Relationship between quality of root canal obturation and periapical lesion in elderly patients: a systematic review

A literature review of local and systemic considerations for endodontic treatments in older adults

OBJECTIVES

The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines.

BACKGROUND

Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age-related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable.

METHODS

PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand-seached for additional relevant publications between 2005-2020. A combination of these terms was performed uing Boolean operators and MeSH terms.

RESULTS

Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta-analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies.

CONCLUSIONS

The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment.

Prevalence of Apical Periodontitis and Conventional Nonsurgical Root Canal Treatment in General Adult Population: An Updated Systematic Review and Meta-analysis of Cross-sectional Studies Published between 2012 and 2020

INTRODUCTION

This study aimed to summarize data on apical periodontitis (AP) and nonsurgical root canal treatment (NSRCT) prevalence and risk factors related to age, gender, and quality of restorative and endodontic treatment in the general population from cross-sectional studies published between 2012 and 2020.

METHODS

An electronic search was performed in the following databases: Web of Science, Scopus, and PubMed. The conducted literature search covered studies published between 2012 and 2020, without restrictions on language. The STROBE and NOS tools were used for quality assessment of the included studies.

RESULTS

Sixteen articles were included in the review. In total, 200,041 teeth were examined. On average, 6.3% of teeth had AP, and 7.4% had NSRCT. Forty-one percent of RCT teeth had AP, and 3.5% of untreated teeth had AP. Female patients were less prone to AP in endodontically treated teeth only, compared with male patients (P < .001). Variable stratification of age subgroups among included studies prevented us from conducting a meta-analysis. An increase in AP frequency was found in teeth with inadequate restorative and endodontic treatment (P < .001 and P < .001, respectively). Because of high heterogeneity, these results should be taken with caution.

CONCLUSIONS

There is an increased AP prevalence in the adult general population compared with data from 2012 (6.3% versus 5.4%) in both endodontically treated (41.3% versus 35.9%) and untreated teeth (3.5% versus 2.1%). In addition, AP developed less frequently in female patients with endodontically treated teeth and in teeth with inadequate compared with adequate restorative and endodontic treatment.

Periapical Status and Quality of Root Canal Fillings in a Moroccan Subpopulation

AIM

The aim of the study was to assess the prevalence of apical periodontitis (AP) and quality of root canal fillings in an adult Moroccan subpopulation.

METHODS

In the study 508 patients were included, attending the Conservative Dentistry Clinic at the Faculty of Dentistry of Casablanca. 508 panoramic and 709 periapical radiographs were observed. The periapical status of all teeth (with the exception of third molars) was examined according to Ørstavik's periapical index. The statistical analysis was performed with the software Epi Info Version 6.04dfr, April 2001.

RESULTS

A total of 12719 teeth were examined. 45.3% of patients had apical periodontitis. 4.2% of teeth were treated endodontically and 70.4% of these treatments were inadequate. 91,5% with inadequate endodontic treatment presented apical periodontitis, while only 8,2% with adequate endodontic treatment had apical periodontitis. The lower molars and the upper premolars were the most affected teeth. The presence of apical periodontitis was correlated significantly with insufficient root canal fillings (p < 0.05).

CONCLUSIONS

The present study found a high prevalence of apical periodontitis in this Moroccan population. Inadequate root canal fillings were associated with an increased prevalence of apical periodontitis.

Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up

OBJECTIVE

Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics.

BACKGROUND

Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population.

MATERIALS AND METHODS

Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured.

RESULTS

All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min.

CONCLUSION

Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.