Preoperative Periapical Status Research Articles

Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study.

To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Radiographic evaluation of preoperative periapical status in teeth with apical abscess

Background: The presence of preoperative periapical lesion is a significant prognostic factor that influences the outcome of endodontic treatment. Radiographic evaluation of periapical status is important for diagnosis, treatment, and prognosis of periapical lesion. Objectives: To radiographically compare and evaluate the preoperative periapical status using periapical index (PAI) in teeth with acute and chronic apical abscess. Methods: An analytical cross-sectional study was conducted in Chitwan Medical College, between 2022 February to 2022 May using nonprobability convenience sampling technique. Forty-eight periapical radiographs with a diagnosis of apical abscess {24 acute apical abscess (AAA) = Group 1; 24 chronic apical abscess (CAA) = Group 2)} were included for evaluation. Four observers (Three endodontists and one oral radiologist) evaluated the periapical status on radiographs and scored them according to PAI scoring system. Statistical analysis was done using the Mann-Whitney U test and SPSS v.22. Results: The most common PAI score for teeth in Group 1 was three (13, 54.20%) with mean PAI score = 3.21 and in Group 2 the score was four (13, 54.20%) with mean PAI score = 3.79. Analysis of PAI scores found significant differences (p = 0.009, p <0.05) between groups. The distribution of PAI varied according to apical diagnosis (p <0.05). Intraobserver and Interobserver agreement values demonstrated good self-agreement and interobserver agreement. Conclusion: Teeth with CAA were more likely to have higher PAI scores and therefore, periapical radiograph and PAI scoring system can be used effectively for the evaluation of preoperative periapical status in teeth with apical abscess.

Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study.

This study evaluated the long-term clinical outcomes of single-visit root canal treatments with apical enlargement on patients with necrotic pulp tissue retrospectively. A total of 137 teeth with necrotic pulp tissue which underwent single-visit root canal treatments were included. The root canals were shaped up until the apical constriction, which was determined by an apex locator. The outcomes were evaluated by two independent and calibrated endodontists clinically and radiographically. Teeth were dichotomized into healed (PAI ≤ 2, no signs or symptoms) and nonhealed (PAI > 2, with/without signs or symptoms) groups. Each patients' preoperative PAI and lesion size were recorded to evaluate the preoperative periapical status as well as several other prognostic factors. Statistical analyses were performed (p = 0.05) on ninety teeth. The mean observation time was 60 months. Out of ninety teeth, 87 (96.7%) were healed and 3 (3.3%) were nonhealed. No correlations were found between the prognostic factors and the outcomes (p > 0.05). Cohen's kappa and Gwet's agreement coefficient scores between the preoperative PAI scores and preoperative lesion sizes showed good agreements, with values of 0.834 and 0.898, respectively. Apical enlargement is a viable treatment option for single-visit root canal treatments.

The "Plan" phase of a Deming cycle: Measurement of quality and outcome of root canal treatments in a university hospital.

In many countries, dental students are taught in private or university hospitals where they treat patients under the supervision of teachers. Assessing the quality of root canal treatments (RCT) would provide information about the quality of care patients receive when treated by students. This study describes the six-step "Plan" phase of a Plan-Do-Check-Act (PDCA) cycle that identifies and analyses clinical practices in endodontics in a university dental hospital service. Step 3 reported that the proportion of RCTs of adequate quality reached 57.1% and this proportion was significantly decreased when specific indicators for treatment difficulties were present. The proportion of successful RCTs after 1year was 65.6%, and its variation was influenced by the preoperative periapical status rather than the quality of RCTs. The consensual meeting in Step 6 proposed to introduce three new procedures for the further Do, Check and Act phases of the PDCA cycle. This study encourages systematic evaluation of RCTs and provides the first step of the methodology that can be reproduced in private and hospital practices where students are asked to treat patients.

Quality of Root Canal Fillings Performed by Undergraduate Students and the Related Factors on the Treatment Outcome: A 2- to 5-Year Follow-Up.

Objective:To evaluate radiographically the quality of root canal fillings performed by undergraduate students between 2012 and 2015, and to investigate the impact of their quality in correlation with root type, preoperative periapical status, and type of restorative treatment on the treatment outcome.Methods:Six hundred seventy-seven non-surgical root canal treatments were performed by undergraduate students from the Aristotle University of Thessaloniki at the endodontic department clinics between 2012 and 2015. Two hundred forty-four teeth (349 roots) fulfilled the criteria and were clinically and radiographically re-examined between 2016 and 2017, and the outcome was classified as “success” or “failure.” Root canal fillings were radiographically evaluated in terms of apical extension and density. The root filling was classified as acceptable when both parameters were rated as acceptable. Statistical analysis was performed using generalized estimating equations. Pairwise comparisons were performed by the sequential Bonferroni method. Intra-examiner and inter-examiner agreements were checked by the intraclass correlation coefficient and Cohen’s kappa. The statistical significance level was set at P<0.05.Results:The percentage of the roots with acceptable root canal fillings was 40.4%. The molar roots demonstrated the lowest rate (30.7%) compared with the anterior (53%, P<0.05) and premolar teeth (43%, P>0.05). The results of the correlation of the quality of the root canal fillings with the root type, preoperative periapical status, type of coronal restoration, and the treatment outcome showed that the unacceptable quality of root canal filling in relation to root or presence of periapical lesion or crown revealed the lowest success rates (47.2%, 40.3%, and 52.3%, respectively). In contrast, results showed that roots with canal fillings of acceptable quality demonstrated success rates close to 90%, regardless of the other variables.Conclusion:Within the limitations of the present study, the percentage of radiographically acceptable root canal fillings performed in the undergraduate clinic of the Department of Endodontology at Aristotle University of Thessaloniki was low (40.4%). Results showed that there was a strong association of higher success rates with root fillings of acceptable quality.

Factors Affecting the Outcome of Non-Surgical Endodontic Treatments Performed by Undergraduate Students in a Greek Dental School.

Objective:To evaluate the outcome of initial endodontic treatments performed by undergraduate students in a Greek dental school and to determine the factors that may impact the treatment outcome.Methods:From a randomly selected sample of 677 non-surgical endodontic treatments performed between 2012 and 2015, follow-up appointments were scheduled with patients whose dental records matched the inclusion criteria. After clinical and radiographic examination, the treatment outcome was classified as ‘success’ (healed/healing) or ‘failure’ (uncertain/unsatisfactory healing). The statistical analysis of the data was performed using generalized estimating equations. Intra-examiner and inter-examiner agreements were checked with the intraclass correlation coefficient and with Cohen’s kappa. The statistical significance level was set at P<0.05.Results:A total of 244 teeth (349 roots) were included for further analysis, and the mean follow-up period was 2.8 years. Overall, the success rate for the treated roots was 72.8%. Μultivariate analysis revealed four decisive factors as having a positive impact on the outcome, namely, the absence of voids within the root fillings (P<0.001), the absence of pre-operative periapical lesions (P=0.001), the extension of the root filling material by 0-2 mm from the radiographic apex (P<0.001) and the root type (anterior roots: P=0.015 and premolar roots: P=0.011). The association of gender, arch, pulp status and type of coronal restoration with the outcome was not statistically significant (P>0.05). Moreover, when the outcome according to pre-operative periapical status and the technical variables of root fillings (apical extension and density) was investigated, roots without periapical lesion, with a root filling material extended 0-2 mm within the apex and without voids revealed the highest success rate (94.5%).Conclusion:The success rate of non-surgical endodontic treatments performed in a Greek dental school was in the range of those reported in other studies. The pre-operative periapical status, technical variables of root fillings (apical extension and density) and root type were regarded as significant prognostic factors of the outcome.

Long-term outcome of primary non-surgical root canal treatment

AimThe aim of this study is to examine the survival distributions of primary root canal treatment using interval-censored data and to assess the factors affecting the outcome of primary root canal treatment, in terms of periapical healing and tooth survival.Materials and methodsAbout one tenth of primary root canal treatment performed between January 1981 and December 1994 in a dental teaching hospital were systematically sampled for inclusion in this study. Information about the patients' personal particulars, medical history, pre-operative status, treatment details, and previous review status of the treated teeth, were obtained from dental records. Patients were recalled for examination clinically and radiographically. Treatment outcomes were categorized according to the status for periapical healing and tooth survival. The event time was interval-censored and subjected to survival analysis using the Weibull accelerated failure time model.ResultsA total of 889 teeth were suitable for analysis. Survival curves of both outcome measures (periapical healing and tooth survival) declined in a non-linear fashion with time. Median survival of the treated teeth was 119 months (periapical healing) and 252 months (tooth survival). Age, tooth type, pre-operative periapical status, occlusion, type of final restoration, and condition of the tooth/restoration margin were significant factors affecting both periapical healing and tooth survival. Apical extent and homogeneity of root canal fillings had a significant impact towards periapical healing (p < 0.05), but not tooth survival.ConclusionThe longevity of treated teeth based on tooth survival was considerably greater than that of periapical healing. Both outcome measures were affected by a number of socio-demographic, pre-, intra-, and post-operative factors.Clinical relevanceRoot canal-treated teeth may continue to function for a considerable period of time even though there may be radiographic periapical lesion present. Decision for extraction may be due to reasons other than a failure of the periapical tissues to heal.

Analysis on results of endodontic treatment and influencing factors

To assess the clinical outcome of root canal therapy (RCT) and the various factors that may influence the outcome of RCT. A total of 695 teeth from 357 patients were retrospectively studied three years after endodontic treatment. Pre- and intra-operative information was collected from the original patient records. The post-operative sign or symptom, periapical status and coronal restoration integrity were examined 3 years after obturation. Data were subjected to bivariate and multivariate analysis. The cure rate for 695 teeth was 75.1%, 96.0% of which was considered to be functional. The tooth group, pre-operative pulp and periapical status, quality of root filling and integrity of coronal restoration were revealed by means of bivariate analysis to exert a significant influence on treatment outcome. The logistic analysis indicated that the odds for cure in the teeth with pre-operative periapical radiolucency, underfilling and "open" coronal restoration were significantly lower by 2 folds, 3 folds and 1.6 folds than their counterparts, respectively. The pre-operative periapical status, quality of root filling and the integrity of coronal restoration are main predictors of outcome in RCT.

Outcome of Endodontic Treatment of Teeth Filled Using Lateral Condensation versus Vertical Compaction (Schilder's Technique)

The purpose of this prospective clinical and radiographic investigation was to assess the treatment results following endodontic therapy of teeth filled with lateral condensation versus teeth filled with vertical compaction of warm gutta-percha. A total of 290 patients were treated using the standardized step-back technique for canal preparation, which were filled with either lateral condensation or vertical compaction in one single session. Five years later, the treatment results were assessed clinically and radiographically and related to the type of the obturation technique using Chi-square analysis. Of the 340 teeth that were reexamined, 160 teeth were filled with lateral condensation, and 180 teeth were filled with vertical condensation. The results showed a significantly higher success rate for the vertical compaction versus the lateral condensation technique of teeth presented with preoperative periapical lesions P<0.04. Regardless of the preoperative periapical status of the teeth, no statistically significant difference was found between the two techniques. The overall success rate of both filling techniques was 80.3%.

Long-term survival of primary root canal treatment carried out in a dental teaching hospital.

This study aimed to examine clinically and radiographically the survival of primary root canal treatment completed in a dental teaching hospital between 10 and 20 years previously. A data collection form was used to collate all information obtained from the written patients' records along with the results from clinical and radiographic examination of 608 teeth, out of a total of 986 randomly selected teeth that had been root filled in the Prince Philip Dental Hospital (PPDH), Hong Kong, between 1981 and 1989. The criteria for failure were extractions (except for documented nonendodontic reason), retreatments and presence of a periapical radiolucency. The survival function of the treated teeth was plotted against the calculated date of failure using the Kaplan-Meier (K-M) method. Covariables were examined further by Cox Regression analysis with a backward stepwise method. A total of 314 teeth (52%) were either documented or deemed to have failed after examination. The median survival time was 111 months. Cox Regression analysis indicated that the survival of root-filled teeth was significantly influenced by the tooth type, preoperative periapical status and the type of coronal restoration. The survival function declined with time, with a rapid drop in the first 18 months or so. The rate at which failures occurred appeared to slow down with a longer observation time. There was a nonlinear decline in the cumulative survival probability of primary root canal treatment. Tooth type, preoperative periapical status and type of post and final restoration significantly affected the long-term survival of the treated teeth.

Preoperative periapical status and survival of root-filled teeth: a pilot investigation

Preoperative periapical status and survival of root-filled teeth: a pilot investigation

Factors influencing the long-term results of endodontic treatment: a review of the literature

The purpose of this review of the literature is to examine the factors and their influence on the outcome of endodontic treatments, and also to attempt to have an authors' consensus concerning the impact of these factors on long-term results. The documentary research was conducted using the meta-analysis principles of critical reading of the literature. Two groups of factors can be identified regarding the outcome of endodontic treatments: those which influence the success of the procedure and those which do not significantly affect the success rate. Agreement is obtained in all studies on two major factors, the preoperative periapical status and the apical limit of the obturation, which appear to strongly influence the success of endodontic therapy. This review highlights the methodological problems of retrospective studies and points out the need for consensus regarding the evaluation criteria of root canal therapy.

The prognosis for endodontic treatment of obliterated root canals

Teeth with obliterated root canals were treated endodontically without any surgical procedure. Clinical and radiographic follow-up examinations were performed for 2 to 12 yr. The overall success rate was found to be 89%. When the preoperative periapical status was taken into consideration, the success rate for roots with an intact periapical contour was 97.9%. In teeth with preoperative periapical radiolucencies, a success rate of 62.5% was noted. Teeth with obliterated root canals were treated endodontically without any surgical procedure. Clinical and radiographic follow-up examinations were performed for 2 to 12 yr. The overall success rate was found to be 89%. When the preoperative periapical status was taken into consideration, the success rate for roots with an intact periapical contour was 97.9%. In teeth with preoperative periapical radiolucencies, a success rate of 62.5% was noted.