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 quality of root fillings and coronal restorations in a Danish population

AIM: The aim of this study was to investigate the quality of endodontic and coronal restorations and the association with periapical status in a Danish population. METHODOLOGY: A total of 614 randomly selected individuals (20-60+ years of age) from Aarhus County had a full-mouth radiographic examination. The quality of endodontic and coronal restorations and the periapical status of endodontically treated teeth were assessed by radiographic criteria. Root fillings were categorized as 'adequate' or 'inadequate' with regard to root filling length and lateral seal. Coronal restorations were categorized into 'adequate' and 'inadequate', defined by the absence or presence of radiographic signs of overhangs or open margins. Results were analysed statistically using the chi-squared test. RESULTS: The total number of endodontically treated teeth was 773, and 52.3% had apical periodontitis (AP). Root-filled teeth with an adequate lateral seal had a lower incidence of AP than teeth with an inadequate seal (44.3% vs. 57.8%), and teeth with an adequate root filling length were associated with a better periapical status than teeth with inadequate length of the root filling (42.0% vs. 67.6%). Similarly, adequate coronal restorations were associated with better periapical status than inadequate restorations (48.0% vs. 63.9%). When both root filling and coronal restoration quality were assessed, the incidence of AP ranged from 31.2% (optimal quality) to 78.3% (all parameters scored as inadequate). CONCLUSIONS: Inadequate root canal and coronal restorations were associated with an increased incidence of AP.     

The influence of endodontic infection on progression of marginal bone loss in periodontitis

Abstract The purpose of the present investigation was to determine magnitude and rate of proximal radiographic attachment loss in relation to endodontic infection in periodontally involved teeth. The investigation was conducted as a retrospective longitudinal study on a periodontitis-prone randomly selected referral population, including 175 single-rooted, root-filled teeth in 133 patients. An observation period of at least 3 years was required. Periapical conditions of the selected sample at baseline and re-examination were evaluated on radiographs, independently by 3 investigators. Each single-rooted, root-filled tooth of the sample was given a score according to the combined registrations. Radio-graphic attachment level was measured as the distance between the most coronal point of the alveolar bone and the apex at the mesial and distal sides of the tooth, and expressed as relative radiographic attachment level (RRAL) (radio-graphic attachment level at baseline/root length) at proximal sites for every tooth. Multiple regression analysis was used to study change in RRAL over time. Teeth in periodontitis-prone patients with progressing periapical pathology indicating a continuous root canal infection were found to lose comparatively more radiographic attachment than teeth with no signs of periapical pathology or teeth with an established periapical destruction which subsided during the observation period. An approximate 3-fold amplification of the rate of marginal proximal radiographic bone loss by endodontic infection in periodontitis-prone patients was found with an average 0.19 mm/year, while 0.06 mm/year was lost for teeth without endodontic infection or subsiding endodontic involvement.     

CBCT在根管治疗后疾病诊治中的临床应用研究

目的：评估CBCT影像系统在根管治疗后疾病诊治中的应用。方法：对41颗完成根管治疗的牙齿进行回访,拍摄X线片,进行CBCT扫描重建,对比研究患牙根管治疗前以及回访时病变区域的变化,了解根管治疗后疾病的发生情况,评价根管治疗效果和预后。结果：17例临床术前诊断为根尖周病的病例在CBCT上均可见根尖周组织存在破坏,而X线上仅8例可见根尖区存在破坏。回访病例中根据X线片和CBCT影像诊断为根管治疗后疾病分别为17.03%和39.02%（P〈0.05）。结论：CBCT有利于评估根管治疗程序的可靠性,对根管治疗后疾病诊断及再治疗方案的选择具有重要的临床参考价值,值得在牙髓病诊治中推广应用。     

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 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.     

Factors affecting the long-term results of endodontic treatment

The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The rate of success for cases with vital or nonvital pulps but having no periapical radiolucency exceeded 96%, whereas only 86% of the cases with pulp necrosis and periapical radiolucency showed apical healing. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. Of all of the periapical lesions present on previously root-filled teeth, only 62% healed after retreatment. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment.     

Regenerative Endodontic Procedures in Necrotic Mature Teeth with Periapical Radiolucencies: A Preliminary Randomized Clinical Study

IntroductionThis preliminary study compared clinical and radiographic outcomes of regenerative endodontic procedures (REPs) with that of conventional root canal treatment (CRCT) in necrotic mature teeth with periapical radiolucencies.MethodsFifty-six mature necrotic teeth with large periapical radiolucencies were distributed into 2 groups: group 1, REPs and group 2, CRCT (n = 28/group). Clinical and radiographic follow-up assessments were undertaken up to 12 months. Statistical analysis was performed using the independent samples t test and the chi-square test, and the level of significance was set at P = .05.ResultsWith a follow-up rate of about 73.4% of the total patients for 12 months, favorable clinical and radiographic outcomes were found in 92.3% and 80% in REPs and CRCT groups, respectively, and the difference was not statistically significant (P > .05). Half of the teeth treated with REPs responded to the electric pulp test.ConclusionsRegenerative endodontic procedures have the potential to be used as a treatment option for mature teeth with large periapical radiolucencies.     

Surgical extrusion of crown-root-fractured teeth: a clinical review

AIM: In this clinical study combined surgical and endodontic treatment was performed in 20 cases of crown-root fracture and the outcomes reviewed. METHODOLOGY: Surgical treatment involved a conventional extraction and stabilization technique. Root canal treatment using calcium hydroxide was performed. Before root canal obturation, a calcium hydroxide dressing was maintained for 3 months. RESULTS: Follow-up examinations, which varied between 6 and 36 (mean 14.5) months, showed that there were no radiographic and clinical signs of progressive root resorption, marginal bone loss or periapical disease in all except one case. CONCLUSIONS: The favourable results of this study demonstrate that surgical extrusion in teeth with crown-root fractures may be an alternative treatment to orthodontic extrusion.     

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.     

Cytotoxicity, histopathological, microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric dentistry: a review

This review aims at describing and comparing materials commonly used in root canal therapy, the cytotoxicity, histopathological, microbiological and clinical aspects ofa iodoform-based paste (Guedes-Pinto Paste-GPP) used in endodontic treatment of primary teeth. GPP has shown excellent biocompatibility to pulp fibroblasts and mild inflammatory reactions, having been well-tolerated by the periapical and connective tissues. Moreover, GPP bactericidal and bacteriostatic effects against many oral microorganisms were also demonstrated. Regarding clinical trials, the GPP technique has achieved success rates when considering clinical and radiographic examinations. In the face of all the above mentioned results, this paper would like to propose the use of this endodontic material as a root canal filling for primary teeth.     

Cross-sectional evaluation of the periapical status and quality of root canal treatment in a selected population of urban Turkish adults

AIM: To investigate the prevalence of apical periodontitis and the quality of root canal treatment in an adult Turkish population who visited a university dental clinic. SUMMARY: The periapical status of 8863 teeth belonging to 375 patients was evaluated by two pre-calibrated observers from panoramic radiographs. The presence of apical periodontitis, and the prevalence and quality of root fillings were recorded. The relationship between the radiographic quality of root fillings and apical periodontitis was examined by chi-squared statistical-analysis. Of 8863 teeth, 470 (5.3%) had undergone root canal treatment. Forty-seven per cent of all the subjects had at least one root-filled tooth. Periapical radiolucencies were visible on 4.2% of teeth examined, with 53.5% of root-filled teeth presenting apical periodontitis. Ninety-one per cent of root-filled teeth with periapical pathosis were determined to have inadequate root fillings. A statistically significant correlation was found between the quality of root fillings and the presence of apical periodontitis (P < 0.05). KEY LEARNING POINTS: The radiographic quality of root fillings correlated with periapical radiographic signs of pathosis in a selected population of Turkish adults. There is a need to improve the standards of root canal treatment in the study population.     

Prevalence and quality of root canal fillings in a German adult population

The few studies in which prevalence, technical quality, and success rates of root canal fillings performed in daily practice have been assessed demonstrated a high proportion of inappropriate root fillings and a great variety of periapical radiolucencies (25–60%). The aim of the present retrospective radiographic study was to determine if changes in prevalence, technical quality, and success of root canal fillings had occurred within a decade. To achieve this goal, orthopantomograms taken in patients who attended a University Dental Clinic for the first time in 1983 (group A) and in 1992 (group B) were evaluated by a calibrated examiner. The following criteria were applied to assess the root-filled teeth: length and homogeneity of the root fillings and the periapical state. The prevalence of root-filled teeth increased significantly from an average 0.5 per person in 1983 to 0.8 per person in 1992. The increase was proportionally greater in older patients. In group A, 55.2% of the root fillings ended 0–2 mm before the radiographic apex and in group B this percentage was 56.8. Insufficient homogeneity was found in 25.0% (group A) and 21.9% (group B) of the root fillings. The prevalence of root-filled teeth without periapical destructions was 76.1% (group A) and 74.1% (group B). It is concluded that, in the future, endodontic treatment need will increase because of the steadily growing number of older people. Further efforts in research and dental education should focus on the treatment of curved root canals. Received: 5 May 1997 / Accepted: 30 March 1998     

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.     

下颌前磨牙变异根管的显微临床诊治

目的用根管显微技术对根管治疗失败的下颌前磨牙进行再处理。方法收集下颌前磨牙可疑因根管变异导致根管治疗失败的病例38例共41颗牙,其中下颌第一前磨牙19颗。利用根管显微镜对每颗患牙进行根管变异的诊断,并在镜下对各根管进行镍钛机动预备、热牙胶垂直加压充填。根管治疗术后定期复查2年。结果初次治疗时诊断为单根管的35颗患牙,在根管显微镜下无一例为单根管,28颗为双根管,7颗为三根管;初次治疗时诊断为双根管的6颗患牙,有2颗为双根管,4颗为三根管,即41颗再处理患牙有30颗(73.17%)为双根管,有11颗为三根管(26.83%),根管遗漏率达95.12%(39/41)。除一例再处理的患牙在寻找根管的过程中出现侧穿需要MTA修补外,其余患牙均能进行根管定位和完成根管治疗。经复查无一例患牙出现治疗失败。结论根管显微技术能提高对变异根管的识别率,为提高根管再处理成功率提供保障。     

Healing Kinetics of Periapical Lesions Enhanced by the Apexum Procedure: A Clinical Trial

The new Apexum procedure (Apexum Ltd, Or-Yehuda, Israel) is based on a minimally invasive removal of periapical chronically inflamed tissues through a root canal access. Its goal is to enhance healing kinetics of periapical lesions. This clinical study was conducted to explore the safety and efficacy of this procedure. The Apexum procedure was applied, as a supplementary step, during conventional root canal treatment in 48 teeth with periapical lesions. Safety and efficacy were clinically and radiographically assessed and teeth of the Apexum-treated group were compared with 39 similar teeth treated by the same endodontic procedure with no additional intervention. No adverse events occurred in either the Apexum-treated or conventional treatment groups. Furthermore, healing kinetics was significantly enhanced in the Apexum-treated group (p < 0.005). At 3 and 6 months, 87% and 95% of the lesions in the Apexum-treated group, respectively, presented advanced or complete healing, whereas only 22% and 39% of the lesions in the conventional treatment group presented this degree of healing at 3 and 6 months, respectively.     

Comparison of success of implants versus endodontically treated teeth

Implants verses root canal therapy is a current controversy in dentistry. The purpose of this investigation was to compare the success of each treatment, with minimal subjective grading. Outcome was determined by clinical chart notes and radiographs. Failure was defined as removal of the implant or tooth. Uncertain findings for implants were defined as mobility class I or greater, radiographic signs of bone loss, or an additional surgical procedure. Mobility, periapical index score of 3 or greater, or the need for apical surgery was classified as uncertain for endodontically treated teeth. Success was recorded if the implant or tooth was in place and functional. Implants were placed by periodontists in a group practice, whereas the endodontic treatments were performed by endodontists in group practice. Charts of 129 implants meeting inclusion criteria showed follow-up of an average of 36 months (range, 15-57 months), with a success rate of 98.4%. One hundred forty-three endodontically treated teeth were followed for an average of 22 months (range, 18-59 months), with a success rate of 99.3%. No statistically significant differences were found (P = .56). When uncertain findings were added to the failures, implant success dropped to 87.6%, and endodontic success declined to 90.2%. This difference was not statistically significant (P = .61). We found that 12.4% of implants required interventions, whereas 1.3% of endodontically treated teeth required interventions, which was statistically significant (P = .0003). The success of implant and endodontically treated teeth was essentially identical, but implants required more postoperative treatments to maintain them.     

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.     

Nonsurgical Endodontic Treatment of Necrotic Teeth Resolved Apical Lesions on Adjacent Implants with Retrograde/Apical Peri-implantitis: A Case Series with 2-year Follow-up

Retrograde (or apical/periapical) peri-implantitis (RPI) presents with radiographic signs of bone loss at the periapical area of endosteal implants and may also present with clinical signs of abscess formation or a sinus tract traceable to the implant periapex. The lesion may form days up to several years after the initial implant placement. In contrast to marginal peri-implantitis, which has a prevalence of 19.83%, RPI may be underreported because many clinicians are currently not aware of this type of lesion. The etiology, although not fully understood, may be attributed to endodontic infection of an adjacent tooth or residual microorganisms present after the extraction of an infected tooth at the implant site. There are several treatment modalities available for the management of RPI. Nonsurgical root canal treatment may be an option if the implant RPI etiology is suspected to be related to an adjacent endodontically involved tooth. In a previous report, surgical treatment modalities to correct RPI were described. This current case series presents 2 cases of RPI in which nonsurgical treatment of the necrotic adjacent teeth resulted in full radiographic and clinical resolution of the adjacent apical peri-implant lesions with 18-month and 2-year follow-ups, respectively. RPI may be prevented by evaluating the endodontic status of natural teeth adjacent to the implants and by addressing endodontic infections near the implant sites. Certain types of implant RPI may successfully be resolved nonsurgically by addressing adjacent endodontic infections as shown by this case series.