The quality of root canal treatment and periapical status of permanent teeth in Turkish children and teens: a retrospective CBCT study

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials

PURPOSE

To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes.

METHODS

This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression).

RESULTS

At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome.

CONCLUSIONS

MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Procedural errors detected by cone beam tomography in cases with indication for retreatment: in vivo cross-sectional study

Objectives

This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis.

Materials and Methods

The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling.

Results

The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction.

Conclusions

CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.

Periapical status and technical quality in root canal filled teeth in a cross sectional study in Jönköping, Sweden

OBJECTIVE

To investigate the quality of root canal fillings and frequency of apical periodontitis (AP) in root canal filled teeth in a Swedish population.

MATERIAL AND METHODS

This study used data from a cross-sectional survey conducted in 2013. The root canal filling quality and periapical status were assessed in 491 root canal filled teeth in 196 individuals aged 20-70 years, randomly selected from the population of Jönköping, Sweden. All root canal filled teeth were examined with periapical radiographs. Three calibrated observers recorded length and density in root canal fillings as well as periapical status according to the Periapical Index. A root filling ending within 0.5-2 mm from the radiographic apex without lateral or apical voids was considered adequate. Data were analyzed in a generalized estimating equation (GEE) model with AP as dependent variable and gender, age, number of teeth, number of root filled teeth, tooth type, and root filling quality as independent variables.

RESULTS

Teeth with technically inadequate root fillings were associated with AP in a simple GEE-analysis. In the multiple GEE-model, the association between technical quality and apical peridontitis was nonsignificant when controlling for tooth type and gender.

CONCLUSIONS

The quality of root canal fillings is poor and the prevalence of AP in root canal filled teeth is high, particularly in molar teeth, in a Swedish population.

Prevalence of apical periodontitis in endodontically-treated maxillary and mandibular posterior teeth in a Saudi Arabian population: a cone-beam computed tomography study

OBJECTIVE

The aim of this retrospective study was to assess the prevalence of apical periodontitis (AP) in root canal-treated maxillary and mandibular posterior teeth in a Saudi Arabian population based on findings from images taken using cone-beam computed tomography (CBCT).

METHODS

The sample included 300 CBCT images from patients (150 females and 150 males) aged between 18 and 80 years old and they were analyzed to detect AP in endodontically treated maxillary and mandibular premolars and molars. Also, the correlation between the prevalence of AP and gender along with location (right/left side of jaw) were analyzed. Periapical lesions were defined as lamina dura gaps appearing disrupted around the width of periodontal ligament and apex at the apical third of the roots.

RESULTS

There was higher prevalence of AP in maxillary (19.1%) when compared to mandibular posterior teeth (17.3%). Mandibular first and maxillary second molars were the most affected teeth with AP (P = 0.05 and P = 0.04, respectively). Also, there was higher prevalence of AP cases with a predilection toward males (Maxillary P = 0.005; Mandibular P = 0.00) and on the right side of the mandibular jaw (P = 0.03).

CONCLUSION

In this study, the prevalence of AP had a significant association between gender with a predilection in males and location with a tendency to occur on the mandibular right side as observed in endodontically treated maxillary and mandibular posterior teeth using CBCT.

Pattern of Endodontic Lesions of Maxillary and Mandibular Posterior Teeth: A Cone-Beam Computed Tomography Study

The pattern of expansion of endodontic lesions in the jaws has been less commonly addressed in the literature. For this reason, the aim of this study is to assess the pattern of endodontic lesions of maxillary and mandibular posterior teeth using cone-beam computed tomography (CBCT). This cross-sectional study was conducted on 317 endodontic lesions of posterior teeth on CBCT scans retrieved from a radiology center in Qazvin, Iran, from 2020 to 2022. Endodontic lesions were assessed on sagittal, coronal, and axial sections by an endodontist and dental student using the Romexis software. The largest lesion diameter was measured occluso-apically, mesiodistally, and buccolingually. Lesion size was analyzed based on age, gender, jaw, tooth type, and presence/absence of root filling by independent samples t-tests and a one-way Analysis Of Variannce (ANOVA). The largest diameter of lesions in the maxilla and mandible was recorded in the occluso-apical dimension followed by buccolingual and mesiodistal dimensions (p > 0.05). The pattern of lesions was the same in teeth with and without endodontic treatment, but it was significantly different in maxillary and mandibular endodontically treated teeth in the occluso-apical and buccolingual dimensions (p < 0.05). No significant correlation was noted with tooth type or jaw except for maxillary and mandibular first molar lesions, which were significantly different in the occluso-apical dimension (p < 0.05). Lesion size in all three dimensions was significantly greater in males than females (p < 0.05), and was the highest in the occluso-apical dimension in both genders. In the maxilla, the mean lesion size significantly decreased in the mesiodistal dimension with age (p < 0.05). In conclusion, the largest lesion diameter in the maxilla and mandible was found in the occluso-apical dimension, indicating the role of bone density in the pattern of lesions.