Inadequate Root Canal Treatment Research Articles

Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study

BackgroundEndodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP.MethodsDigital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models.ResultsPrevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96–15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28–0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09–0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08–0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP.ConclusionsWithin the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.

Evaluation of endodontically treated teeth and related apical periodontitis using periapical and endodontic status scale: Retrospective cone-beam computed tomography study.

The purpose of this study was to evaluate the technical treatment quality and the status of apical pathology of endodontically treated teeth, as well as apical periodontitis (AP) prevalence, in a Turkish population using cone-beam computed tomography (CBCT). The CBCT images obtained between January 2018 and April 2020 were retrospectively examined. The quality of the endodontic treatments and the related periapical inflammatory lesions were classified according to the periapical and endodontic status scale (PESS). The data were statistically analysed using logistic regression, crosstabs and chi-square tests. AP was detected in 41% of 429 endodontically treated teeth. The prevalence of AP was significantly higher in teeth with inadequate root canal treatment compared with those with adequate treatment, 70.8% and 29.3%, respectively. Inadequate canal length and homogeneity, and complications were significantly associated with the prognostic periapical status scores of higher risk.

Effect of prosthetic restorations and root canal fillings on periapical health in a selected patient group.

Aims To examine the effect of the quality of root canal fillings and prosthetic restorations on the frequency of apical periodontitis (AP).Methodology A total of 200 radiographs of 1,098 teeth with indirect restorations were selected. Each case was documented by age, sex, tooth location, tooth type, restoration type and presence of root canal treatment (RCT). Teeth were categorised as healthy or diseased considering periapical health. The quality of RCT and prosthetic restorations was categorised by radiographic and clinical examinations. Data were analysed using chi-squared test and logistic regression.Results Inadequate prosthetic restorations were found to be less healthy than the adequate ones. Statistical significance was found in teeth with RCT, which had a higher rate of AP (15.8%). Root-filled teeth categorised as inadequately treated (24.1%) were significantly unhealthier than the adequately root-filled teeth. Teeth with inadequate prosthetic restorations and RCT had an increase in AP risk of 6.41 and 20.74 times, respectively (p <0.05).Conclusions Results showed that AP risk was increased by both inadequate RCT and prosthetic restorations. Quality of RCT significantly affected periapical health more than the quality of prosthetic restorations. Not only radiographic but also clinical examination of restorations is required for successful evaluation.

Prevalence of periradicular radiolucencies and its association with the quality of root canal procedures and coronal restorations in an adult urban Indian population.

Aims:The aim of this cross-sectional study was to determine the prevalence of periradicular radiolucencies (PR) from an urban adult Indian population and to investigate the quality of root canal procedures and coronal restorations and their association with prevalence of PR in root-filled teeth.Settings and Design:Cross-sectional study.Material and Methods:A total of 1,340 subjects (18+ years of age) who reported for non-emergency dental care to 5 different dental care centers had their panoramic radiographs taken during the period from January to December 2013. The periradicular status of 30,098 teeth in these radiographs was evaluated using the Periapical Index Score (PAI). The assessment of the technical quality of the procedure was evaluated based on the criteria of root canal filling length and quality of coronal restoration.Statistical Analysis Used:The data was analyzed statistically by chi-squared test and odds ratio.Results:PR was found in 65% of subjects (n = 865) and 5.8% (n = 1,759) of the 30,098 teeth evaluated (4.30% untreated teeth and 1.53% were root-filled teeth). In all, 4.1% of the teeth (n = 1,234) had some filling material in the root canal(s) and the prevalence of PR in these root-filled teeth was 37.4%, while the remaining 62.6% of root canal-filled teeth showed no evidence of PR. PR occurred significantly more often in teeth where root canal filling was filled more than 2 mm short of radiographic apex or when root filling extruded through the apex.Conclusions:The prevalence of PR in teeth with untreated root canals in India is 4.30%, which is more than twice the weighted world average, while the prevalence of root-filled teeth (4.1%) is lower than the world average (9.6%). The prevalence of PR in root-filled teeth in India is comparable to that in other populations. Inadequate root canal treatment and poor quality of coronal restoration were associated with increased prevalence of PR.

Endodontically related lesions on panoramic radiographs in a Turkish subpopulation

Objective: The purpose of this study was to evaluate the prevalence of detectable endodontically related lesions as determined from the reports of panoramic radiographs in a Turkish subpopulation. Materials and Methods: There were 19,625 reports of panoramic radiographs that were evaluated. Four investigators assessed the radiographs and reports that had been written. For each tooth of the subjects, the following items were surveyed: presence of periapical lesion, inadequate root canal treatment, external and internal root resorption. Results: The patients who had panoramic radiography reports were between the ages of 3 and 91 years (mean age 29,43 ± 18,83 years). 10,941 (56%) were female and 8684 (44%) were male patients. Inadequate root canal treatment was recorded in 588 (3%) radiography reports and it was more frequent in mandibular molar teeth. 2287 (11.7%) of the patients had periapical lesions and it was more frequent in maxillary incisor teeth and mandibular molar teeth. External resorption was observed in 61 (0.3%) patient records, while internal root resorption was reported in 14 (0.1%) reports. 81 inadequate root-filled teeth presented a periapical lesion. A positive strong linear correlation was found between the presence of inadequate root canal treatment and a periapical lesion among the patients (r = 0.098, P = 0.000). Conclusions: The results of this study suggest that external and internal root resorption were not frequent clinical conditions. The high frequency of periapical lesions and inadequate canal treatment in molar teeth indicate the need to improve the technical quality of root fillings, especially in molar teeth.

Influence of the Quality of Endodontic Treatment and Coronal Restorations on the Prevalence of Apical Periodontitis in a Turkish Cypriot Population

Objectives: The aim of this study was to assess the prevalence of periapical lesions in root canal-treated teeth in a Turkish Cypriote population and to investigate the influence of the quality of root canal fillings and coronal restorations on the prevalence of periapical lesions. Subjects and Methods: The sample for this cross-sectional study consisted of 1,006 adult patients seeking routine dental care. Patients who had received dental care in the last 2 years were excluded. Radiographs of 2,200 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. Periapical status was assessed using periapical index (PAI) scores. Results: Of the 2,200 root canal-treated teeth, 1,364 (62%) had apical periodontitis as compared with 1,364 (5.5%) of the total sample. Root-filled teeth classified as adequately treated had apical periodontitis in 223 (26.6%) cases compared with 1,192 (87.7%) in teeth classified as inadequately root filled. PAI 1 scores of adequate root canal treatment were significantly higher than in inadequate root canal treatment, regardless of the quality or presence of coronal restorations (p < 0.01). Conclusion: Our findings showed a high prevalence of periapical pathology with or without endodontic treatment and poor technical standard of both root fillings and coronal restorations of root-treated teeth. Hence, we suggest the need for better education for dental health providers so that they can perform better root canal treatments and coronal restorations.

Root-filled teeth with adequate restorations and root canal treatment have better treatment outcomes

Medline, Embase, the Cochrane Library, the Wiley online database, four journals (Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology and Endodontics and Dental Traumatology) and the references of identified articles were searched manually. There was no language restriction. Clinical studies that provided sample size, and where success was based on radiographic and/or clinical criteria that evaluated quality of root filling, the quality of coronal restoration and periapical status at least one year after root canal treatment that provided an overall success rate or sufficient data to allow it to be calculated from the raw data were included. Data were collected based on predetermined criteria. Percentages of teeth without apical periodontitis were recorded for each category: adequate root canal treatment (AE); inadequate root canal treatment (IE); adequate restoration (AR); and inadequate restoration (IR). Data were analysed using meta-analysis for odds ratios (ORs). Nine article were included . After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE:-AR/AE versus AR/IE (OR = 2.734; 95%CI, 2.61-2.88; P < .001)AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001). On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these two combinations.

Cross-sectional evaluation of the periapical status as related to quality of root canal fillings and coronal restorations in a rural adult male population of Turkey

BackgroundTo determine the prevalence of periapical lesions in root canal-treated teeth in a rural, male adult, Turkish population and to investigate the influence of the quality of root canal fillings on prevalence of periapical lesions.MethodsThe sample for this cross-sectional study consisted of 552 adult male patients, 18-32 years of age, presenting consecutively as new patients seeking routine dental care at the Dental Sciences of Gulhane Military Medicine, Ankara. The radiographs of the 1014 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. The criteria used for the examination were slightly modified from those described by De Moor. Periapical status was assessed by the Periapical Index scores (PAI) proposed by Orstavik.ResultsThe overall success rate of root canal treatment was 32.1%. The success rates of adequately root canal treatment were significantly higher than inadequately root canal treatment, regardless of the quality or presence of the coronal restoration (P < .001). In addition, the success rate of inadequate root canal treatment was also significantly affected by the quality of coronal restorations.ConclusionsOur results revealed a high prevalence of periapical lesions in root canal treatment, which is comparable to that reported in other methodologically compatible studies from diverse geographical locations. In addition, the results from the present study confirm the findings of other studies that found the quality of the root canal treatment to be a key factor for prognosis with or without adequate coronal restoration.

Timeliness and effectiveness in the surgical management of persistent post‐treatment periapical pathosis

Common problems that cause persistent post‐treatment periapical pathosis include infection remaining in the apical inaccessible areas, extraradicular infection including apically extruded dentine debris with bacteria present in dentinal tubules, radicular true cysts, foreign body reactions, inadequate non‐surgical root canal treatment with or without iatrogenically altered root canal morphology, and vertical root fractures. Inadequate root canal treatment may be corrected non‐surgically, while more complex problems may require surgical intervention. The important factors that warrant a successful surgery include good quality of the orthograde root canal treatment, deep retrograde preparation of the apical canal, and carefully cleaning and filling of the exposed isthmuses and accessory canals. Ideally, apical surgery and orthograde retreatment are performed simultaneously. In a recent study, 97% of the lesions including large ones of &gt;10 mm in diameter healed completely within 1 year after surgical intervention. Of the teeth that showed ‘complete healing’ at 4 years more than 85% already ‘completely healed’ at 2 years; thus, the endodontic post‐treatment disease might be treated surgically or non‐surgically within 2 years after the previous treatment.

A radiographic study of the relationship between technical quality of coronoradicular posts and periapical status in a Jordanian population

A radiographic study was conducted to investigate the relationship between the technical quality of coronoradicular posts and periapical status. A total of 400 periapical radiographs, including 560 posts, of patients attending the Dental Department at Jordan University Hospital were scanned and studied. It was found that maxillary teeth were more frequently restored with posts (65.36%) than mandibular teeth (34.64%). Tapered posts accounted for 73.93% of the posts used. The ratio of the mean post length to crown length was 0.8, and that to root length was 0.45. The mean length of the remaining gutta percha apical to the end of the post was 6.22 mm. In addition, 25% of the posts deviated from the line of the root canal. Periapical radiolucency was evident in 53.93% of the assessed teeth. It is concluded that inadequate root canal treatment and coronoradicular posts are associated with increased prevalence of periapical radiolucency, and that general dental practitioners should be better trained in performing endodontic treatment and restoring endodontically treated teeth.