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%.     

A radiographic study of the prevalence of endodontically treated teeth and procedural errors of root canal filling.

The aim of this radiographic investigation was to study procedural errors encounterd in root canal treatment in a Jordanian population as evidenced using periapical radiographs A total of 2380 periapical radiographs including 3178 endodontically treated teeth were assessed in respect of the quality of endodontic treatment. The results indicated that the prevalence of endodontically treated teeth in the maxilla was higher than that in the mandible ( P < 0.001 ), the maxillary central incisors have the highest prevalence of endodontic treatment, and the maxillary second molars have the lowest prevalence of endodontic treatment. In respect of the quality of endodontic treatment, 30.2% of endodontically treated teeth exhibited an ideal length of root canal filling, 23.64% of the evaluated teeth were mummified, 37.45% of the teeth have short root canal fillings, 6.25% were overfilled, 1.35% were with preparations which deviated from the line of the root canal and 1.10% of the evaluated teeth have perforations of the root walls or the floor of the pulp chamber. It is concluded that the Maxillary teeth were found to be endodontically treated more frequently than the mandibular teeth, anterior teeth were found to be endodontically treated more than premolar and molar teeth, maxillary central incisors have the highest prevalence of endodontic treatment whilst the maxillary second molars have the lowest prevalence. The quality of endodontic treatment was disappointing. Therefore, emphasis on continuing education and post graduate courses in endodontics must be a priority in Jordan.     

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.     

Frequency and technical standard of endodontic treatment in a Swedish population

Abstract The purpose of this investigation was to study the frequency and technical standard of endodontic treatment in a Swedish population. The material consisted of full-mouth radio-graphic surveys from 200 patients treated by general practice dentists, and the radiographs were analyzed by two observers. Thirteen percent of the teeth had been endodontically treated. Periradicular radiolucencies were found in 5.2% of the teeth and 26.4% of the endodontically treated teeth had such periradicular radiolucencies. In nearly half of the root-filled teeth, the root filling ended more than 2 mm from the apex, and only 56.3% were judged to have a proper seal. It is concluded that the need for endodontic treatment is great and the technical standard of the root fillings is poor. This strongly indicates that there is a need for standardized endodontic treatment methods and for more specialists in endodontics in Sweden.     

A longitudinal study of changes in frequency and technical standard of endodontic treatment in a Swedish population

Abstract Longitudinal studies of endodontic treatment are rare. The purpose of this investigation was to study changes in frequency, technical standard and treatment need in a Swedish population with an interval of 5–7 years. The number of endodontically treated teeth in the population increased while the number of periradicular radiolucencies was at about the same level at the second examination. The number of radiolucencies found in endodontically treated teeth was reduced while it was increased in untreated teeth. The number of root fillings ending ≤2 mm from the apex of the tooth as well as fillings with a proper seal had increased at the second examination, but still only 40.2% ended ≤2 mm from the apex of the tooth and 59.1% of the root fillings were judged to have a proper seal. It was concluded that a great need for endodontic treatment existed in the population examined. A slight improvement in the quality of the treatment was evident at the second examination. However, the technical standard was still poor and obviously affected the outcome of the treatment. It is the opinion of the authors that endodontic treatment methods should be simplified as much as possible in an effort to improve the technical quality of the treatment. The prognosis of endodontic treatment would then improve as well.     

A longitudinal study of changes in frequency and technical standard of endodontic treatment in a Swedish population

Longitudinal studies of endodontic treatment are rare. The purpose of this investigation was to study changes in frequency, technical standard and treatment need in a Swedish population with an interval of 5-7 years. The number of endodontically treated teeth in the population increased while the number of periradicular radiolucencies was at about the same level at the second examination. The number of radiolucencies found in endodontically treated teeth was reduced while it was increased in untreated teeth. The number of root fillings ending less than or equal to 2 mm from the apex of the tooth as well as fillings with a proper seal had increased at the second examination, but still only 40.2% ended less than or equal to 2 mm from the apex of the tooth and 59.1% of the root fillings were judged to have a proper seal. It was concluded that a great need for endodontic treatment existed in the population examined. A slight improvement in the quality of the treatment was evident at the second examination. However, the technical standard was still poor and obviously affected the outcome of the treatment. It is the opinion of the authors that endodontic treatment methods should be simplified as much as possible in an effort to improve the technical quality of the treatment. The prognosis of endodontic treatment would then improve as well.     

Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population

A random sample of 967 subjects selected from the total population in a Swedish county were examined radiographically regarding prevalence and quality of endodontic treatment and occurrence of periapical lesions. The relationship between the technical standard of endodontic treatment and the occurrence of periapical lesions was also analyzed. Of the selected individuals, 95% attended examination (751 dentate and 169 edentulous individuals). Of the 17,430 teeth examined, 1,492 (8.6%) were endodontically treated. Approximately 70% of the treated root canals were inadequately obturated; 10% showed excess of root filling beyond the apex. The prevalence of periapical lesions was 2.9%, and 24.5% of the endodontically treated roots demonstrated periapical lesions. Root fillings ending more than 2 mm from apex had a significantly lower frequency of periapical lesions than root fillings ending within 2 mm of the apex. No difference in the frequency of periapical lesions was found between properly and improperly obturated root canals. Excess of root filling material beyond the apex was related to a significantly higher frequency of periapical lesions.     

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.     

Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population

Abstract A random sample of 967 subjects selected from the total population in a Swedish county were examined radiographically regarding prevalence and quality of endodontic treatment and occurrence of periapical lesions. The relationship between the technical standard of endodontic treatment and the occurrence of periapical lesions was also analyzed. Of the selected individuals, 95% attended examination (751 dentate and 169 edentulous individuals). Of the 17,430 teeth examined, 1,492 (8.6%) were endodontically treated. Approximately 70% of the treated root canals were inadequately obturated; 10% showed excess of root filling beyond the apex. The prevalence of periapical lesions was 2.9%, and 24.5% of the endodontically treated roots demonstrated periapical lesions. Root fillings ending more than 2 mm from apex had a significantly lower frequency of periapical lesions than root fillings ending within 2 mm of the apex. No difference in the frequency of periapical lesions was found between properly and improperly obturated root canals. Excess of root filling material beyond the apex was related to a significantly higher frequency of periapical lesions.     

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.     

A 20-year follow-up study of endodontic variables and apical status in a Swedish population

AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. RESULTS: The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings. CONCLUSIONS: There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.     

Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan

OBJECTIVES: The objective of this study was to evaluate radiographically the technical standard of root canal treatment performed by undergraduate dental students at the Dental Teaching Center in Jordan. METHODS: A random sample of 8500 records of dental patients was examined. A total of 542 endodontically treated teeth with 912 roots were evaluated. Periapical radiographs were used to assess the technical quality of the root canal filling. The length of each root canal filling was categorized as acceptable, short and overfilled based on their relationship with the radiographic apex. Density and taper of filling was evaluated based on the presence of voids and the uniform tapering of the filling, respectively. Chi-square analysis was used to determine statistically significant differences between adequacy of root canal filling in each group of teeth according to its location, position and curvature. RESULTS: Sixty-one percent of roots had fillings of acceptable length, while 34.5% were short and 4.2% were overfilled. The root canal fillings of 47.4% were found to be adequate. Adequate fillings were found more in maxillary than mandibular teeth (P < 0.005), anterior compared to posterior teeth (P < 0.05) and in straight canals compared to curved canals (P < 0.001). CONCLUSION: The technical quality of root canal treatment performed by undergraduate dental students using step-back preparation and lateral condensation was found to be less than 50%. Review of the endodontic curriculum requirements, specialized clinical supervision and increasing the time of training at the preclinical and clinical levels should improve this quality.     

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.     

Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population

AIM: The aim of this study was to investigate the prevalence of endodontically treated teeth and apical periodontitis (AP) in a Danish population. METHODOLOGY: From Aarhus County 614 individuals were radiographically examined, and the frequency of endodontic treatment and periapical status of all teeth were assessed. The year of birth of the subjects ranged from 1935 to 1975. The chi-squared test was used to determine the significance of differences between males and females and amongst age and tooth groups for the following parameters: AP, the number of endodontically treated teeth, and the number of endodontically treated teeth with AP. RESULTS: A total of 15 984 teeth were examined; of these 538 (3.4%) had AP and 773 (4.8%) had been endodontically treated. Of the endodontically treated teeth, 404 (52.2%) had AP. Females had more endodontically treated teeth than males; otherwise, no effect of gender was observed. Significantly more molars (P < 0.01) had been endodontically treated (8.1%) compared to premolars (5.4%) and anterior teeth (2.5%). The prevalence of AP in connection with molars was significantly (P < 0.01) higher (7.0%) than premolars (2.8%) and anterior teeth (1.5%). The prevalence of endodontically treated teeth and of teeth with AP gradually increased with age. CONCLUSIONS: The average number of teeth, the number of teeth with AP and the number of teeth with endodontic treatment in Danish adults were comparable to findings in other European countries. The frequency of endodontically treated teeth with AP was found to be high compared to that demonstrated in other epidemiological studies.     

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.     

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.     

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.     

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

IntroductionThis 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.MethodsAn 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.ResultsSixteen 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.ConclusionsThere 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.     

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.     

Bone level around endodontically treated teeth in periodontitis patients

Objectives: This retrospective study compared the marginal bone level of teeth with root canal fillings with contra‐lateral teeth without. Methods: Of 286 consecutive patients (35 years), referred to practice for periodontology in the Netherlands, 67 full sets of radiographs contained 1 endodontically treated tooth and its contra‐lateral tooth without root canal treatment. Bone level at the mesial and distal of these teeth was scored from the CEJ. In multi‐rooted teeth, the presence of interradicular radiolucency was assessed. The presence of posts, and periapical radiolucencies was assessed. Analysis for differences between treated teeth and contra‐laterals was controlled for tooth surface, presence of a post and tooth type. Results: The mean distance from the root filling to the apex was 2.6 mm. Periapical radiolucencies were found in 14%. The mean bone level was at 4.3 mm for endodontically treated teeth and at 3.7 mm for contra‐laterals. Significantly more bone loss (0.6 mm) was found at the endodontically treated teeth. No difference was found between mesial and distal, teeth without and with posts and different tooth types. The presence of interradicular radiolucency was more frequent in endodontically treated teeth (OR 2.1, p_{(McNemar test)}=0.039). Conclusion: In periodontitis patients, teeth with endodontic treatment had more bone loss as compared with untreated contralaterals.