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.     

Periapical status and quality of root fillings and coronal restorations in an adult Spanish population

AIM: To investigate the quality of root fillings and coronal restorations and their association with periapical status in an adult Spanish population. METHODOLOGY: A total of 180 subjects, aged 37.1 +/- 15.7 years, who presented as new patients at the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all root filled teeth, excluding third molars, were examined. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. Radiographic signs of overhang or open margins associated with coronal restorations were also evaluated. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohen's kappa test and logistic regression. RESULTS: The total number of root filled teeth was 93, and 60 (64.5%) had apical periodontitis (AP). Presence of AP in root filled teeth was associated with inadequate adaptation of the filling (OR = 2.29; P = 0.06), inadequate length of the root filling (OR = 2.44; P = 0.048), and with poor radiographic quality of the coronal restoration (OR = 2.38; P = 0.054). Only 34.4% of the root fillings were adequate from a technical perspective. When both root fillings and coronal restorations were adequate the incidence of AP decreased to 31.3% (OR = 5.50; P < 0.01). CONCLUSIONS: The incidence of AP in root filled teeth was high. Many root fillings were technically unsatisfactory. Adequate root fillings and coronal restorations were associated with a lower incidence of AP; an adequate root filling had a more substantial impact on the outcome of treatment than the quality of the coronal restoration.     

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.     

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.     

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.     

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

The aim of this study was to investigate the post‐treatment apical periodontitis in endodontically treated teeth related to the technical quality of root fillings and restorations in Thai population. Full‐mouth periapical radiographs from Thai patients attending the Faculty of Dentistry, Mahidol University, Thailand were examined. The periapical status, quality of root fillings and coronal restorations, existence of intraradicular post and its relationship to the root fillings were evaluated. Among 1586 patients, 37.4% presented endodontically treated teeth. The total number of endodontically treated teeth was 1511, and 35% presented apical periodontitis. Combined data for root filling and coronal restoration qualities revealed significantly better outcome in teeth with adequate qualities of both parameters than the other combinations (P < 0.001). The prevalence of post‐treatment apical periodontitis among Thai population was relatively high and significantly associated with substandard technical quality of root fillings and restorations.     

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

Abstract – 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.     

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.     

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%.     

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.     

Periapical health related to the quality of coronal restorations and root fillings

AIMS: To evaluate the impact of the quality of coronal restorations scored on a clinical and radiographic basis and the quality of root fillings on periapical health. METHODOLOGY: Periapical radiographs were taken of 745 root-filled teeth, randomly selected from patients attending the Ghent University Dental School. The teeth had not received restorative treatment in the previous year. The coronal status was scored both clinically according to modified Ryge's criteria, and radiographically by evaluating the presence of signs of marginal leakage or decay. The quality of the root filling was scored according to criteria of length and homogeneity and the periapical status was categorized on the basis of presence or absence of radiographic signs of apical periodontitis. The relationship between coronal status, quality of root filling and periapical health was determined. The data were analyzed using Chi2 test, Odds ratio, Spearman's r(S) and logistic regression. RESULTS: Thirty-three percent of the teeth had apical periodontitis as diagnosed radiographically. Teeth with good and poor coronal restorations scored clinically had apical periodontitis in 31.1 and 36.8%, respectively; this difference was not statistically significant. The quality of the coronal restorations scored radiographically had a statistically significant influence on the periapical condition (P<0.001) with apical periodontitis in 23.8 and 49.1%, respectively, for acceptable and unacceptable restorations. Marginal decay did not influence the periapical status. Teeth restored without a base under the coronal filling had apical periodontitis in 41.3%, whereas teeth with a base had significantly less (P<0.005) apical periodontitis (25.9%). Composite-restored teeth exhibited apical periodontitis in 40.5% of cases whilst amalgam-restored teeth had apical periodontitis in 28.4% of cases; this difference was statistically significant (P<0.01). Root-canal posts had no influence on periapical health. The length and homogeneity of the root-canal fillings had a significant influence (P<0.01 and P<0.001, respectively) on the presence of apical periodontitis, as well as the quality of the coronal restoration scored radiographically (P<0.001). CONCLUSION: The importance of a good coronal restoration, as well as of a good root filling should be emphasized as the technical quality of both influencing the periapical status.     

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

Objective

This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation.

Material and Methods

The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test.

Results

The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth].

Conclusions

The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics.     

Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations

AIM: The prevalence of apical periodontitis (AP) and the quality of root fillings and restorations were determined in two Canadian populations differing in avail-ability of endodontists. METHODOLOGY: Radiographs of first-time university patients aged 25-40 years in Toronto and Saskatoon were examined for missing teeth, presence and standard of root fillings, standard of restoration, and AP according to the Periapical Index. Patients with root-filled teeth were invited for clinical examination and interview to inspect the restorations, and to reveal the providers of endodontic treatment and reasons for extractions of missing teeth. Chi-square and independent t-tests interpreted at the 5% significance level were used to examine associations between the prevalence of AP in root-filled teeth and the standard of the root filling, restoration, and providers of treatment. RESULTS: Proportion of patients with root-filled teeth was significantly higher (P < 0.001) in Toronto than in Saskatoon (39 and 26%, respectively). Presence of AP about root-filled teeth (44% in Toronto, 51% in Saskatoon) was significantly associated with poor density (OR = 2.7) short (OR = 2.4) and long (OR = 2.8) root fillings, and with poor radiographic quality of the restoration (OR = 1.7) Prevalence of AP did not differ significantly between teeth treated by generalists and endodontists. CONCLUSIONS: The prevalence of AP in root-filled and untreated teeth was comparable to that reported in previous methodologically compatible studies. The quality of both the root filling and the restoration were found to impact on the periapical health of root-filled teeth, with the impact of the restoration being most critical when the quality of the root filling was adequate.     

Radiographic evaluation of endodontic therapy and the influence of observer variation

Abstract – In radiographic evaluation of the results of endodontic therapy the development or persistence of periapical radiolucencies often serve as criteria for therapeutic failure. In the present study the influence of inter- and intraexaminer variation on these results was investigated. Three endodontists and three radiologists interpreted periapical conditions and quality of root filling seal in radiographs of 119 endodontically treated roots. Consensus on the pretence of periapical lesion was reached in 27% of cases classified as pathologic. In 6% reports of increased width of the periodontal membrane space accorded. The examiners agreed completely on normal periapical conditions in 37% of the cases. On assessing the quality of root filling seal the opinions of observers differed even more. Complete agreement on cases with adequate and defective seal was reached in 25% and 12%, respectively. For the individual examiner the widened periodontal membrane space was the diagnosis most difficult to reproduce. The present study indicates that the large variation noted among clinical and radiographic studies on the results of endodontic therapy could partly be explained by difficulties in defining and maintaining criteria for radiological evidence of periapical disease.     

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.     

Radiographic evaluation of endodontic therapy and the influence of observer variation

In radiographic evaluation of the results of endodontic therapy the development or persistence of periapical radiolucencies often serve as criteria for therapeutic failure. In the present study the influence of inter- and intraexaminer variation on these results was investigated. Three endodontists and three radiologists interpreted periapical conditions and quality of root filling seal in radiographs of 119 endodontically treated roots. Consensus on the presence of periapical lesion was reached in 27% of cases classified as pathologic. In 6% reports of increased width of the periodontal membrane space accorded. The examiners agreed completely on normal periapical conditions in 37% of the cases. On assessing the quality of root filling seal the opinions of observers differed even more. Complete agreement on cases with adequate and defective seal was reached in 25% and 12%, respectively. For the individual examiner the widened periodontal membrane space was the diagnosis most difficult to reproduce. The present study indicates that the large variation noted among clinical and radiographic studies on the results of endodontic therapy could partly be explained by difficulties in defining and maintaining criteria for radiological evidence of periapical disease.     

Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration

The purpose of this study was to evaluate the relationship of the quaality of the coronal restoration and of the rot canal obturation on the radiographic periapical status of endodontically treated teeth. Full-mouth radiographs from randomly selected new patient folders at Temple University Dental School were examined. The first 1010 endodontically treated teeth restored with a permanent rstoration were evaluated independtly by two examiners. Post and core type restorations were excluded. According to a predetermined radiographic standard set of criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the quality of the coronal restoration similarly good (GR) or poor (PR). The apical one-third of the root and surrounding structures were then evaluated radigraphically and the periradicular status categorized as (a) absence of periradicular inflammation (API) or (b) presence of periradicular inflammation (PPI). The rate of API for all endodontically treated teeth was 61.07%, GR resulted in significantly more API cases than GE, 80%, versus 75.7%. PR resulted in significantly more PPI cases than PE, 30.2% versus 48.6%. The combination of GR and GE had the highest API rate of 91.4%, significantly higher than PR and PE with a API rate of 18.1%.     

Endodontic surgery failure: SEM analysis of root-end filling

This study investigated the quality of root-end filling in cases of periapical lesions persisting after endodontic surgery. Ten patients requiring extraction of an endodontically treated tooth were included. The root-ends of extracted teeth were examined by scanning electron microscopy. Defects at the interface between the root-end filling and cavity margin were classified as ideal, imperfect (some marginal disruption) or inadequate (continuous marginal disruption involving >30% of the interface). Four cases were scored as imperfect, and six were scored as inadequate. A defective apical seal could favour continuous leakage of surviving bacteria and their by-products from the infected root canal system to periapical tissues, thereby sustaining inflammation.