Root-treated Teeth Research Articles

Investigating the Knowledge of Yazd Dental Students about the Taught Factors of Direct Restoration of Endodontically Treated Teeth in 1401

Introduction: Treatment of root-treated teeth depends largely on proper restoration. Direct restorations are a better choice if there is sufficient residual tissue. This study aimed to investigate the knowledge of dental students in School of Dentistry in Yazd City about the taught factors of direct restoration of endodontically treated teeth.
 Methods: In this descriptive-cross-sectional study, the knowledge of 67 dental students of School of Dentistry in Yazd City about the taught factors of direct restoration of root-treated teeth was studied using a valid and reliable questionnaire containing demographic characteristics (age and gender) and 28 knowledge questions. After collecting the data, using SPSS version 16 software, they were analyzed using descriptive statistics, Chi-square test, Fisher's exact test, Mann-Whitney test, T test and Pearson correlation coefficient.
 Results: 36 (53.7%) female students and 31 (46.3%) male students with an average age of 25 ± 3.14 participated in this study. The average awareness score was 32.74 ± 9.65. The average knowledge score of female students (35.30±10.27) was higher than that of male students (31.95±8.70), but this difference was not statistically significant (p = 0.156). In the age group under 25, the average score of awareness (34.78 ± 9.94) was higher than the average above 25 (30.43 ± 8.1). There was an inverse and significant relationship between knowledge score and age, r=-0.242 and P 0.049. Conclusion: The average knowledge score of dental students regarding the taught factors of direct restoration of endodontically treated teeth was good. Gender did not have a significant effect on the knowledge of students, and the knowledge of students under 25 years old was higher than ones over 25 years old.

Reasons and Pattern of Demand for Root Canal Treatment Among Patients Attending A Tertiary Care Center of Madhesh Province: A Descriptive Cross-Sectional Study

Introduction: Root canal treatment (RCT) for permanent teeth involves the use of biologically acceptable chemical and mechanical treatment of the root canal system to promote healing and repair of the peri radicular tissues. The aim of the study was to analyze the reasons and pattern of demand for root canal treatment among patients attending a tertiary care center of Madhesh Province, Nepal.
 Materials and Methods: This was a descriptive cross-sectional study of patients who received root canal treatment in the Department of Conservative Dentistry and Endodontics, National Medical College, Birgunj, Nepal between September 2022 and February 2023.The demographic and clinical data of patients were recorded and statistical analysis was performed using SPSS version 24. Association between the variables was analyzed by Fischer exact tests. P-value<0.05 was considered as statistically significant.
 Results: 206 patients who received root canal treatment participated in this study. More mandibular teeth (53.9%) were root-treated compared to maxillary teeth (46.1%). The first molars constituted the most prevalent root-treated teeth (43.7%), followed by the second molars (26.7%) and the central incisors (10.7%). The most common chief complaint was pain (66%) and caries (75.7%) was the most frequently encountered pathology. The association of age category and dental arch with the type of root-treated teeth was statistically significant (p < 0.001 and p <0.004 respectively).
 Conclusion: Irreversible pulpitis caused by caries was the predominant indication for root canal treatment, with pain being the most common presenting complaint. The demand for treatment was higher in females and among patients within 21-40 years age category. More teeth from the mandibular arch were root-treated while the first molar was the most frequently treated tooth.

Influence of technical quality and coronal restoration on periapical health of root canal treatment performed by Malaysian undergraduate students

Introduction: Root canal treatment (RCT) and its coronal restoration should be regularly assessed to ensure a successful treatment outcome. The aim of the current study is to evaluate the relationship between the obturation technical quality and coronal restoration in the clinical and radiographic outcome of RCT provided by Malaysian undergraduate students. Materials and Methods: A total of 143 root-treated teeth from 136 patients were evaluated through clinical examinations and periapical radiographs with a mean follow-up period of 2.4 (standard deviation = 1.59) years. The quality of the coronal restoration was classified according to modified United States Public Health Service criteria and the technical quality of the obturation was assessed based on two variables: length and density. Periapical status was evaluated according to periapical index scores. Results: About 64% of the teeth were classified as healthy with a significant reduction of apical periodontitis from 70.3% preoperatively to 36% at reassessment (P < 0.001). About 92.1% of obturation was of acceptable length, whereas 5% underfilled and 2.9% overfilled. Teeth with acceptable obturation length were five times less likely associated with apical periodontitis than the inadequately filled ones. 90% of canals had adequate obturation density with no significant association to apical periodontitis. Teeth restored with intracoronal restorations had 50% more chance of developing apical periodontitis. Inadequately restored teeth and teeth with poor obturation quality were associated with three times more likely apical periodontitis occurrence. The quality of endodontic treatment and the coronal restoration significantly influenced the periapical status (P < 0.001). Conclusion: The radiographic obturation quality and coronal restorations of the RCTs performed by the undergraduate students in a Malaysian public dental school were acceptable in 63.8% of cases with a 64% favorable outcome.

Radiographic periapical healing associated with root-treated teeth accessed through existing crowns: a historical controlled cohort study.

The aim of this study was to determine the periapical healing rate and complications arising from non-surgical root canal treatment (NSRCT) conducted through the existing and retained restoration, compared to that conducted after removal of restoration (direct or indirect) with subsequent placement of a new crown. Two-hundred-and-forty-five teeth met the inclusion criteria and were followed up for 2 years. One-hundred-and-six teeth had NSRCT completed through existing cast restorations, and 57 and 82 had the existing crowns and direct restorations removed (respectively) and received a new crown after NSRCT. Periapical healing was assessed radiographically using strict (complete healing) and loose (complete and incomplete healing) criteria. Multivariable logistic regression models were used to investigate the effect of prior restoration removal on periapical healing following NSRCT, adjusting for potential confounding (p < 0.05). There was no significant (p > 0.05) difference in the periapical healing rates amongst teeth accessed through existing crowns (72%, 90%) versus those where crowns (79%, 93%) or direct restorations (77%, 90%) were removed for NSRCT. The findings were adjusted for the significant influencing factor: size of pre-operative radiolucency (p < 0.05). Of the 109 teeth that were initially accessed through existing crowns, 9 (8%) displayed porcelain fracture or crown de-cementation. Performing root canal treatment through an existing full coverage restoration did not compromise periapical healing and was associated with a low incidence of associated complications. Crown removal before NSRCT is not mandatory for periapical healing but requires a judicious pre-assessment of current and future marginal and restorative integrity.

Complexity of root canal treatment: Evaluation of cases using the restorative index of treatment need system: A descriptive cross sectional study

Introduction: The complex anatomy of the root canal system, the challenging oral environment as well as some patient factors tend to pose challenges to realizing endodontic treatment goals. The aim of this study was to evaluate the complexity of root canal treatment using the Restorative Index of Treatment Need (RIOTN) system. Materials and Methods: This was a descriptive cross-sectional study of patients who received endodontic treatment between May 2018 and July 2019. The data obtained were medical history, tooth for endodontic treatment, and clinical and radiographic findings. The RIOTN system was applied to grade the complexity of root canal treatment. All data garnered were statistically analyzed using IBM SPSS software. Results: The sample population consisted of 114 patients with 124 root-treated teeth. In all, 12.9% of the teeth were graded as complexity Grade 3, 14.5% as Grade 2, and 72.6% as Grade 1. Modifying factors were present in 13.7% of the teeth, with the most prevalent modifying factor being endodontic re-treatment. There was no statistically significant association between number of roots of the teeth and complexity grade (P = 0.57). Conclusion: It is important to grade the complexity of teeth in order to predict the prognosis of treatment and decide whether it is within one's proficiency.

Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: journey from splinted metalloceramic prosthesis to all-ceramic crowns

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible.

Operational specification for clinical use of dental intraradicular fiber post

Fiber-reinforced resin composite posts (fiber posts) are used extensively for the restoration of root-treated teeth with excessive loss of coronal structure. However, the longevity of a fiber post restoration still needs to be improved because of the various confounding factors that affect bonding procedures. Operational specification for clinical use of dental intraradicular fiber post was established based on the in-depth discussions by a panel of experts from Society of Prosthodontics, Chinese Stomatological Association. This specification should be helpful in standardizing the clinical technique of fiber post placement and improving the clinical longevity of a fiber post restoration.

Posttreatment endodontic disease among patients seeking treatment at a referral dental hospital in Kenya

Background: The incidence of postendodontic treatment disease has equally increased in prevalence among patients with previous root-treated teeth. Objective: This study aimed at determining the characteristics of post-treatment disease following endodontic treatment. Materials and Methods: This was a descriptive cross-sectional study. Convenience sampling was used to select periapical radiographs of patients who needed treatment of teeth with previous root canal treatment. Data were analysed using SPSS. Study Benefits: This research will aid in the development of realistic, evidence-based oral health care policies that could be integrated into general health care within the region. Results: A total of 42 patients participated in the study with 54 teeth presenting with posttreatment endodontic disease (PTEDx). The ages of most patients were distributed in the range of 31–40 years with maxillary molars (25.9%) being the most commonly affected teeth. Thirty-nine (72.2%) teeth were asymptomatic, whereas 15 (27.8%) were associated with pain of varying severity. Well-defined radiolucent lesions were present in 59.3% of the cases, whereas 74.1% of the teeth presented with voids. Inadequate root-filling length (79.6%) appeared to be the most common characteristic of PTEDx. Conclusion: Posttreatment disease in this sample presented with the comparatively high substandard technical quality of root fillings and restorations. Recommendations: Academic institutions teaching dentistry and related authorities should collaborate managing this problem of posttreatment disease judiciously. Technical skills, technology, and performance of root canal filling procedures should be emphasized, and suitable methods should be developed in order to achieve better treatment outcomes. Further studies should be done to establish the challenges that lead to substandard root canal treatment.

Value of root-filled teeth in maintaining a functional dentition for life.

The purpose of this article is to draw attention to the strategic goals of planning for a functionally and aesthetically optimal dentate quality of life, and the role that teeth maintained through root canal treatment can play in such a plan. The perception that root-treated teeth should largely, and wherever possible, be discarded as a viable option is a seriously flawed judgment. The utility of root-treated teeth must be properly and critically discriminated as they can play a significant role in the long-term plan, despite having unique characteristics that must be accounted for.

Dental practice in the UK in 2015/2016. Part 3: aspects of indirect restorations and fixed prosthodontics.

This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials. The data presented were extracted from the data obtained from a validated,121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. A response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material. Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pinscontinued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry.

Effect of Preparation Design on Fracture Resistance and Failure Mode of Root Canal Treated Maxillary Premolars Restored with Onlay Restorations

Purpose: Cusp fractures are among the major reasons for the extractions of root-treated teeth. With the intention of increasing information about the mechanical behavior of minimally invasive cusp coverage restorations, the aim of current study was to evaluate the fracture resistance and failure modes of endodontically treated maxillary premolars restored with onlays employing various cusp reduction designs (anatomic, horizontal and beveled) to identify the optimum design and to assess whether these designs influence the restorable fracture rate.Materials and methods: Fifty defect-free maxillary premolar teeth were divided into 5 groups: onlay with anatomic occlusal reduction design (OA), onlay with horizontal occlusal reduction design (OH), onlay with beveled occlusal reduction design (OB), full-coverage crown (CR) and non-restored sound teeth (NR). In OA, OH, OB and CR groups, the access cavities were sealed using bonded composite after endodontic treatment. For OA, OH and OB groups, cusps were prepared with anatomic, horizontal and beveled designs. Except for NR group, all teeth were restored with resin-infiltrated ceramic restorations. After thermal aging for 10000 cycles between 5°C and 50 °C, all specimens were submitted to compressive axial load at a crosshead speed of 1 mm min-1 till failure. The data were analyzed using ANOVA test.Results: The highest load to fracture values (N) was recorded in control non-restored group (1657±167.7N), followed by CR, OA, OB and OH groups where the mean values were 887.5±40.3, 789.4±54.8, 722.2±46.2 and 634.8±74.2N respectively. Significant differences were found among fracture values of test groups (p<.05). The intact teeth predominantly fractured with favorable fracture patterns followed by CR group; while both OB and OH groups showed the heights non-favorable pattern of fracture. Group OA represented moderate percentage of favorable fracture.Conclusions: Root treated teeth restored with anatomic cusp reduction design displayed greater fracture resistance and greater rates of restorable fractures than root treated teeth submitted to horizontal and beveled reduction deigns.

Pattern of Endodontic Treatment among Nigerian Adults: A Single Centre Study

Objective: To determine the pattern and frequency of root canal treatments (RCTs) performed among patients seen at a tertiary hospital in North-eastern Nigeria. Material and Methods: A retrospective epidemiological survey using hospital records of patients that had RCTs done over a 5-year period. Case record forms (CRFs) were used as tools of data collection from patient records to record demographic and clinical information such as age, gender, tooth involved, diagnosis and tooth treated. Students t test and One-way analysis of variance (ANOVA) were used to compare mean root-treated teeth by gender and age group respectively. Results: A total of 321 RCTs were carried out on 256 patients, ranging from 1 to 4 teeth (mean, 1.3 ± 0.6 [SD]) teeth per patient. The frequency and mean number of RCTs carried out were not significant for age (p = 0.16) and gender (p = 0.78). The lower first molar was the most root-treated tooth (20.9%), and overall, dental caries (84.4%) was the most predominant etiology of pulpal and periradicular disease necessitating RCT. Forty-two percent of the RCTs were carried out due to acute apical periodontitis. Conclusion: Gender and age group did not affect the frequency of RCTs performed, and majority of the root canal treatments were due to dental caries and its sequelae.

Technical Quality of Root Canal Treatment Performed by Undergraduate Clinical Students of Isfahan Dental School.

Introduction:The aim of the present study was to evaluate the radiographic quality of RCTs performed by undergraduate clinical students of Dental School of Isfahan University of Medical Sciences. Methods and Materials:In this cross sectional study, records and periapical radiographs of 1200 root filled teeth were randomly selected from the records of patients who had received RCTs in Dental School of Isfahan University of Medical Sciences from 2013 to 2015. After excluding 416 records, the final sample consisted of 784 root-treated teeth (1674 root canals). Two variables including the length and the density of the root fillings were examined. Moreover, the presence of ledge, foramen perforation, root perforation and fractured instruments were also evaluated as procedural errors. Descriptive statistics were used for expressing the frequencies of criteria and chi square test was used for comparing tooth types, tooth locations and academic level of students (P<0.05). Results:The frequency of root canals with acceptable filling was 54.1%. Overfilling was found in 11% of root canals, underfilling in 8.3% and inadequate density in 34.6%. No significant difference was found between the frequency of acceptable root fillings in the maxilla and mandible (P=0.072). More acceptable fillings were found in the root canals of premolars (61.3%) than molars (51.3%) (P=0.001). The frequency of procedural errors was 18.6%. Ledge was found in 12.5% of root canals, foramen perforation in 2%, root perforation in 2.4% and fractured instrument in 2%. Procedural errors were more frequent in the root canals of molars (22.5%) than the anterior teeth (12.3%) (P=0.003) and the premolars (9.5%) (P<0.001). Conclusion:Technical quality of RCTs performed by clinical students was not satisfactory and incidence of procedural errors was considerable.

Complications of an ageing dentition part 3: overview and case report

This is the third, and final, part of this three-part series. The first paper discussed the occlusal and cracked tooth aetiological factors which may be responsible for restoration failure. The second paper discussed the restorative options with regards to cracked and root-treated teeth. This paper will provide an overview of the previous two papers and conclude with a case report. CPD/Clinical Relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case is the same. Therefore, a competent diagnosis and implementation of the most appropriate, minimally invasive treatment option requires an adequate knowledge of current literature.

Complications of an Ageing Dentition Part 1: Occlusal Trauma and Cracked Teeth.

A growing problem in dentistry is complications associated with failing amalgam restorations that have been in place for many years. At present, there is a wide variety of treatment options available in the clinician’s armamentarium when this situation arises, however, without the correct diagnosis, the prognosis for the tooth may quickly diminish, despite the clinician’s best efforts. A confusing array of symptoms and failures may confound even the most experienced dentist, which will inevitably lead to invasive and time consuming approaches in a desperate attempt to rectify the initial problem. This paper, the first part of a three-part series, discusses the possible aetiological factors responsible for restoration failure, including occlusal issues and cracks within the tooth structure. The second part of the series will focus on restorative options and root-treated teeth. The third, and final, part of the series will provide an overview of the previous papers and conclude with a case report. Clinical relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case presents in the same way. A competent diagnosis regarding the occlusion and tooth structure, followed with implementation of the most appropriate, minimally invasive treatment option, requires an adequate knowledge of current literature.

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.

The detection of periapical pathoses in root filled teeth using single and parallax periapical radiographs versus cone beam computed tomography – a clinical study

To clinically assess the diagnostic yield from single parallel periapical, two parallax radiographs and cone beam computed tomography (CBCT) by comparing the prevalence of periapical lesions associated with individual roots, and the total number of root canals in root-treated teeth in patients referred for root canal retreatment. Single and parallax periapical radiographs, and CBCT scans, were taken of 100 teeth in 78 patients who had been referred for root canal retreatment. The presence of a periapical lesion associated with each specific root and the number of identifiable root canals were assessed using each imaging modality by a consensus panel of two examiners. The number of root canals was confirmed using the dental-operating microscope during treatment. In addition, the panel was asked to decide whether they felt they had adequate information to manage each case. A total of 209 paired roots were assessed for periapical lesions. Lesions were identified in 41%, 38% and 68% of paired roots when using single radiographs, two parallax radiographs and CBCT respectively. The number of root canals identified were 186, 218, 242 and 239 when using parallel, parallax, CBCT and the dental-operating microscope, respectively. CBCT detected significantly more periapical lesions and root canals than both single and parallax periapical radiographs. There was no significant difference between CBCT and the clinical microscope in the identification of root canals. Whilst two parallax radiographs detect significantly more root canals than a single radiograph, they did not increase detection of periapical lesions when compared to a single periapical radiograph.

Long-term outcome of non-surgical root canal treatment: a retrospective analysis

This study investigated the long-term clinical outcome of root canal treatment. 240 root-treated teeth (n = 61 patients) were initially classified on the basis of radiographic presence/absence of initial apical periodontitis (IAP) and clinical data. The final outcome measure was the periapical healing (healed/disease). The outcome at 6-9 months was correlated with the outcome at 10 years following treatment. Prognostic factors for the periapical healing were assessed. Extraction data were recorded. Univariate and multivariate logistic regression analysis was used to identify risk indicators for apical periodontitis (AP) development. Chi-square analysis was performed to evaluate a possible relationship between the 6-9 months outcome and the final outcome related to IAP. Mean observation time was 14 ± 3.7 years. Survival rate was 84.6% and healing rate was 79% (10-19 years). Predictors of outcome (p < .05) were considered statistically significant. Multivariate logistic regression analysis showed that initial pulpal and periapical status and the quality of root canal filling as assessed two-dimensionally were independent predictors of outcome. The 6-9 months evaluation appears to be an indicator for the final outcome of primary root canal treatment both in the presence and in the absence of IAP. An initial radiolucency associated with an unsatisfactory quality and extent of root canal filling significantly diminishes the possibility of achieving long-term radiographic success. For those with uncertain healing at 6-9 months (91%), clinicians should consider the high healing rate when estimating the prognosis and adjust the decision making accordingly.

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.

Relationship of root canal treatment to C-reactive protein as an inflammatory marker for cardiovascular disease

Periodontal disease and elevated C-reactive protein (CRP) tests both are positively correlated with cardiovascular disease (CVD) in many studies. Some health practitioners have concerns that root canal treatment may provide a source for inflammation and hence increase the risk for CVD. To explore the relationship between CRP as a marker of inflammation and presence and number of root canal treatments in primary care patients. Cross-sectional questionnaire about dental care followed by a blood test for serum CRP in patients from two New Zealand urban family practices. One hundred and 34 patients participated. The study showed no significant association between CRP and root canal treatment on multivariate analysis controlling for socioeconomic status, age, gender and smoking. The CRP level for those with > or = 3 root-treated teeth was 1.68 while the level for those with < 3 was 2.36, but the p-value was not statistically significant (p = 0.198). Age, missing teeth and smoking were all significantly related to CRP levels so the sample has biological validity. Root canal treatment was not associated with higher CRP levels. The CRP levels were non-significantly lower in those with higher numbers of root-treated teeth. While there are a number of potential biases in this paper, the dataset appears to be biologically valid and consistent with known facts. These findings do not support the hypothesis that root canal treatment is associated with higher levels of inflammation. At this point patients should not consider having their root canal teeth removed.