Post-treatment apical periodontitis related to the technical quality of root fillings and restorations in Thai population

Apical periodontitis and associated factors in a rural population of southern Brazil: a multilevel analysis

OBJECTIVES

This study aims to evaluate the association between apical periodontitis (AP) and sociodemographic/clinical factors in a probability sample of individuals living in a rural area of southern Brazilian.

MATERIALS AND METHODS

A cross-sectional study was conducted involving 584 non-edentulous adult individuals who had undergone a full-mouth radiographic survey. Periapical status was analysed using the periapical index (PAI). Endodontic status was evaluated considering the occurrence of voids in the filling material and the root filling length. Crown status was classified based on the presence of caries, restorations, and prosthetic crowns. Sociodemographic variables, frequency of dental care, and periodontal disease were also registered. The data were analysed using hierarchical multilevel Poisson regression analysis. The multilevel structure was composed of three models: sociodemographic variables, clinical variables, and clinical variables adjusted by sociodemographic variables (α = 5%).

RESULTS

The prevalence of AP in the sample was 60.45%. AP was significantly associated with age, skin colour, schooling, periodontal disease, and frequency of dental care (P < 0.005). Among the 10,396 teeth evaluated, 868 (8.35%) had AP, which was significantly associated with tooth group, dental arch, crown status, and endodontic treatment (P < 0.005).

CONCLUSIONS

The prevalence of AP was high in the population studied. An older age, black/brown skin colour, low level of schooling, infrequent dental care, severe periodontal disease, mandibular teeth, posterior teeth, inadequate crown status, and having undergone endodontic treatment were significantly associated with the outcome. Clinical relevance This study about a rural probability sample reinforces that AP is still a recurrent oral health problem.

Impact of access cavity cleaning on the seal of postendodontic composite restorations in vitro

AIM

To investigate the influence of cavity cleaning and conditioning on marginal integrity of directly placed postendodontic composite class-I-restorations in vitro.

METHODOLOGY

168 fully intact teeth without caries or fillings received preendodontic composite restorations (class-II) after their extraction. Occlusal endodontic access-cavities were prepared, root-canals were instrumented and filled with guttapercha and an epoxy-resin based sealer. Prior to postendodontic class-I-restoration, access cavities were completely contaminated with sealer, cleaned with alcohol and pretreated as follows: Cleaner only (alcohol), glycine-polishing, Al₂ O₃ -sandblasting, carbide bur (immediate as well as delayed restoration). A positive control (not contaminated with sealer and adhesive used) and negative control (cleaner used but no adhesive) were established. Half of the teeth from each group were subjected to thermocycling and mechanical loading (TCML). Marginal integrity of postendodontic restoration was evaluated in oro-vestibular or mesio-distal sections after AgNO₃ -dye-penetration (DP) by standardized photomacroscopic imaging and expressed in percent of margin length along all segments and separately for enamel, dentine and composite, respectively. Results were analyzed non-parametrically (α=0.05).

RESULTS

No restorations or teeth fractured or debonded completely. Without TCML, the median DP of all segments was significantly higher for the negative control compared to all other groups in oro-vestibular cutting direction (53%; P=0.002) and in mesio-distal cutting direction (51%; P≤0.041). The other groups without TCML revealed 16-24% DP (oro-vestibular) and 12-24% DP (mesio-distal). With TCML, the median DP in oro-vestibular cutting direction for all segments ranged between 48-62% for all groups, a significant difference was only observed between glycine-polishing and carbide bur (P=0.041). In mesio-distal cutting direction, the median DP in negative control was 69% with TCML and significantly higher compared to all other groups (P=0.002). For all other groups, the median DP of all segments ranged between 28% and 40% with TCML without significant differences. Error rates method (k=7) revealed a significant influence of TCML in general on penetration of all segments in both, oro-vestibular and mesio-distal cutting directions.

CONCLUSION

Additional access cavity pretreatment after alcohol cleaning did not improve the marginal integrity of postendodontic composite restorations. Thorough cleaning of the access cavity with alcohol seems to assure an acceptable marginal integrity to the tooth and restorative composite.

Clinical and radiographic assessment of post-treatment endodontic disease by primary healthcare professionals: A hospital-based 1-year follow-up

Background:

The comprehensive healthcare approach including prophylactic guidance and motivation by the primary healthcare professionals towards oral and maxillofacial diseases such as post-treatment endodontic disease (PTED) plays a significant role in diagnosing and managing the condition. Especially in the developing countries like India where the hygiene practices are severely compromised, the primary healthcare professional plays an upfront role.

Objectives:

The present study was conducted to assess the clinical and radiographic characteristics of PTED by primary healthcare professional.

Materials and Methods:

The cross-sectional study was conducted in a dental hospital in Kutch, Gujarat, India. In the present study, out of a total of 755, 96 patients were diagnosed with PTED, met the inclusion criteria, and were enrolled for the study. After performing intraoral and extraoral examination, intraoral periapical radiographs were taken of the concerned teeth. Under dark room conditions, radiographs were examined using dentsply light box and magnifying glass by healthcare professionals.

Results:

Out of 755 patients, 96 (12.71%) patients were enrolled in the study with 98 concerned teeth. The most common teeth diagnosed with PTED were maxillary molars with 25.51% (21) individuals. Well-defined radiolucent lesions were seen in 62.24% (61) individuals. Voids in both coronal and apical region were seen in majority (38.77%) of patients. The length of root-end fillings with respect to the radiographic apex was satisfactory in 44.89% (44) individuals. The present study showed strong correlation between sinus formation and presence of periapical lesion with P value of 0.0219*.

Conclusion:

The proper guidance and preventive care by primary healthcare professionals leads to the relatively less prevalence of post-treatment endodontic disease in Indian population. The present study further suggests the higher substandard quality of root-end fillings of endodontically treated teeth.

Is Coronal Restoration a Predictor of Posttreatment Apical Periodontitis?

Objectives  To investigate the posttreatment apical periodontitis (AP) in endodontically treated teeth through a multivariate approach and to analyze the relative importance of quality and type of coronal restoration as predictors of periapical disease.

Materials and Methods  The present study sample was drawn within 2-year period from the 1,072 consecutive patients older than 18 years, first time attending the Dental Clinic of the Clinical Hospital Center Rijeka, Croatia. A total of 1,350 endodontically treated teeth were included in the study. For each tooth, the periapical status, root filling quality, intracanal post, separated file presence, marginal bone loss, and quality and type of coronal restoration were recorded.

Statistical Analysis  Chi-square tests were used to analyze the variations in the periapical status, quality of root canal filling, and quality of coronal restoration in different tooth types. The effect of explanatory variables on periapical status was explored using univariate and multivariate logistic regression models. The outcome variable was set as the presence versus absence of AP in the tooth.

Results  Multivariate logistic regression analysis revealed statistically significant associations and increased risk for AP presence in molars (odds ratio [OR] = 2.15; p  < 0.001), teeth positioned in mandible (OR = 1.49; p  = 0.007), teeth with short length of root filling (OR = 4.08; p  < 0.001), overfilled teeth (OR = 2.99; p  = 0.001), and teeth with inadequate density of root filling (OR = 4.14; p  < 0.001). Considering variables related to coronal restoration, neither coronal restoration type nor quality was found to be predictive for posttreatment AP. Merely, the presence of intracanal post significantly increased the odds of AP presence (OR = 1.57; p  = 0.009).

Conclusion  The results of the present study did not indicate that type or quality of coronal restoration may be predictors of posttreatment AP. Periapical disease was significantly associated with molars, mandibular teeth, substandard quality of root fillings, and intracanal post presence.

Effect of prosthetic restorations and root canal fillings on periapical health in a selected patient group

Aims To examine the effect of the quality of root canal fillings and prosthetic restorations on the frequency of apical periodontitis (AP).Methodology A total of 200 radiographs of 1,098 teeth with indirect restorations were selected. Each case was documented by age, sex, tooth location, tooth type, restoration type and presence of root canal treatment (RCT). Teeth were categorised as healthy or diseased considering periapical health. The quality of RCT and prosthetic restorations was categorised by radiographic and clinical examinations. Data were analysed using chi-squared test and logistic regression.Results Inadequate prosthetic restorations were found to be less healthy than the adequate ones. Statistical significance was found in teeth with RCT, which had a higher rate of AP (15.8%). Root-filled teeth categorised as inadequately treated (24.1%) were significantly unhealthier than the adequately root-filled teeth. Teeth with inadequate prosthetic restorations and RCT had an increase in AP risk of 6.41 and 20.74 times, respectively (p <0.05).Conclusions Results showed that AP risk was increased by both inadequate RCT and prosthetic restorations. Quality of RCT significantly affected periapical health more than the quality of prosthetic restorations. Not only radiographic but also clinical examination of restorations is required for successful evaluation.

Prevalence of Lateral Radiolucency, Apical Root Resorption and Periapical Lesions in Portuguese Patients: A CBCT Cross-Sectional Study with a Worldwide Overview

Objective:

Apical periodontitis develops when bacteria, or their by products, migrate from the infected root canal system space to the surrounding apical tissues. The objective of the present multi-center cross-sectional study was to analyze the prevalence of lateral radiolucency, apical root resorption and periapical lesions in 7 districts of Portugal using cone-beam computed tomographic (CBCT) assessment.

Methods:

A total of 1,249 CBCT scans, from 11 dental clinics, were screened. Data regarding 22,899 teeth was included. For each tooth the recorded data was the presence of lateral radiolucency, apical root resorption, periapical lesions, previous root canal treatment, missed root canals, length of root canal filling (short, good or overfilling) and type of coronal restoration (intact tooth, non-restored, filling or crown). Differences between districts were tested using chi-squared. A P<0.05 was considered significant.

Results:

The proportion of lateral radiolucency ranged between 0.0% (Aveiro, Braga and Coimbra) and 0.9% (Lisbon), while the prevalence of apical root resorption ranged from 0.0% (Braga and Coimbra) to 3.0% in Setubal. The nationwide proportion of lateral radiolucency was 0.4%, while for apical root resorption was 1.1%. The prevalence of periapical lesions varied from 4.1% (Braga) and 13.0% (Lisbon) with a nationwide proportion of 10.0%. Significant differences were noted between districts (P<0.05).

Conclusion:

The prevalence of lateral radiolucency and apical root resorption were low in all districts. Root canal filled teeth were associated with higher periapical lesions proportions than non-treated teeth. Independently of the assessed district, the periapical status may be influenced by both quality of the endodontic treatment and coronal restoration.

The global prevalence of apical periodontitis: a systematic review and meta-analysis

BACKGROUND

Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide.

OBJECTIVES

To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP.

METHODS

A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome.

RESULTS

The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I²  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I²  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I²  = 98.5%) and 3% (95% CI 2%-3%; I²  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I²  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I²  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I²  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I²  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I²  = 98.3%).

DISCUSSION

The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution.

CONCLUSIONS

Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

Successful management of a tooth with endodontic-periodontal lesion: A case report

BACKGROUND

Endodontic-periodontal lesion is a commonly encountered dental condition. However, the prognosis of the condition varies from good to poor. Some cases are associated with a poor prognosis that requires tooth extraction. This report presents a case of an endodontic-periodontal lesion in a tooth that was successfully treated by root canal treatment.

CASE SUMMARY

A 51-year-old female patient with no medical history complained about persistent pain and discomfort in her left mandibular first molar. Clinical examination showed the left mandibular first molar with poor restoration. It was also associated with underlying necrotic pulp and periodontal involvement. Radiographic examination revealed visible bone defects in the apical and periodontal areas. Based on the findings, the patient was diagnosed with a primary endodontic lesion. A root canal treatment for the endodontic lesion was performed. The patient received a coronal all-ceramic endocrown restoration. A follow-up was arranged to check the prognosis. At the 3 mo follow-up, the clinical and radiography evaluations showed complete disappearance of signs and symptoms and an increase in the radiopacity of the root area.

CONCLUSION

Despite the poor prognosis associated with many endodontic lesions, this case report highlights that a good prognosis is still possible for an endodontic lesion with apical and periodontal bone loss. In this case, it was achieved via successful root canal treatment without the need for periodontal or surgical intervention.

Effectiveness of a reciprocating single file, single cone endodontic treatment approach: a randomized controlled pragmatic clinical trial

OBJECTIVES

To compare the root filling quality, the sealer extrusion, and the healing rates of apical lesions addressed via two endodontic treatment approaches. The hypothesis tested was that both techniques present similar apical periodontitis healing results.

MATERIALS AND METHODS

This study was a parallel-design, pragmatic, and randomized clinical trial. One hundred twenty anterior teeth with necrotic pulps and apical periodontitis were randomly allocated to be either instrumented with hand files and obturated with the lateral compaction technique or instrumented with a single file in a reciprocating movement and obturated with a single-cone technique. The root canal filling quality, the occurrence of sealer extrusion, and apical periodontitis healing were the outcomes of interest. Data were analyzed through chi-square analysis, and the odds ratio for healing was adjusted using a logistic regression model (α = 0.05).

RESULTS

No significant differences were observed between the endodontic techniques regarding the root filling quality or sealer extrusion. Six months after treatment, both endodontic techniques presented equivalent results regarding apical periodontitis healing. The healing rate was affected only by the periapical status at baseline.

CONCLUSIONS

The obturation of the root canal of the anterior teeth using reciprocating file-matched single cones presented a similar quality to that obtained with manual instrumentation followed by the lateral condensation technique. Similar healing rates of apical lesions were also observed.

CLINICAL RELEVANCE

For treating anterior teeth with apical periodontitis, a reciprocating single-file, single-treatment protocol was as effective as a traditional protocol combining hand instrumentation and the lateral compaction obturation technique.