Prevalence of apical periodontitis in endodontically-treated maxillary and mandibular posterior teeth in a Saudi Arabian population: a cone-beam computed tomography study

Evaluation and comparison of mandibular molar root canal filling quality performed by undergraduate preclinical dental students

The present study aims to evaluate the quality of root canal fillings (RCFs) on extracted mandibular molars performed by undergraduate students during their preclinical training which spans 2 academic years. Endodontics records and periapical radiographs of 260 extracted human first and second mandibular molars without site specification consisted the sample of this retrospective cross-sectional study. All root canal fillings were performed by undergraduate students during the preclinical phase of their training The samples collected were assessed using radiographs based on three quality criteria: length, density, and taper. Chi-square test was used for statistical analysis and Cohen's Kappa coefficient was implemented to assess inter-rater reliability. The majority of the evaluated RCFs were of inadequate quality. Of the 260 mandibular molars included in the study, 67 (25.8%) were deemed sufficient in terms of overall technical quality across both academic years. 3rd-year students (44.5%) were significantly more efficient compared to their 2nd- year counterparts (12.0%) regarding the overall technical quality of RCFs (p < 0.05). RCFs performed by the 3rd -year students, were of relatively higher quality compared with those performed by the 2nd-year trainees. However, the overall technical quality of RCFs was inadequate. Improvement of the current curriculum should be considered by incorporating contemporary techniques and materials to enhance the performance of undergraduate students on RCFs, before entering the clinical phase of their training.

Prevalence of Apical Periodontitis in Saudi Arabia: A Systematic Review and Meta-analysis

Objective

This systematic review was aimed to assess the prevalence of apical periodontitis (AP) in Saudi Arabia, focusing on individual-level prevalence and the frequency of AP in endodontically versus untreated teeth.

Methods

This review followed the PRISMA guidelines and involved searches in several databases, including PubMed-MEDLINE, Cochrane-CENTRAL, and EMBASE, without date restrictions until August 19th, 2023. Eligibility criteria encompassed studies using CBCT, panoramic, and periapical radiographs to diagnose AP in the Saudi population. The meta-analysis employed a random-effects model due to high heterogeneity among studies.

Results

From 359 records, 13 studies were included, indicating a 40% prevalence of AP in individuals and a 6% prevalence across all teeth within the Saudi population. Root canal-treated teeth demonstrated a higher prevalence at 47%. The data revealed a substantial prevalence of AP compared to global averages, with first molars being the most affected. Studies showed moderate risk of bias and significant heterogeneity.

Conclusion

The high occurrence of AP in Saudi Arabia, particularly in root-treated teeth, emphasizes the need for enhanced endodontic care and more accurate diagnostics. Urgent improvements in dental health policies and further research are essential to understand AP's impact and improve oral health outcomes.

Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects

The interest of the scientific community on sex and gender differences in health and disease has increased substantially over the past 25 to 30 y as a result of a long process of events and policies in the biomedical field. This is crucial as compelling evidence from human and animal model studies has demonstrated that sex and gender influence health, molecular and cellular processes, and response and predisposition to disease. The present scoping review aims to provide a synthesis of sex differences in oral diseases, ranging from periodontal disease to orofacial pain conditions, from risk of caries development to apical periodontitis. Overall, findings from this review further support a role for sexual dimorphism influencing disease predisposition and/or progression in oral diseases. Of note, this review also highlights the lack of consideration of additional factors such as gender and other psychosocial and external factors potentially influencing oral health and disease. New conceptual frameworks capable of capturing multiple fundamental domains and measurements should be developed in clinical and preclinical studies to inform sex-based individualized preventive and treatment strategies.

Cone-Beam Computed Tomography Assessment of Quality of Endodontic Treatment and Prevalence of Procedural Errors in Mandibular Molars

Objectives

This study assessed the quality of endodontic treatment and the prevalence of procedural errors in permanent mandibular molars using cone-beam computed tomography (CBCT).

Materials and Methods

This cross-sectional study was conducted on 328 CBCT scans (182 females and 146 males) of endodontically treated mandibular molars retrieved from the archives of two radiology centers in Ardabil city, Iran, in 2019. Mandibular molars were evaluated on sagittal, coronal, and axial sections regarding obturation length, obturation density (voids), missed canals, broken instruments, apical perforation, strip perforation, ledge formation, transportation, root fracture, root resorption, and periapical lesions by a senior dental student under the supervision of an oral and maxillofacial radiologist and an endodontist. Differences between the frequency of procedural errors and tooth type and gender were analyzed by the chi-square test.

Results

The frequency of underfilling, missed canals, overfilling, voids, apical perforation, transportation, ledge formation, broken instruments, root fracture, strip perforation, root resorption, and periapical lesions was 34.8%, 17.4%, 16.8%, 14.3%, 7.3%, 6.1%, 4.3%, 3%, 1.2%, 0.6%, 5.5%, and 46%, respectively. The frequency of root fracture was significantly higher in females than in males (P < 0.05). The prevalence of underfilling was the highest in right second molars (47.2%), followed by right first molars, left second molars, and left first molars (P < 0.005). The frequency of transportation was maximum in right first molars (10%), followed by right second molars, left first molars, and left second molars (P < 0.04).

Conclusion

Underfilling, missed canals, and overfilling were the most prevalent procedural errors in mandibular molars in our study population.

Prevalence of Periapical Radiolucency and Conventional Root Canal Treatment in Adults: A Systematic Review of Cross-Sectional Studies

Cross-sectional studies assess a population's health state and the prevalence of diseases or treatments. Few systematic reviews regarding the prevalence of periapical radiolucency (PARL) and nonsurgical root canal treatment (NSRCT) were conducted in the last decade. The goal of this study was to collect and review all updated and available cross-sectional studies that focus on the prevalence of both PARL and NSRCT in adult populations. It involves a systematic literature review of cross-sectional studies on the prevalence of PARL and NSRCT published from 1987 to 2022 in PubMed, Google Scholar, Web of Science, and Scopus with specific keywords used in the search process. A total of 52 articles were included in this systematic review. The majority of the included articles were from different populations. The overall prevalence of teeth with PARL was 43,522 (6.40%), while the prevalence of NSRCT teeth was 52,149 (7.67%). On the other hand, the overall prevalence of PARL in teeth that have received endodontic treatment and teeth that have not received endodontic treatment were 22,110 (3.25%) and 21,412 (3.15%), respectively. A meta-analysis was not performed due to underreporting of publication bias and the high degree of heterogeneity between studies. The overall risk of bias assessment revealed a low risk of bias in 25 (48%) of the included studies. The prevalence of NSRCT was higher at 7.67%, followed by PARL at approximately 6.40%. However, future studies are recommended to investigate the prevalence of both PARL and NSRCT in different patient populations.