Abstract
Objectives To investigate the posttreatment apical periodontitis (AP) in endodontically treated teeth through a multivariate approach and to analyze the relative importance of quality and type of coronal restoration as predictors of periapical disease. Materials and Methods The present study sample was drawn within 2-year period from the 1,072 consecutive patients older than 18 years, first time attending the Dental Clinic of the Clinical Hospital Center Rijeka, Croatia. A total of 1,350 endodontically treated teeth were included in the study. For each tooth, the periapical status, root filling quality, intracanal post, separated file presence, marginal bone loss, and quality and type of coronal restoration were recorded. Statistical Analysis Chi-square tests were used to analyze the variations in the periapical status, quality of root canal filling, and quality of coronal restoration in different tooth types. The effect of explanatory variables on periapical status was explored using univariate and multivariate logistic regression models. The outcome variable was set as the presence versus absence of AP in the tooth. Results Multivariate logistic regression analysis revealed statistically significant associations and increased risk for AP presence in molars (odds ratio [OR] = 2.15; p < 0.001), teeth positioned in mandible (OR = 1.49; p = 0.007), teeth with short length of root filling (OR = 4.08; p < 0.001), overfilled teeth (OR = 2.99; p = 0.001), and teeth with inadequate density of root filling (OR = 4.14; p < 0.001). Considering variables related to coronal restoration, neither coronal restoration type nor quality was found to be predictive for posttreatment AP. Merely, the presence of intracanal post significantly increased the odds of AP presence (OR = 1.57; p = 0.009). Conclusion The results of the present study did not indicate that type or quality of coronal restoration may be predictors of posttreatment AP. Periapical disease was significantly associated with molars, mandibular teeth, substandard quality of root fillings, and intracanal post presence.
Highlights
The importance of natural teeth preservation cannot be overemphasized
Multivariate logistic regression analysis revealed statistically significant associations and increased risk for apical periodontitis (AP) presence in molars, teeth positioned in mandible, teeth with short length of root filling, overfilled teeth, and teeth with inadequate density of root filling
Considering variables related to coronal restoration, neither coronal restoration type nor quality was found to be predictive for posttreatment AP
Summary
The importance of natural teeth preservation cannot be overemphasized. when given options are extraction and root canal treatment, endodontic treatment should be treatment of choice as it can provide the best health and cosmetic result.[1]. Cross-sectional studies conducted in different European, American, and Asian populations reported that endodontically treated teeth are prevalent among adults, ranging from 1.5 to 21% out of all examined teeth.[4,5,6,7] Posttreatment disease, a phrase suggested by Friedman, describes the persistence of apical periodontitis (AP) in endodontically treated teeth.[8] Studies conducted at dental schools, where endodontic treatment was performed or supervised by an endodontic specialist reported a success rate to be more than 90%.8–11. The studies reflecting a more realistic outcome of endodontic treatments in the general populations reported the prevalence of AP in endodontically treated teeth to range from 25 to more than 65%.4,12. Further investigations are required to improve the outcomes of root canal treatment and benefits related to the oral health of the population
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