Quality of root canal treatment performed by undergraduate dental students at the University of Khartoum, Sudan

The aim of the present study was to evaluate the quality of root canal treatment performed by undergraduate dental students at the University of Khartoum. Assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by undergraduate dental students. A total of 166 postoperative periapical radiographs compromising 265 roots were included. The quality of endodontic treatment was examined in relation to the length of the root filling in relation to the radiographic apex, the density of the obturation according to presence of voids and the taper of root canal fillings. Adequate length of the root filling was found in 34.7% of the maxillary teeth and in 10.9% of mandibular teeth in this study. Adequate density was found in 38.87% of maxillary and 16.98% of mandibular teeth and appropriate taper was found in 40% of maxillary and 16.6% of mandibular teeth. Overall 24.2% in all evaluated teeth were found to have a root filling of an acceptable quality. This result may be because of insufficient preclinical endodontic training of the students' operators or because of the introduction of students to endodontic clinical practice late in their program.     

Periapical status and prevalence of endodontic treatment in an adult Dutch population

This study examined the prevalence of endodontic treatment in a group of 184 Dutch adults, and determined the periapical status of all teeth using panoramic radiographs. The results indicate that in this group, 2.3% of the teeth were root-filled, and that 5.2% of all non-endodonticallv treated teeth showed signs of periapical pathology. Around the apices of 39.2% of the endodontically treated teeth in this survey, radiographic signs of periapical pathology were observed. Using the level of the root canal filling as a criterion for evaluating the quality of the root canal treatment, 50.6% of the endodontic treatments were qualified as inadequate. There was a significant correlation between the presence of periapical pathology and underfilling of the root canal(s). 44.6% of the patient sample had at least one tooth with radiographic signs of periapical pathology, indicating a substantial future need for endodontic treatment.     

Association between Endodontically Treated Maxillary and Mandibular Molars with Fused Roots and Periapical Lesions: A Cone-beam Computed Tomography Cross-sectional Study

IntroductionFused root variations of the root canal system increase the complexity of the inner root canal system anatomy. The aim of the present study was to determine, in in vivo conditions, the proportion of periapical lesions in association with endodontically treated maxillary and mandibular molars with fused roots presenting previous root canal treatment by assessing preexisting data via cone-beam computed tomographic volumes.MethodsA total of 1160 CBCT scans with an overall sample of 20,836 teeth were screened. A global count of 3701 maxillary molars and mandibular second molars were included in the study. The Cohen kappa test and interclass correlation coefficient tested the intra- and interrater reliability, respectively. The percentage of periapical lesions associated with molars with or without root fusion was determined. Proportions were expressed with 95% confidence intervals (CIs). The z test for proportions was used to analyze differences between subgroups, and an odds ratio was calculated in order to understand the association between periapical lesions and root configuration.ResultsFused molars presented a prevalence of periapical lesions in endodontically treated teeth of 74.0% (95% CI, 65.2%–82.8%), whereas nonfused molars had a proportion of periapical lesions in root canal–treated teeth of 69.5% (95% CI, 65.2%–73.8%; P > .05). Endodontically treated molars with fused roots presented with 1.3 higher odds of being associated with periapical lesions than endodontically treated molars with nonfused roots.ConclusionsA tendency of a higher proportion of periapical lesions was found in the fused rooted molars with a history of root canal treatment when compared with nonfused teeth; however, no statistically significant difference was noted.     

Periapical health related to the quality of root canal treatment in a Belgian population

AIM: The aim of this study was to collect data on the prevalence and technical standard of root canal treatment as well as the prevalence of apical periodontitis in Belgium. METHODOLOGY: The panoramic radiographs of 206 Belgian adults attending the Dental School of the University Hospital of Gent were examined for endodontic treatment, periapical conditions and coronal restorations. RESULTS: Of the 4617 teeth examined, 6.8% were endodontically treated. Periapical radiolucencies were found in 6.6% of all teeth and in 40.4% of the endodontically treated teeth. More than half of the root-filled teeth (56.7%) were scored inadequate on the basis of a criterion evaluating the level of the root canal filling. CONCLUSION: The endodontic treatment need of this Belgian subpopulation was great and the technical standard of root canal treatment disappointing. The findings indicate that there is still a substantial need for postgraduate endodontic education in Belgium and a need for specialists in endodontology.     

Prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults

The aim of this study was to assess the prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. A total of 1,372 periapical radiographs of endodontically treated teeth were analyzed based on the quality of root filling, status of coronal restoration and presence of posts associated with apical periodontitis (AP). Data were analyzed statistically using odds ratio, confidence intervals and chi-square test. The prevalence of AP with adequate endodontic treatment was low (16.5%). This percentage dropped to 12.1% in cases with adequate root filling and adequate coronal restoration. Teeth with adequate endodontic treatment and poor coronal restoration had an AP prevalence of 27.9%. AP increased to 71.7% in teeth with poor endodontic treatment associated with poor coronal restoration. When poor endodontic treatment was combined with adequate coronal restoration, AP prevalence was 61.8%. The prevalence of AP was low when associated with high technical quality of root canal treatment. Poor coronal restoration increased the risk of AP even when endodontic treatment was adequate (OR=2.80; 95%CI=1.87-4.22). The presence of intracanal posts had no influence on AP prevalence.     

偏移投照技术与显微治疗诊治遗漏根管的疗效分析

目的分析根管治疗术后偏移投照技术与显微根管治疗的应用对遗漏根管的发现与治疗的临床疗效。方法选择需行初次牙髓治疗的下颌前牙、下颌前磨牙、下颌第一、二磨牙及上颌第一、二磨牙共360颗(分别为49、68、62、50、85、46颗)。常规拍摄术前正位根尖片,并于根治后拍摄正位及20°～30°偏位根尖片,通过对比分析,对可疑遗漏根管的患牙,在显微镜下寻找及治疗遗漏根管。结果经显微治疗,360颗患牙中25颗(6.9%)确诊为遗漏根管,各牙位依次为3、5、5、4、6、2颗,其中23颗患牙发现并成功充填遗漏根管,2颗根管可找到但不完全通畅;正位发现8颗(2.2%),偏位发现23颗(6.4%),术后偏移投照发现率明显高于正位(P<0.05)。结论根治术后偏移投照技术与显微根管治疗对遗漏根管的发现与治疗有较大的帮助。     

The Influence of Missed Canals on the Prevalence of Periapical Lesions in Endodontically Treated Teeth: A Cross-sectional Study

IntroductionUntreated root canals may have a direct impact on the prognosis of root canal treatment. The objective of this cross-sectional study was to evaluate the association of missed canals with periapical lesions in endodontically treated teeth.MethodsOne thousand one hundred sixty preexisting cone-beam computed tomographic scans from 8 different health centers were assessed between January 2018 and December 2018 by 5 independently calibrated observers. Two thousand three hundred five endodontically treated teeth were identified in a sample of 20,836 teeth (27,046 roots). All endodontically treated teeth were evaluated for the presence or absence of missed root canals and periapical lesions. The z test for proportions was used to analyze differences between groups, and an odds ratio was calculated in order to analyze the association between missed canals and lesions. P < .05 was considered statistically significant.ResultsThe prevalence of missed canals was 12.0%, and teeth with untreated canals were associated with periapical pathology in 82.6% of the cases. The root presenting with the highest percentage of missed canals (62.8%) was the mesiobuccal root of the maxillary first molar, being associated with periapical lesions in 75.2% of cases. Maxillary molar mesiobuccal roots presenting with a missed canal were 3.1 times more likely to be associated with periapical pathology than maxillary molars with all canals identified and treated.ConclusionsThe association between untreated root canals and the presence of periapical lesions noted in the present study shows that missed canals have a significant impact on treatment prognosis.     

Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population

Abstract The objective of this study was to determine the periapical status and the quality of root canal fillings and to estimate the endodontic treatment needs in a German population. Clinical and radiographic data and the operative procedures performed were evaluated on 323 patients coming to a dental surgery in Stuttgart, Germany, in 1993. In 182 individuals at least one tooth exhibited a root canal filling, a necrotic pulp or an irreversible pulpitis. Out of the 7897 teeth examined, 215 (2.7%) had a root canal treatment (category A), 122 being nonendodontically treated (1.5%) did not respond to the sensitivity test (category B) and 53 (0.7%) were diagnosed as having irreversible inflamed pulp tissue (category C). The prevalence of teeth associated with radiographic signs of periapical pathosis was 61 % in the group of root canal filled teeth and 88% in the group of pulpless and non-endodontically treated teeth. Using the level and the density of the root canal filling as criteria for evaluating the technical standard, only 14% of the endodontic treatments of non-apicectomized teeth were qualified as adequate. The minimal endodontic treatment need is 2.3% related to all examined teeth when the root canal filled teeth with clinical symptoms of periapical periodontitis (category A) and those of categories B and C are included. The real endodontic treatment need is suggested to be larger when considering that the technical quality of the obturation is poor in most symptomless endodontically treated teeth associated with a periapical lesion. In the case of retreatment of these teeth, the endodontic treatment need would then be calculated at 3.7%.     

Prevalence of Apical Periodontitis in Root Canal–Treated Teeth From an Urban French Population: Influence of the Quality of Root Canal Fillings and Coronal Restorations

This cross-sectional study determined the prevalence of apical periodontitis in 1035 root canal–treated teeth from adult French patients and investigated the influence of the quality of canal fillings and coronal restorations on the periradicular status. Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periapical index scoring system. Overall, the prevalence of apical periodontitis in root canal–treated teeth was 33%. Only 19% of the teeth had endodontic treatments rated as adequate. The success rate (number of healthy teeth) for cases with adequate endodontic treatment was 91%, which was significantly higher when compared with teeth with inadequate treatment (61%). Teeth with adequate restorations had significantly decreased prevalence of apical periodontitis (29%) as compared with teeth with inadequate restorations (41%). The combination of adequate endodontic treatment and adequate restorations yielded the highest success rate (93.5%). The quality of the endodontic treatment was the most important factor for success, although the quality of the coronal restoration also influenced the treatment outcome.     

Periapical Status Related to the Quality of Coronal Restorations and Root Fillings in a Korean Population

Introduction

The purpose of this study was to assess the prevalence of apical periodontitis in root canal–treated teeth from the Korean population and to evaluate the relationship between the quality of root canal fillings and coronal restorations and the periapical status of these teeth.

Methods

Full-mouth periapical radiographs at the Dental Hospital of Yonsei University, Seoul, South Korea, were examined. A total of 1030 endodontically treated teeth restored with full veneer crown–type restorations were evaluated by 2 independent examiners. Teeth were classified as healthy or diseased according to the periapical status. The quality of endodontic treatment and coronal restorations were also classified via radiographic and clinical evaluation. The data were analyzed using the chi-square test and logistic regression.

Results

Forty-one percent of all endodontically treated teeth were classified as diseased. Approximately 35.6% of the teeth had endodontic treatments that were rated as adequate. The diseased teeth rate for cases with adequate endodontic treatment was 24.5%, which was significantly lower when compared with teeth with inadequate endodontic treatment (49.9%). The number of teeth with adequate coronal restorations was 706 (68.5%). Teeth with adequate coronal restorations had a significantly decreased prevalence of diseased teeth (34.7%) compared with teeth with inadequate coronal restorations (54.3%). Teeth with both adequate root fillings and restorations showed a significantly better outcome (82.3%) than the others, and teeth with both inadequate root fillings and restorations showed a significantly worse outcome (41.2%) than the others.

Conclusions

Data from this Korean population showed a relatively high prevalence of apical periodontitis. The quality of endodontic treatment and coronal restorations were of equal importance and were strong independent predictors of the periapical status.     

Incidence and distribution of root canal treatment in the dentition among a Jordanian sub population

AIM: To determine and compare the incidence of endodontically treated teeth in the maxilla and mandible, and to present the frequency of endodontic treatment for each tooth in the dentition in a group of the Jordanian population; then to compare these results with previously published surveys. METHOD: A total of 1,404 root canal treated teeth were examined clinically and radiographically. RESULTS: Most teeth were treated in a one visit procedure (40.1%). The results showed that 77.7% of the treated teeth were in the maxilla and 22.3% were in the mandible. Posterior teeth accounted for 39.0% of all treated teeth, among which, 20.3% were molars. The most frequently treated tooth was the maxillary central incisor tooth (39.6%), with the maxillary lateral incisor second (10.1%). Furthermore, the maxillary incisors alone accounted for almost half (49.7%) of the cases. The maxillary first molar was the third most frequently treated tooth (8.2%) with the mandibular first molar at 7.5%.The lowest frequency of treatment was for mandibular lateral incisors and canines which made up only 1.1% and 1.9% respectively. CONCLUSION: Comparison with previously published surveys revealed a lower percentage of molar endodontics than in other surveys.     

Prevalence and quality of endodontic treatment in an urban adult population in Norway

Abstract There are few studies on the prevalence of chronic apical periodontitis and endodontic treatment in society. In this study, the periapical status of a representative sample of 35-year-olds in Oslo, Norway was studied by analyses of orthopantomograms and intraoral radiographs. The study also included quality assessment of root fillings and a correlation between quality and periapical status. Of the 3917 teeth evaluated, 133 (3.4%) were endodontically treated and 54 (1.4%) presented a periapical pathosis. More than half of these were associated with root-filled teeth. Endodontic treatment was considered successful with normal periapical structures in 64% of the cases. However, only 41% of the root fillings were of optimal quality, terminating 1–2 mm from the radiographic apex. Based on a survey of orthopantomograms, it was estimated that 30% of the subjects investigated presented an endodontic treatment need. The prevalence of endodontic treatment among 35-year-olds was unchanged from 1973 to 1984.     

A radiographic study of the relationship between technical quality of coronoradicular posts and periapical status in a Jordanian population

A radiographic study was conducted to investigate the relationship between the technical quality of coronoradicular posts and periapical status. A total of 400 periapical radiographs, including 560 posts, of patients attending the Dental Department at Jordan University Hospital were scanned and studied. It was found that maxillary teeth were more frequently restored with posts (65.36%) than mandibular teeth (34.64%). Tapered posts accounted for 73.93% of the posts used. The ratio of the mean post length to crown length was 0.8, and that to root length was 0.45. The mean length of the remaining gutta percha apical to the end of the post was 6.22 mm. In addition, 25% of the posts deviated from the line of the root canal. Periapical radiolucency was evident in 53.93% of the assessed teeth. It is concluded that inadequate root canal treatment and coronoradicular posts are associated with increased prevalence of periapical radiolucency, and that general dental practitioners should be better trained in performing endodontic treatment and restoring endodontically treated teeth.     

Influence of coronal restorations on the periapical health of endodontically treated teeth

The purpose of the study was to evaluate a possible relationship between the quality of the coronal restoration, the root canal obturation and the periapical status of endodontically treated teeth. Full mouth series of radiographs from randomly selected patient charts at the Dental Faculty, University of Oslo were examined. A total of 1001 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. According to a predetermined set of radiographic criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the technical quality of the coronal restoration was scored as good (GR) or poor (PR). The root and the surrounding structures were then evaluated and according to the periradicular findings, the treatment was categorized as success or failure. The success rate for all endodontically treated teeth was 67.4% (n = 1001). Teeth with root canal posts had a success rate of 70.7% (n = 527) and teeth without posts had a success rate of 63.6% (n = 472). The two groups with technically good endodontics had the highest success rates. In combination with technically good restorations the success rate was 81% (GE + GR, 81%) and combined with technically poor restorations the success rate was 71% (GE + PR, 71%). The two groups with technically poor endodontics combined with either good restorations or poor restorations had significantly lower success rates (PE + GR, 56% and PE + PR, 57%). The technical quality of the endodontic treatment as judged radiographically was significantly more important than the technical quality of the coronal restoration when the periapical status of endodontically treated teeth was evaluated.     

Endodontic re‐treatment associated with the elimination of amalgam root‐end filling through sinus tracts: A report of two cases

Two patients presented with complaints of recurrent drainage of purulent exudate from sinus tracts, inflammation and pain after endodontic re‐treatment of the maxillary left (Case 1) and right (Case 2) lateral incisors. The periapical lesions persisted after apical curettage, apicectomy and root‐end filling with silver amalgam. Radiographic examination exposed the poor quality of the endodontic treatments and the silver amalgam root‐end fillings, which were associated with periapical radiolucent areas in both teeth. The sinus tract persisted after root canal cleaning and shaping, followed by a calcium hydroxide root canal dressing. The root‐end fillings were periapically dislodged with endodontic K‐files, and showed progressive displacement by sinus tracts up to elimination in the oral cavity. Follow ups of 42 and 65 months post procedure revealed clinical disappearance of the symptoms, sinus tracts and exudates, and radiographs revealed that the repair process of the periapical radiolucent areas was quite advanced.     

Prevalence and quality of endodontic treatment in an elderly urban population of Switzerland.

Little oral health data on the elderly are available in Switzerland. This study assessed endodontic findings in 66-yr-old residents of the city of Zurich using intraoral radiographs. Of the 143 volunteers having a total of 2004 natural teeth, 78% had at least one endodontically treated tooth. Twenty percent of all teeth were root filled, two thirds of them being in the upper jaw. Sixty-four percent of the root fillings were judged insufficient and 8.5% of all teeth showed periapical radiolucencies, most of the latter (73%) being associated with insufficient root canal treatments. Ninety-eight percent of the root-filled teeth had intracanal retentive devices. Fifty-two percent of the teeth with insufficient root fillings were judged not to need revision, 37% needed revision, 9% needed apicectomy, and 2% were ready for extraction. The considerable endodontic treatment needs of the elderly can only be reduced by an improvement of quality of initial endodontic treatment.     

Endodontic morphology. IV. A comparative study.

One hundred sixty-four extracted human teeth of all denominations were subjected to radiographic study after their canal systems were prepared with endodontic instruments and perfused with a water-soluble, radiopaque contrast medium. The same specimens had been studied prior to endodontic instrumentation by means of the same technique, and a comparison of the two sets of radiographs was made. Results of this comparative study were combined with information gained during the instrumentation procedures, and an analysis of the success rate for each group of specimens has been given. The over-all rate of success was high (92 per cent), being highest in the case of maxillary incisors and canines (100 per cent) and lowest in mandibular incisors and canines (81.8 per cent). The belief that the canals of molars present more difficulties than those of other teeth was not substantiated in this experiment, with the success rate for maxillary and mandibular molars being 92.1 per cent. Discussed were the potential for the packing of debris into the apical ends of root canals during instrumentation, the presence of residual traces of alloy within canals after canal preparation, and the known and unknown fracturing of endodontic instruments.     

Prevalence and quality of endodontic treatment in the Northern Manhattan elderly

Pulpitis results in significant morbidity among the elderly, particularly in underserved communities. We collected panoramic oral radiographs from 244 (mean age 67) participants of the Northern Manhattan Study, a prospective cohort study of stroke risk in a multiethnic urban population. Radiographs were evaluated for missing teeth, caries, restorations, periodontal bone loss, adequacy of endodontic treatment, and periapical radiolucencies. In the study 206 subjects were dentate (mean 17.1 teeth). 5.1% of teeth had periapical radiolucencies, and 4.8% had been endodontically treated; 37.5% of endodontically treated teeth had periapical radiolucencies. Teeth with restorations, periodontal bone loss, pulpotomy, and inadequate root canal filling had a significantly higher occurrence of periapical radiolucency (p < 0.05). Among all root filled teeth, only 26% were deemed satisfactory. We conclude that apical periodontitis is widely prevalent and the technical standard of root fillings is poor in this cohort. There is a substantial need for improved dental care among the northern Manhattan elderly.     

Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study

OBJECTIVES: This study compared the fracture strength and survival rate of endodontically treated crowned maxillary incisors with approximal class III cavities and different core build-ups. METHODS: Sixty-four caries free human maxillary central incisors were selected for standardized size and quality, endodontically treated and prepared with approximal cavities 3mm in diameter. Group 1 was restored with titanium posts, group 2 received zirconia posts, in group 3 the root canal was partially filled with a hybrid composite. In the control group, only the access opening was restored. All teeth were prepared for and restored with full cast metal alloy crowns and subsequently exposed to 1.2 million cycles in a computer-controlled chewing simulator with simultaneous thermocycling. In addition, the samples were loaded until fracture in a static testing device. RESULTS: One specimen with composite reinforced root canal did not survive the dynamic load test. The following median fracture strengths in Newtons for the different groups were: titanium post 1038, zirconia 1057, composite resin 750, control (no post) 1171. The fracture load in group 3 (composite resin) was significantly lower (P<0.05) than in the other groups. CONCLUSIONS: The reconstruction of endodontically treated single rooted teeth with approximal cavities can be successfully performed by closure of the endodontic and additional cavities with composite. Cementation of endodontic posts offers comparable but no advantageous fracture resistance. Enlargement of the root canal space after completion of endodontic treatment should be avoided and cannot be compensated for by injection of composite resin. Less catastrophic failures were observed without post reconstruction.     

2306个根管充填质量的X线影像学评估

目的:从X线影像学角度评估牙体牙髓科专科医师完成的成年人根管治疗的充填质量。方法:随机抽取2012~2013年东莞健力口腔医院牙体牙髓科的1600份病历,共计1050个病人的1391个进行根管治疗患牙的2306个根管纳入评估,每一根管充填的牙齿至少检查3张根尖X线片:术前片、试尖片和术后片。评估的指标为根管充填的长度、致密度和锥度。根管充填的长度依据根充物与影像学根尖的关系记录为恰充、欠充或超充。根管充填的致密度和锥度依据有无空隙和充填物的连续锥度记录为足够或欠缺。用卡方检验统计分析不同牙位、上下颌及不同弯曲度根管的充填质量。结果:根充长度、致密度和锥度的合格率分别为87.6%、69.8%和95.8%,只有57.8%的根管充填3项指标同时合格。根充的长度、致密度和锥度与根管弯曲度的关系有统计学显著性(P<0.001)。上颌牙根充合格率高于下颌牙(P<0.001);前牙的根充合格率高于后牙(P<0.001);直根管的根充合格率高于弯曲根管(P<0.001);上颌尖牙的根充合格率最高(78.8%)。结论:牙体牙髓科专科医师完成的成年人根管治疗根充质量合格率高于50%。