Apical Periodontitis In Root-filled Teeth Research Articles

Frequency of apical periodontitis in root-filled teeth restored with post and core: A 5-year retrospective study.

In conjunction with post placement in root-filled teeth with periapical healthy conditions, root canal retreatment may be performed to improve the seal of the root canal. Whether root canal retreatment for technical reasons (retreatments in teeth without apical periodontitis (AP)) results in lower frequency of AP is unknown. To examine whether there is a difference in frequency of AP between roots with root canals retreated for technical reasons, and roots with root canals not retreated before post placement, with a minimum follow-up of 5 years. Also, to examine changes in root filling quality following root canal retreatment for technical reasons. This retrospective study included radiographs of 441 root-filled roots without periapical radiolucencies at baseline, scheduled for post and core treatment. Follow-up data for a minimum of 5 years were available for 305 roots (loss to follow-up 30.8%), 46 of which were retreated for technical reasons. Two calibrated observers assessed root filling sealing quality and length, respectively, and periapical status according to the Periapical Index. The main outcome of the study, AP, was used as the dependent variable and all analyses were performed at root level. The overall frequency of AP at follow-up was 13.8%. The difference in frequency of AP between retreated (4.3%) and nonretreated (15.4%) root canals was not statistically significant, p = .061. Analyses including only roots with preoperatively inadequate root filling quality showed a statistically significant difference (p = .017) between the two treatment groups (2.4% vs. 22.9%). Root canal retreatment for technical reasons before post and core placement significantly reduces the frequency of AP in roots with inadequate root filling quality.

Assessment of Treatment Quality Risk Factors Influencing the Radiographic Detection of Apical Periodontitis in Root-Filled Teeth: A Retrospective CBCT Analysis.

This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images. Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chi-square and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05. AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respectively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively. The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images. (EEJ-2024-02-042).

The global prevalence of apical periodontitis: a systematic review and meta-analysis.

Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34668 individuals and 639357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 =97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 =99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2 =98.5%) and 3% (95% CI 2%-3%; I2 =99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2 =97.8%) and hospitals (51%; 95% CI 40%-63%; I2 =95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2 =96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2 =89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2 =98.3%). The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

Evaluation of the Relationship between Type II Diabetes Mellitus and the Prevalence of Apical Periodontitis in Root-Filled Teeth Using Cone Beam Computed Tomography: An Observational Cross-Sectional Study

Objective: This study aimed to investigate the prevalence of apical periodontitis (AP) in patients with type II diabetes mellitus (DM) with either optimal glycemic control (OGC) or poor glycemic control (PGC) compared with nondiabetics using cone beam computed tomography (CBCT). Subjects and Methods: The periapical status of 75 teeth with adequate root canal treatment performed at least 1 year ago that could be visualized in the field of view of CBCT images of 43 DM patients (29 females, 14 males) was compared with a control group consisting of 162 teeth of 86 nondiabetics (56 females, 30 males). In addition, the DM group was divided into subgroups according to the patients’ mean glycated hemoglobin level as either having OGC or PGC. The periapical status of the teeth was evaluated using the CBCT periapical index (CBCTPAI), and AP was diagnosed as a CBCTPAI ≥1. χ², Fisher’s exact test, and independent-samples t tests were used for the statistical analysis, and p < 0.05 was considered significant. Results: Significant differences between the DM group and the control group were observed (p< 0.05) in terms of AP (the frequencies of both CBCTPAI ≥1 and CBCTPAI ≥3) and the frequency of cardiovascular disease, while there were no significant differences between the DM subgroups (p > 0.05). Conclusion: The prevalence of AP and severe bone destruction in periapical tissues was significantly higher in the DM patients compared with the nondiabetic patients.

Book Review: Apical periodontitis in root-filled teeth: endodontic retreatment and alternative approaches

Book Review: Apical periodontitis in root-filled teeth: endodontic retreatment and alternative approaches

Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20years later.

The study aimed at assessing, as primary objective, the periapical status and quality of root fillings, and, as secondary objective, the endodontic treatment need of a German urban population in a cross-sectional study 20years after the first one. Clinical and radiographic data of 353 patients were evaluated. Descriptive and regression analyses were performed and the endodontic treatment need was calculated. Results were compared with data from the year 1993. A total of 9269 teeth were examined (26.2 teeth per patient; 1993, 24.4), of which 337 teeth were root filled (3.6%; 1993, 2.7%). Prevalence of apical periodontitis in root-filled teeth was 34% (1993, 61%). Quality of root fillings was adequate in 117 cases (35%; 1993, 14%). Minimum endodontic treatment need was estimated with 1.6% (1993, 2.3%), including teeth with clinical symptoms. Considering symptomless teeth with apical periodontitis and poor quality of root filling, the treatment need was 2.9% (1993, 3.7%). Regression analysis identified quality of root filling as a significant factor for periapical health (p = 0.01, odds ratio 3.4×, 95% CI 1.9-6.3×), likewise the type of instrumentation. Teeth treated with rotary files had a significantly better outcome (p = 0.02, odds ratio 2.0×, 95% CI 1.1-3.7×). Quality of root fillings and the periapical status have improved over the last 20years in Germany. However, there is still a need for an increase in quality of root canal treatment.

Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Sudanese population.

The aim of this study was to estimate the prevalence of teeth with apical periodontitis (AP) and root‐filled (RF) teeth in an adult Sudanese population. Panoramic and periapical radiographs were obtained for 200 patients over 18 years of age seeking routine dental care and attending the dental clinics (University of Khartoum) and the dental hospital (University of Science and Technology) for the first time. The periapical status of all teeth (except third molars) was categorized on the basis of the presence or absence of radiographic signs of AP. In addition, the frequency of RF teeth was recorded. Data were analyzed using the chi‐square test and odds ratio (OR).The periapical status of 4,967 teeth was assessed. AP in one or several teeth was identified in 95 (47%) patients and in 3.3% of the teeth. The prevalence of AP was higher in molar teeth (7.3%) than in premolar (3.5%) and anterior teeth (0.9%, p ≤ .001). There were 80 (1.6%) RF teeth in 42 (21%) patients. The probability of root‐filling in molar and premolar teeth was almost twice that of anterior teeth (OR with 95% confidence intervals: 1.06 < 1.91 < 3.44, p ≤ .05).The prevalence of RF teeth increased with age (OR of 48 ± year = 3.06, p ≤ .001). Statistical analysis showed that the probability of radiological detection of AP in RF teeth was 17‐fold higher than in nonfilled ones (OR with 95% confidence intervals: 9.87 < 16.83 < 28.25, p ≤ .001).Therefore, the probability of AP, RF teeth with or without AP, and missing teeth was high in molar teeth than in anterior or premolar teeth. The frequency of RF teeth was low compared to that demonstrated in most other epidemiological studies. This highlights the need to focus on improving the quality of restorations and the procedure by which root canal is shaped and disinfected.

Relationship between apical periodontitis and marginal bone loss at individual level from a general population

To study the relationship between the presence of apical periodontitis in root-filled teeth and marginal bone loss (MBL) in individual subjects from a general population. The study was conducted on a sample of 1,152 dentate individuals (participants in an epdemiological investigation) who were subjected to clinical and radiographic investigations. The presence of root fillings and apical periodontitis were registered. MBL was measured mesially and distally at all roots. The MBL index of the subject was defined as the mean MBL value at all measurable points in the same individual. Multiple regression analysis was adopted to calculate the influence of the presence of apical periodontitis and potential confounders on the dependent variable, MBL index. There was a significant correlation between MBL and the percentage of root-filled teeth and the percentage of root-filled teeth with apical periodontitis. The results of the multiple regression analysis showed that the relative frequency of root-filled teeth with apical periodontitis was significantly higher in subjects with more MBL, irrespective of age, number of remaining teeth, relative frequency of root-filled teeth and smoking habits. A significant association between the presence of apical and marginal periodontitis in individual subjects was found. The mechanisms behind the associations between these diseases are unknown and this cross-sectional observational study did not permit distinction between cause and effect. It is hoped that future cohort studies may provide more knowledge about the biological actions behind the relationship between apical and marginal disease.

Root canal treatment and prevalence of apical periodontitis in a nigerian adult subpopulation: a radiographic study.

To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis. The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'under-filled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2. Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of root-filled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were under-filled teeth (P < 0.001 and P < 0.05, respectively). The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment.

Assessment of possible risk indicators for apical periodontitis in root-filled teeth in an adult Turkish population

The objective of this study was to determine possible independent risk indicators of apical periodontitis (AP) in root-filled teeth in an adult Turkish population. This study included subjects older than 15 years who had 1 or more root-filled teeth examined at the Baskent University Faculty of Dentistry. A total of 812 root-filled teeth were evaluated in 425 individuals. AP was the dependent variable and age, gender, length and density of root fillings, presence of periodontal problems, posts, localization of tooth, and tooth type were identified as independent variables. Generalized Estimating Equation (GEE) models were used in statistical analysis. AP was detected on 148 teeth (18.2%) in 812 root-filled teeth. According to multiple GEE model, males were more likely to have AP than females. Of the dental variables, length of root fillings, periodontal problems and tooth type were significantly associated with AP. The present study indicates that to be male and dental variables including length of root fillings, periodontal problems, and molar teeth were significantly associated with AP.

The relation between apical periodontitis and root‐filled teeth in patients with periodontal treatment need

To investigate a number of clinical and treatment variables that might have influenced the prevalence of apical periodontitis in root-filled teeth in a population of periodontally compromised patients. This investigation was a retrospective cross-sectional study on data collected from periodontal charts in addition to intra-oral full-mouth radiographs from patients attending the Department of Periodontology of the Dental School of the Ghent University Hospital. Periodontal parameters (clinical attachment loss and the lowest marginal bone level, the history of periodontal treatment), endodontic treatment (length, homogeneity and overall quality of the root filling) and the quality of coronal restorations were related to the prevalence of apical periodontitis. A total of 272 root-filled teeth in 94 patients were evaluated. The periapical condition was significantly influenced by the quality of the root filling and the coronal filling (P < 0.05). More apical periodontitis was seen when the coronal level of the root filling exceeded the marginal bone level (P < 0.005). The marginal periodontal condition seemed to influence the periapical status. Teeth with apical periodontitis were associated with significantly more extended marginal bone loss (P < 0.001). Significantly less apical periodontitis was seen in patients that had received marginal periodontal treatment (P < 0.005), compared with untreated periodontal patients. Signs of periodontal disease, as reflected by marginal bone loss, are of importance for the periapical condition of root-filled teeth. Efforts should be taken in preventing spread of infection through the periodontal-endodontic pathway by periodontal infection control and a high quality of root filling and coronal filling. Care should also be taken to seal the coronal cavity up to the level of the root filling, where it is advisable to reduce the coronal level of the root filling below or at least at the level of the surrounding marginal bone.