their treatment (range across
implant-supported fixed criteria. Focus group Inclusion criteria: (i) patients who thematic items, 60–94%). The results show
prostheses discussions were held and received one root canal therapy or a analysis similar overall OHIP scores and
audio-recorded for single implant-based rehabilitation; (ii) show a high rate of satisfaction
subsequent thematic analysis. patients with a coronal restoration with with both treatment modalities.
Data were analysed to identify at least 1 year in occlusal function; (iii) Content analysis of the discussion
common themes within each patients whose treatment was groups revealed several themes
category and compared to provided by clinicians with the same and subthemes. The major themes
assess any differences in level of proficiency (i.e. graduate were importance of overall health,
quality of life between the two students in the respective financial implications of the
treatments. OHIP-14 was departments); and (iv) patients who treatments, perception of the
given before the discussion were ≥18 years old; and (v) patients treatments and its outcomes, time
group and the responses who were American Society of since treatment, and follow-up
analysed Anesthesiology I and II. 37 patients dental visits
participated in the study: 17 were
endodontically treated and 20 had an
implant-supported prosthesis

(continued)
QoL of Patients with Endo Treated Teeth

3
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Table 1 (continued)

OHRQoL
Reference Aim Study type Methodology Patient recruitment and no. outcome Authors’ comments & conclusion

Yu et al. To determine the incidence of Cross- Patients from a university 127 patients with 185 persistent lesions Modified Oral Overall incidence of flare-up
(20) painful exacerbations sectional hospital clinic (National were recruited. Median age of patients Impacts on (requiring an unscheduled dental
(including both flare-ups and University Hospital Singapore) at recruitment was 56 years (range, 21 Daily visit) was only 5.8% 20 years after
less severe pain with an were screened to identify –82 years). Median time since Performances treatment. Less severe pain was
impact on daily activities) in a root-filled teeth with periapical treatment was 5 years (range, 4– (OIDP) more frequent, with a combined
cohort of patients identified as lesions at time of treatment 38 years) incidence of 45% pain at 20 years
having persistent lesions for at and not resolved at least after treatment. Female patients,
least 4 years after root canal 4 years later. A clinical and treatment involving a mandibular
therapy. Patient and treatment radiographic examination and molar or maxillary premolar, and
QoL of Patients with Endo Treated Teeth

factors were studied for questionnaire survey were preoperative pain were significantly
correlation with the conducted. Patient and associated with pain after
occurrence of pain treatment characteristics and treatment. The most commonly
details of pain experience affected activities during painful
were studied exacerbations were eating and
tooth brushing, with minimal
impact on daily living
Liu et al. To assess changes in quality of Cohort Pre–post comparison. The A consecutive sample of 279 patients OHIP-14 There were significant changes in
(21) life after endodontic treatment patients completed the with endodontic disease who met with OHIP-14 scores over the study
and to determine if changes in assessments before the inclusion and exclusion criteria was period after conventional
quality of life were associated endodontic treatment and 1 recruited at a university teaching orthograde endodontic treatment
with changes in patient- and 6 months after root canal hospital in Southern China. 213 (76.3%) (from pretreatment–6 months
perceived oral health and obturation. A global oral completed OHQoL assessments at all postobturation). The magnitude of
clinical assessments of health transition assessment three time points. Inclusion criteria: (i) statistical change (effect size) was
success was ascertained by a single patients who require root canal moderate (0.61) in the short-term
(global) item rating of oral therapy; (ii) adults ≥18 years old; (iii) (after 1 month) and large (0.71) in
health improvement and patients of Chinese ethnicity; and (iv) the longer-term (after 6 months).
clinical assessment mainly patients who could read traditional Changes in the OHIP-14 were
based on the Periapical Index Chinese. Exclusion criteria: (i) patients associated with changes in patient
(PAI) of periapical radiographs with serious medical conditions for self-rating oral health status, which
which they were hospitalised in the was also associated with changes
past year and/or taking medication for in PAI scores. The OHIP-14
their condition that required measure is both sensitive and
consultation with a physician before responsive to endodontic
dental treatment; (ii) patients with treatment and is likely to be useful
physical disabilities; and (iii) patients in understanding patients’
with communication difficulties noted perspectives of outcomes from
on their record endodontic care

(continued)
D. J. X. Leong and A. U-J. Yap

© 2019 Australian Society of Endodontology Inc

 Table 1 (continued)

OHRQoL
Reference Aim Study type Methodology Patient recruitment and no. outcome Authors’ comments & conclusion

Vena To determine the prevalence Cross- All patients presenting to 64 network practices enrolled 1323 OHIP-14 5% of the patients reported persistent
et al. and factors associated with sectional participating network patients; 13 were ineligible, 12 did not pain. 3.1% experience persistent
(22) persistent pain 3–5 years after practices who received receive a final restoration, and 41 were pain not attributable to
primary root canal therapy in primary root canal therapy extracted, leaving 1257 for analysis. odontogenic causes 3–5 years
general practice-based and restoration for a The average time to follow-up was after primary root canal therapy
D. J. X. Leong and A. U-J. Yap

research network (PEARL permanent tooth 3–5 years 3.9  0.6 years. Excluded were teeth that may adversely impact their
Network) and its effect on the previously were invited to with an incompletely formed apex, quality of life. Teeth treated by
patient’s perceived OHRQoL enrol. The patients completed teeth that served as an abutment for a specialists had a greater frequency
an oral health-related quality removable partial denture or of persistent pain than teeth

© 2019 Australian Society of Endodontology Inc

of life questionnaire (OHIP-14) overdenture, teeth that were in active treated by generalists (9.3% vs.
orthodontic therapy, and third molars 3.0%, respectively). Sex, age, tooth
type, type of dentist, and arch
were not found to be associated
with non-odontogenic persistent
pain; however, ethnicity (non-
Hispanic/Latino) and a preoperative
diagnosis of pulpitis without
periapical pathosis were found to
be associated
He et al. To determine the outcomes of Cohort The retreatment procedures 63 patients referred to the graduate OHIP-17 (same 9.6% were determined to be non-
(23) non-surgical endodontic were performed by endodontic clinic at Baylor College of as Dugas healing at the last follow-up with
retreatment in first molars endodontic residents. Patients Dentistry for retreatment were et al. 2002); new or persistent periapical
using contemporary were followed up at 6, 12 and recruited to participate in the study. subjective lesions. 71.2% patients had
techniques. Success was 24 months after the Inclusion criteria: (i) adult patients 18– masticatory complete resolution of apical
measured using clinical and placement of a permanent 80 years of age; (ii) generally healthy ability periodontitis, and the remaining
radiographic criteria as well as coronal restoration. without any immunocompromising questionnaire 19.2% remained asymptomatic and
patient-centred criteria Treatment outcomes were systemic diseases such as uncontrolled showed radiographic evidence of
including OHQOL and categorised into healed, diabetes, AIDS and so on; and (iii) teeth healing. Oral health-related quality
subjective chewing ability healing or non-healing based requiring treatment were either of life scores and chewing ability
on clinical and radiographic previously endodontically treated improved significantly over time,
criteria. At the preoperative maxillary or mandibular first molars with the biggest increase observed
visit and all the subsequent with opposing dentition. Exclusion within the first week of treatment
follow-up visits (1-week, 1- criteria: (i) vertical root fracture; (ii) completion
month, 6-month, 12-month advanced periodontal disease; (iii) non-
and 24-month), patients were restorable teeth; and (iv) major
presented with the modified malocclusion. 52 of the 63 patients
OHQOL questionnaire and the were available for final analysis
chewing ability questionnaire
QoL of Patients with Endo Treated Teeth

5
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Table 2 Performance of the included articles on the JBI critical appraisal checklist for quasi-experimental studies (non-randomised experimental studies)

He et al.
Dugas et al. (18) Gatten et al. (19) Yu et al. (20) Liu et al. (21) Vena et al. (22) (23)

Q1 Is it clear in the study what is the Y Y Y Y Y Y

‘cause’ and what is the ‘effect’ (i.e. there
is no confusion about which variable
comes first)?
Q2 Were the participants included in any Y Y Y Y Y Y
comparisons similar?
Q3 Were the participants included in any Y Y Y Y Y Y
comparisons receiving similar
treatment/care, other than the exposure
QoL of Patients with Endo Treated Teeth

or intervention of interest?
Q4 Was there a control group? NSingle group pre-test post-test design NBoth were test NSingle group NSingle group pre-test NSingle group NSingle
groups pre-test post- post-test design pre-test post- group
test design test design pre-test
post-test
design
Q5 Were there multiple measurements of NStudy design might introduce a recall bias, NOnly NOnly NMultiple postoperative NOnly Y
the outcome both pre and post the because patients’ recollections of the postoperative postoperative measurements were postoperative
intervention/exposure? impact of particular problems both pre- and measurements measurements captured; Only one measurements
postoperatively were captured were captured were captured preoperative were captured
measurement
Q6 Was follow-up complete and if not, NA NA NA Y NA Y
were differences between groups in
terms of their follow-up adequately
described and analysed?
Q7 Were the outcomes of participants Y Y Y Y Y Y
included in any comparisons measured
in the same way?
Q8 Were outcomes measured in a reliable Y Y Y Y UDetails about the Y
way? reliability of
measurement
not mentioned
Q9 Was appropriate statistical analysis Y Y Y Y Y Y
used?

NA, not applicable; N, no; U, unclear; Y, yes.

D. J. X. Leong and A. U-J. Yap

© 2019 Australian Society of Endodontology Inc

D. J. X. Leong and A. U-J. Yap QoL of Patients with Endo Treated Teeth

Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of study selection.

differences were particularly significant in the domains of

Operator type
physical pain, psychological discomfort and disability.
All but one paper (21) mentioned the operator type for Gatten et al. (19) and He et al. (23) studied treatments
the endodontic treatments performed. Dugas et al. (18) performed by postgraduates and showed a significant
reported that the quality of life was generally equally improvement in quality of life, although prolonged
improved after treatment provided by generalists and mouth opening was a frequent concern among the
endodontists, although subjects treated by endodontists patients (19). Yu et al. (20) included teeth treated by
reported significantly more improvement in temperature endodontists, family dentists and dental students and no
sensitivity and the ability to resume their usual jobs than statistical difference in outcome was found among the
subjects treated by generalists. Patients treated by operator types.
endodontists were also found to be significantly more sat-
isfied and indicated the treatment time to be the main
Comparison with alternative therapies
reason for the satisfaction, while the usually higher fees
were not perceived as a greater cause of dissatisfaction The paper by Gatten et al. (19) was the only available
than were the lower fees for patients treated by general- study that compared endodontic treatment with alterna-
ists (18). In contrast, Vena et al. (22) found that the qual- tive treatment modality such as dental implant. The
ity of life of patients treated by specialists was lower study showed comparable overall OHIP scores and a high
compared with patients treated by generalists. The level of patient satisfaction with both therapies.

© 2019 Australian Society of Endodontology Inc 7

QoL of Patients with Endo Treated Teeth D. J. X. Leong and A. U-J. Yap

Discussion found that subjects treated by endodontists reported sig-

nificantly more improvement in temperature sensitivity
This systematic review assessed the impact of endodontic and the ability to resume their usual jobs than subjects
treatment on patients’ quality of life and found that most treated by generalists. The subjects treated by endodon-
studies concluded that non-surgical root canal therapy tists were also found to be significantly more satisfied. On
(primary root canal treatment and non-surgical the other hand, Vena et al. (22) found that the quality of
endodontic retreatment) improved patients’ quality of life of patients treated by specialists was lower compared
life. This concurs with the finding by Antunes et al. (16). with patients treated by generalists, particularly in the
It is not surprising since it is known that a vast majority physical pain, psychological discomfort and disability
of patients experience pain relief and restoration of func- domains. The authors explained that this might be due to
tion through endodontic treatment (25,26). No articles the increased complexity of cases performed by special-
regarding endodontic surgery were included as the inclu- ists. Yu et al. (20) included teeth treated by endodontists,
sion criterion ‘at least 6 months in occlusal function’ was family dentists and dental students and found no statisti-
not fulfilled. The criterion ‘at least 6 months in occlusal cal difference in outcome among the operator types.
function’ was included because in our opinion, it might Treatments performed by postgraduates showed a signifi-
be too soon to evaluate transformations in patients’ qual- cant improvement in quality of life. Although prolonged
ity of life if the time period was anything earlier. mouth opening was a frequent concern among the
Three out of the six studies (19,21,22) had utilised the patients (19,23), the authors felt that this concern would
OHIP-14. This is the condensed version of the OHIP and have negligible effect on the patient’s quality of life and
comprised of two items for each of the seven domains of might not be of a concern in the private sector where
impact on patients’ well-being. The specific domains are clinicians might be more competent than in the universi-
(i) functional limitation; (ii) physical pain; (iii) psycho- ties. The variance in findings was not surprising given the
logical discomfort; (iv) physical disability; (v) psychologi- differences in training, skills, experience and personality
cal disability; (vi) social disability; and (vii) handicap. The of the various operator types.
modified Oral Impacts on Daily Performances (OIDP) was One study attempted to evaluate the quality of life and
employed in one study [20]. The OIDP assessed eight satisfaction of patients after root canal therapy provided
daily performances incorporating: (i) eating and enjoying by undergraduates, postgraduates and endodontic spe-
food; (ii) speaking and pronouncing clearly; (iii) cleaning cialists through a longitudinal study of a middle eastern
teeth; (iv) sleeping and relaxing; (v) smiling, laughing cohort (27). Results showed that there was significant
and showing teeth without embarrassment; (vi) maintain improvement in patients’ quality of life after endodontic
usual emotional state without being irritable; (vii) carry- therapy with no significant difference among patients
ing out major work or social role; and (ix) enjoying con- managed by specialists, postgraduates or undergraduates.
tact with people. Although both instruments have been The investigators suggested that the failure to find a sig-
shown to be valid and reliable, they are not disease-speci- nificant predilection between treatment providers might
fic and may not be the most ideal methods to determine be explained by the lack of statistical power from the
patients’ quality of life after endodontic treatment. insufficient sample size to have a significant difference
Dugas et al. (18) developed an endodontic-specific among the items of the OHIP that showed more than
quality of life instrument by selecting 17 items from the 80% improvement. The study revealed that patients had
49 items included in the OHIP. The authors first pilot- significantly greater satisfaction with their root canal
tested the instrument and confirmed it as having a high therapy performed by specialists, followed by postgradu-
reliability, before using it for the study. However, the ates and then undergraduates, primarily because of the
investigators pointed out that the instrument was not shorter treatment time. However, patients managed by
perfect, as other perceived factors (e.g. items relating to specialists were least satisfied with the cost of treatment.
finance or personality) affecting oral health-related qual- The results were consistent with those of Dugas et al.
ity of life were absent. They proposed overcoming this (18).
using a qualitative approach. Gatten et al. (19) used the Only one study (19) comparing endodontic treatment
qualitative method by asking open-ended questions, with alternative treatment modality such as dental
thereby allowing patients to discuss different aspects of implant was included in this systematic review. Although
their lives perceived to have been affected by their oral the study showed comparable overall OHIP scores and a
health. high level of patient satisfaction with both therapies, the
The effect of operator type (endodontists, postgradu- surveyed patients expressed a clear desire to save their
ates, generalists, dental students) on quality of life after natural dentition whenever possible. A comparative
endodontic treatment was ambivalent. Dugas et al. (18) study performed by Torabinejad et al. (28) also

8 © 2019 Australian Society of Endodontology Inc

D. J. X. Leong and A. U-J. Yap QoL of Patients with Endo Treated Teeth

demonstrated a great degree of patient satisfaction with 4. Ng YL, Mann V, Gulabivala K. Tooth survival following
both procedures. Coupled with the numerous studies non-surgical root canal treatment: a systematic review of
that have presented comparably high clinical success the literature. Int Endod J 2010; 43: 171–89.
rates between the two treatments (29–31), it is crucial to 5. Strindberg LZ. The dependence of the results of pulp ther-
realise that endodontic and implant treatments are two apy on certain factors. An analytic study based on radio-
different treatment modalities with their own specific graphic and clinical follow-up examination. Acta Odontol
indications and contraindications, and should not be Scand 1956; 14 (Suppl): 21.
viewed as competing alternatives, but as complementary 6. Ørstavik D, Kerekes K, Eriksen HM. The periapical index:
a scoring system for radiographic assessment of apical peri-
treatment options for the appropriate patient situation.
odontitis. Endod Dent Traumatol 1986; 2: 20–34.
As the available evidence on this topic is still scarce,
7. Kvist T. Endodontic retreatment. Aspects of decision mak-
more research in this area is warranted. Further well-
ing and clinical outcome. Swed Dent J Suppl 2001; 144:
constructed studies with a large number of participants
1–57.
must be performed to establish the impact of treatment
8. Allen PF. Assessment of oral health related quality of life.
modalities on patient’s quality of life. A comprehensive Health Qual Life Outcomes 2003; 1: 40.
disease-specific quality of life instrument should be 9. McGrath C, Bedi R. The value and use of ‘quality of life’
developed for endodontics. Additionally, more studies measures in the primary dental care setting. Prim Dent
comparing patient-centred outcomes of endodontic treat- Care 1999; 6: 53–7.
ments (both non-surgical and surgical treatments) and 10. Inglehart MR, Bagramian RA. Oral health-related quality
implant should be conducted. of life: an introduction. In: Inglehart MR, Bagramian RA,
eds. Oral health-related quality of life. Chicago, IL: Quin-
tessence Publishing; 2002a. pp. 1–6.
Conclusion
11. Slade GD. Assessment of oral health-related quality of life.
Despite the paucity of well-designed clinical studies, cur- In: Inglehart MR, Bagramian RA, eds. Oral health-related
rent studies showed that non-surgical endodontic treat- quality of life. Carol Stream, IL: Quintessence Publishing;
ment improved patients’ quality of life. Clinicians should 2002. pp. 29–46.
consider patients’ perceptions and preferences, besides 12. Slade GD, Spencer AJ. Development and evaluation of
prognosis and outcomes, during treatment planning. Fur- the oral health impact profile. Community Dent Health
ther research on the association between endodontic 1994; 11: 3–11.
treatment and the improvement of patients’ quality of 13. Slade GD. Derivation and validation of a short-form oral
life is warranted. health impact profile. Community Dent Oral Epidemiol
1997; 25: 284–90.
14. Adulyanon S, Sheiham A. Oral impacts on daily perfor-
Conflicts of interest mances. In: Slade GD, ed. Measuring oral health and qual-
ity of life. Chapel Hill, NC: Dental Ecology; 1997. pp. 152–
The authors deny any conflicts of interest related to this
60.
study
15. The Centre for Evidence-Based Medicine (CEBM). Oxford
Centre for Evidence-Based Medicine 2011 Levels of Evi-
Authorship declaration dence. [Cited 6 Aug 2018.] Available from URL: https://
www.cebm.net/wp-content/uploads/2014/06/CEBM-Le
Both authors, Dephne Jack Xin Leong and Adrian U-Jin vels-of-Evidence-2.1.pdf
Yap, have contributed significantly and are in agreement 16. Antunes LS, Souza CR, Salles AG, Gomes CC, Antunes
with the manuscript. LA. Does conventional endodontic treatment impact oral
health-related quality of life? A systematic review Eur
Endod J 2018; 3: 2–8.
References
17. Moola S, Munn Z, Sears K et al. Conducting systematic
1. American Association of Endodontists (AAE). Saving your reviews of association (etiology): the Joanna Briggs Insti-
natural teeth. [Cited 6 Aug 2018.] Available from URL: tute’s approach. Int J Evid Based Healthc 2015; 13: 163–9.
https://www.aae.org/patients/root-canal-treatment/sa 18. Dugas NN, Lawrence HP, Teplitsky P, Friedman S. Quality
ving-natural-tooth/ of life and satisfaction outcomes of endodontic treatment.
2. Friedman S. Prognosis of initial endodontic therapy. J Endod 2002; 28: 819–27.
Endod Topics 2002b; 2: 59–88. 19. Gatten DL, Riedy CA, Hong SK, Johnson JD, Cohenca N.
3. Salehrabi R, Rotstein I. Endodontic treatment outcomes in Quality of life of endodontically treated versus implant
a large patient population in the USA: an epidemiological treated patients: a University-based qualitative research
study. J Endod 2004; 30: 846–50. study. J Endod 2011; 37: 903–9.

© 2019 Australian Society of Endodontology Inc 9

QoL of Patients with Endo Treated Teeth D. J. X. Leong and A. U-J. Yap

20. Yu VS, Messer HH, Yee R, Shen L. Incidence and 26. Pak JG, White SN. Pain prevalence and severity before,
impact of painful exacerbations in a cohort with post- during, and after root canal treatment: a systematic
treatment persistent endodontic lesions. J Endod 2012; review. J Endod 2011; 37: 429–38.
38: 41–6. 27. Hamasha AA, Hatiwsh A. Quality of life and satisfaction of
21. Liu P, McGrath C, Cheung GS. Improvement in oral patients after nonsurgical primary root canal treatment
health-related quality of life after endodontic treatment: a provided by undergraduate students, graduate students
prospective longitudinal study. J Endod 2014; 40: and endodontic specialists. Int Endod J 2013; 46: 1131–9.
805–10. 28. Torabinejad M, Salha W, Lozada JL, Hung YL, Garbacea
22. Vena DA, Collie D, Wu H et al. Prevalence of persistent A. Degree of patient pain, complications, and satisfaction
pain 3 to 5 years post primary root canal therapy and its after root canal treatment or a single implant: a prelimi-
impact on oral health-related quality of life: PEARL Net- nary prospective investigation. J Endod 2014; 40: 1940–5.
work findings. J Endod 2014; 40: 1917–21. 29. Doyle SL, Hodges JS, Pesun IJ, Law AS, Bowles WR. Ret-
23. He J, White RK, White CA, Schweitzer JL, Woodmansey rospective cross sectional comparison of initial nonsurgical
KF. Clinical and patient-centered outcomes of nonsurgical endodontic treatment and single-tooth implants. J Endod
root canal retreatment in first molars using contemporary 2006; 32: 822–7.
techniques. J Endod 2017; 43: 231–7. 30. Iqbal MK, Kim S. For teeth requiring endodontic treat-
24. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. ment, what are the differences in outcomes of restored
Chapter 3: systematic reviews of effectiveness. In: Aro- endodontically treated teeth compared to implant-sup-
mataris E, Munn Z, eds. Joanna Briggs Institute Revie- ported restorations? Int J Oral Maxillofac Implants 2007;
wer’s Manual. Adelaide, SA: The Joanna Briggs Institute; 22 (Suppl): 96–116.
2017. https://wiki.joannabriggs.org/display/MANUAL/ 31. Torabinejad M, Anderson P, Bader J et al. Outcomes of
Chapter+3%3A+Systematic+reviews+of+effectiveness root canal treatment and restoration, implant-supported
25. Friedman S, Mor C. The success of endodontic therapy: single crowns, fixed partial dentures, and extraction with-
healing and functionality. J Calif Dent Assoc 2004; 32: out replacement: a systematic review. J Prosthet Dent
493–503. 2007; 98: 285–311.

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