Radiographic Parameters of Quality of Root Canal Fillings and Periapical Status: A Retrospective Cohort Study

Influence of post type on periapical status: a prospective study in a Brazilian population

OBJECTIVES

This prospective study assessed the effect of post type used to restore endodontically treated teeth in the onset, progression, and remission of periapical lesions.

MATERIALS AND METHODS

One hundred and forty teeth (92 patients) were endodontically treated and received a glass fiber post or a cast metal post and a final restoration at a University Clinic by undergraduate students. All patients were followed up for a mean period of 5.1 ± 2.2 years. Periapical Index (PAI) was used for endodontic assessment. Two calibrated and blind examiners assessed the radiographs. The longevity of the endodontic treatment was analyzed using Kaplan-Meier statistics.

RESULTS

Of the included teeth, 67.1% received glass fiber posts while 32.9% received cast metal posts. There were 4 endodontic failures, two glass fiber posts with a PAI = 3 in the baseline and PAI = 4 in the last follow-up, and one PAI = 4 in baseline and last follow-up. One cast metal post-failure was PAI = 4 in the baseline and the last follow-up. After 9.4 years, the overall success rate of the endodontic treatment was 97.1% (p = 0.7).

CONCLUSIONS

The tested posts presented similar endodontic healing. Precautions taken during endodontic therapy, post cementation, and final restoration are more likely to be responsible for the success of endodontic treatment rather than a specific type of post. Clinical relevance The type of post is not related to the success of the endodontic treatment.

The Radiological Assessment of Root Features and Periodontal Structures in Endodontically Treated Teeth Subjected to Forces Generated by Fixed Orthodontic Appliances. A Prospective, Clinical Cohort Study

The various side effects of orthodontic treatment with fixed orthodontic appliances (FOAs) and their impact on apical and periodontal structures have been widely reported. However, the existing data is not yet conclusive. Aims and objectives: To investigate the status of roots and periodontium in endodontically treated teeth that have undergone orthodontic treatment with the use of FOAs and to evaluate their impact on apical/periodontal structures. Material and methods: The prospective clinical cohort study initially involved 69 participants aged 16–40, without underlying systemic conditions, who received orthodontic treatment with ligatureless FOA systems due to different types of mild and moderate malocclusions. To meet the required criteria, 88 teeth in 34 patients were assessed clinically and radiologically. Participants had at least one tooth treated endodontically while the corresponding tooth from the same anatomical group on the opposite side was vital and intact (a ‘split-mouth’ approach). Four cohorts were allocated: Group IA consisted of 15 teeth, treated utilising the principles of modern endodontics, that were subjected to orthodontic forces no less than six months after completing the root canal obturation. Group I consisted of 13 similarly endodontically treated teeth, which commenced orthodontic treatment at least six months after the completed endodontic therapy. Group II contained 16 teeth treated by conventional endodontic methods and the control group, Group III, contained 44 clinically and radiologically intact teeth (incisors and premolars) with vital and sound dental pulp. The response of apical and periodontal structures to FOAs was determined by data collected from intraoral periapical radiographs taken within the course of five consecutive appointments during the orthodontic treatment. Results: No statistically significant differences were observed in susceptibility to FOA-induced external apical root resorption (EARR) between combined Groups IA + IB and II. An association was, however, demonstrated, between the occurrence of EARR and the degree of expansion of the periodontal ligament (PDL) space, regardless the method of root canal treatment. Cumulative data revealed a positive correlation between the width of the PDL space and the stage of FOA treatment (the third and the fourth appointment). The subtle changes in radiological length of roots have been observed (min 0 mm/max 0.38 mm), particularly between the second and third appointment in Group II (p < 0.05). Conclusions: The standard orthodontic therapy with FOAs is a safe option with predictable outcome for persons who have recently received endodontic therapy. The anterior teeth, predominantly incisors, were more susceptible to minimal EARR than premolars, which suggests that the rate of EARR occurrence may depend upon the original morphology of the apical portion of the root. The use of additional orthodontic forces increases the risk of EARR and is associated with a higher incidence of radiologically detected PDL space widening.

Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: A randomized controlled pragmatic clinical trial

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.

Effectiveness of a reciprocating single file, single cone endodontic treatment approach: a randomized controlled pragmatic clinical trial

OBJECTIVES

To compare the root filling quality, the sealer extrusion, and the healing rates of apical lesions addressed via two endodontic treatment approaches. The hypothesis tested was that both techniques present similar apical periodontitis healing results.

MATERIALS AND METHODS

This study was a parallel-design, pragmatic, and randomized clinical trial. One hundred twenty anterior teeth with necrotic pulps and apical periodontitis were randomly allocated to be either instrumented with hand files and obturated with the lateral compaction technique or instrumented with a single file in a reciprocating movement and obturated with a single-cone technique. The root canal filling quality, the occurrence of sealer extrusion, and apical periodontitis healing were the outcomes of interest. Data were analyzed through chi-square analysis, and the odds ratio for healing was adjusted using a logistic regression model (α = 0.05).

RESULTS

No significant differences were observed between the endodontic techniques regarding the root filling quality or sealer extrusion. Six months after treatment, both endodontic techniques presented equivalent results regarding apical periodontitis healing. The healing rate was affected only by the periapical status at baseline.

CONCLUSIONS

The obturation of the root canal of the anterior teeth using reciprocating file-matched single cones presented a similar quality to that obtained with manual instrumentation followed by the lateral condensation technique. Similar healing rates of apical lesions were also observed.

CLINICAL RELEVANCE

For treating anterior teeth with apical periodontitis, a reciprocating single-file, single-treatment protocol was as effective as a traditional protocol combining hand instrumentation and the lateral compaction obturation technique.

Categorización del fracaso para el tratamiento endodóntico primario

Objetivo: caracterizar la enfermedad periapical posterior al tratamiento endodóntico primario realizado en una cohorte de individuos asistentes a las clínicas de la Especialidad en Endodoncia de la Facultad de Odontología de la Universidad Nacional de Colombia. Métodos: se realizó un estudio observacional retrospectivo en una muestra de 232 dientes con tratamiento endodóntico primario, procedentes de 155 individuos. Un análisis de frecuencia estimó la prevalencia entre la presencia de enfermedad periapical y las siguientes covariables: sexo, edad, tipo y localización del diente, diagnóstico previo, condiciones del tratamiento endodóntico, y tipo de restauración. Resultados: se registró un 24% de prevalencia de enfermedad periapical en la población observada. De este porcentaje, el 13,7% fue categorizado como EPE y el 10,3% fue categorizado como EPP. La distribución por sexo fue de 59% para mujeres y 41% para hombres, con promedio de edad de 55,8 años. La prevalencia de la enfermedad fue mayor en molares (44%) y el diagnóstico pulpar más frecuente fue necrosis pulpar (34%). El 20% de los tratamientos analizados presentó longitud de obturación corta y, de ellos, el 54,3% se asoció con aparición de la enfermedad. Conclusiones: la longitud de obturación corta resultó ser el factor que registró mayor relación clínica con la aparición de la enfermedad. Se reconoce a la EPE como el verdadero fracaso del tratamiento endodóntico primario.

Impact of orthodontic treatment on the integrity of endodontically treated teeth

AIM

The purpose of this study was to evaluate the periapical status of endodontically treated teeth and the integrity of endodontic treatment before and after orthodontic treatment.

MATERIALS AND METHODS

This retrospective study was conducted by evaluating 128 teeth with root canal treatment (RCT). The teeth were obtained from 72 patients (23 males, 49 females) who had undergone fixed orthodontic treatment. Panoramic radiographs were taken and were evaluated before the start and after the completion of orthodontic treatment. Apical periodontitis (AP) was evaluated by the periapical index (PAI) and the probability index (PRI) of periapical bone destruction. Other variables related to the quality of root canal fillings were included, such as RCT quality index, length, and homogeneity, and coronal restoration.

RESULTS

According to the PRI, the proportion of teeth with periapical bone destruction was significantly higher after orthodontic treatment. Overall, there was no significant change in the PAI scores after orthodontic treatment. However, the quality of the endodontic treatment moderated the change in the PAI score, as well as the change in the PRI. There was no significant increase in PAI and PRI scores after orthodontic treatment for adequately treated teeth. However, the risk for periapical lesions and bone destruction after orthodontic treatment was significantly increased for teeth receiving inadequate endodontic treatment compared with those receiving adequate endodontic treatment.

CONCLUSION

Increased PAI and PRI after orthodontic treatment correlated with the quality of endodontic treatment.

Impact of room lighting and image display device in the radiographic appearances of the endodontic treatments

OBJECTIVES

To assess the radiographic appearances of the endodontic treatment in different room lighting conditions and image display devices.

METHODS

After approval by Research Ethical Board, 20 images were obtained from blocks with one endodontically treated tooth. Of the 20 endodontic treatments conducted in the laboratory, of those the randomly selected 10 teeth (50% of sample) received some quality defect in three parameters-apical limit, adaptation to root canal and homogeneity of the root canal filling material. Digital radiographs (DIGORA® Optime, Soredex, Milwaukee, WI) were obtained, which were evaluated (8 times) by 10 observers in two different conditions of room lighting, with bright (1000 to 1200 lux) and dim light (25 to 50 lux), using two different image display devices, smartphones and laptop computers. The observers assessed the radiographic appearances of the endodontic treatment with respect to quality of each one of three parameters individually. The data of observers' responses in terms of the quality of each parameter were statistically compared using Cronbach's α coefficient, diagnostic tests, π coefficient and ANOVA with Tukey tests, at a significant level setting of 5% (α = 0.05).

RESULTS

The mean of reliability of observer responses ranged from 0.89 (intra-evaluator) to 0.66 (inter-evaluator). The mean values of the receiver operating characteristic (ROC) area were 0.661 (PD = 0.098), with laptop in bright lighting appraising homogeneity of the root canal filling material on the worst performance (ROC area = 0.57), which was statistically significant (p < 0.05), and 0.81 with laptop in dim lighting appraising apical limit on the best performance. Differences (p < 0.05) occurred mainly among parameters used for assessment.

CONCLUSIONS

Room lighting and image display devices have very little influence in the radiographic appearances of the endodontic treatment. Thus, we suggest the use of smartphones as an acceptable image display device in daily clinical practice in routine bright lighting conditions.

Apical periodontitis in southern Estonian population: prevalence and associations with quality of root canal fillings and coronal restorations

Background

Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root. Reported prevalence of AP ranges from 27% to 83% while the data about most post-Soviet countries are still missing. Knowing the prevalence of AP within a certain population helps to plan the treatment need and evaluate the success of endodontic interventions. We aimed to collect data about prevalence and determining factors of AP for the first time in Estonia.

Methods

The cross-sectional study included 6552 patients (age 35.5±19.2 years). Radiographic examination was applied to investigate the prevalence of AP and quality of endodontic treatment.

Results

AP was diagnosed in 54.7% of subjects. Endodontically treated teeth were present in 58.2% of subjects. Periapical finding was present in 44.6% of endodontically treated and in 30.8% of untreated teeth.

Out of 181,495 teeth, 52.7% were intact. AP was diagnosed in 6.3% of teeth, 6.9% of teeth were endodontically treated.

Risk factors for AP included caries (OR = 2.30), male gender (OR = 1.44), too short (OR = 1.76) or too long root canal filling (OR = 2.51), root canal filling of low density (OR = 1.61) while not orthodontic appliance. Lower AP risk was associated with restoration of the tooth – filling (OR = 0.45), crown (OR = 0.34) and bridge (OR = 0.33).

Conclusions

AP is highly prevalent in Southern Estonian population. Most cases are associated with root canal-treated teeth. The overall quality of root canal fillings tends to be low, consistent with the mediocre outcome of treatment. Considerable efforts are required to improve the standards of endodontic treatment.

Electronic supplementary material

The online version of this article (10.1186/s12903-017-0429-7) contains supplementary material, which is available to authorized users.

Factors Affecting the Periapical Status of Root-Filled Canals: A Cross-Sectional Study at the Undergraduate Level

OBJECTIVE

The aim was to evaluate the influence of multiple factors on the periapical status of endodontically treated (ET) teeth.

METHODS

The patients were clinically and radiographically reevaluated after root canal therapy. The quality of the root-filled canals, coronal restorations, intraradicular posts, dental caries, and periodontal parameters were associated with the teeth's periapical status.

RESULTS

The 122 patients provided 154 ET teeth; 97.4% teeth were asymptomatic, and 75.5% had a normal periapical status. The percentage of perfect, satisfactory, and deficient root-filled canals was of the order of 41.6%, 46.1%, and 12.3%, respectively. The percentage of adequate and inadequate coronal restorations was 31.2% and 68.8%, respectively. A total of 14.9% teeth had intraradicular posts, and 29.2% had cavitated carious lesions in the dentin. Gingival bleeding was observed in 31.8% of teeth, and dental biofilm was visible in 58.4%. A total of 11.7% showed pathologic tooth mobility, and 22.1% teeth were diagnosed with periodontal disease.

CONCLUSIONS

Carious lesions, gingival bleeding, and tooth mobility were significantly associated with the occurrence of periapical lesions in root-filled canals.

Radiological, stereological, and microscopic evaluation of the quality of canal fillings in oval-shaped root canals prepared with self-adjusting file

The aim of this study was to evaluate the quality of the canal fillings performed by thermoplastic technique (Herofill) and cold lateral condensation (CLC) techniques in oval shaped canals following self-adjusting file (SAF) preparation using radiological, stereological, and microscopic evaluation methods. Twelve pairs of oval-shaped root canals were prepared with SAF and filled using CLC (n = 12) or the Herofill system (n = 12). The quality of the root canal filling was evaluated by (i) scoring bidirectional storage phosphor plate images, (ii) stereological (volumetric) analysis of cone beam computerized tomography (CBCT) images, and (iii) microscopic analysis of the cross-sectioned area of the canal and gutta-percha via image analysis software. Chi-square test, t-test, and Mann-Whitney U-tests were used respectively (p < 0.05) for the aforementioned evaluations. 58.33% of the fillings (total n = 24) that were found to be sufficient in a bucco-lingual (BL) projection were considered insufficient in the mesio-distal (MD) projection according to radiological scoring. The difference in the findings between the two types of projections (BL and MD) was significant (p < 0.05). The results of the stereological evaluation of CBCT images and image analysis of cross-sections showed no statistically significant difference between the CLC and Herofill (p > 0.05). Herofill was not superior to cold lateral compaction. Stereology can be used to obtain unbiased information about the volume of root canal fillings. Both filling techniques failed to achieve the desirable goal of 0% empty volume in all of the cases and all evaluation systems confirmed this result. SCANNING 38:427-433, 2016. © 2015 Wiley Periodicals, Inc.

Evaluation of three different rotary systems during endodontic retreatment - Analysis by scanning electron microscopy

Background

Endodontic therapy is considered a series of important and interdependent steps, and failure of any of these steps may compromise the treatment outcome. This study aimed to evaluate the effectiveness of three different rotary systems in removing obturation materials during endodontic retreatment using scanning electron microscopy (SEM) analysis.

Material and Methods

Thirty-six endodontically treated teeth were selected and divided into 3 groups of 10 and 1 control group with 6 dental elements. The groups were divided according to the rotary system used for removing gutta-percha, as follows: G1: ProTaper system; G2: K3 system; G3: Mtwo system; and G4: Control group. Thereafter, the roots were split and the sections were observed under SEM, for analysis and counting of clear dentinal tubules, creating the variable “degree of dentinal tubule patency” (0: intensely clear; 1: moderately clear; 2: slightly clear; 3: completely blocked). The data were subjected to the Friedman and Kruskal-Wallis statistical tests.

Results

No differences were observed in the “degree of dentinal tubule patency” neither between the root thirds (to each evaluated group) nor between the groups (to each evaluated third). Nevertheless, when the three root thirds were grouped (providing evaluation of all root extension), the “degree of dentinal tubule patency” was lower in G1 than in G3 (p<0.05), but showed no differences neither between G1 and G2 nor G2 and G3.

Conclusions

No technique was able to completely remove the canal obturation material, despite G1 having shown better results, although without significant difference to G2

Key words:Scanning electron microscopy, NiTi, retreatment.

Progression of periapical cystic lesion after incomplete endodontic treatment

We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.

Assessment of endodontically treated teeth by using different radiographic methods: an ex vivo comparison between CBCT and other radiographic techniques

Purpose

To compare different radiographic methods for assessing endodontically treated teeth.

Materials and Methods

Root canal treatments were applied in 120 extracted mandibular teeth, which were divided into four groups: (1) ideal root canal treatment (60 teeth), (2) insufficient lateral condensation (20 teeth), (3) root canals filled short of the apex (20 teeth), (4) overfilled root canal treatment (20 teeth). The teeth were imaged using intraoral film, panoramic film, digital intraoral systems (CCD and PSP), CCD obtained with portable X-ray source, digital panoramic, and CBCT images obtained at 0.3 mm³ and 0.2 mm³ voxel size. Images were evaluated separately by three observers, twice. Kappa coefficients were calculated. The percentage of correct readings obtained from each modality was calculated and compared using a t-test (p<0.05).

Results

The intra-observer kappa for each observer ranged between 0.327 and 0.849. The inter-observer kappa for each observer for both readings ranged between 0.312 and 0.749. For the ideal root canal treatment group, CBCT with 0.2 mm³ voxel images revealed the best results. For insufficient lateral condensation, the best readings were found with periapical film followed by CCD and PSP. The assessment of teeth with root canals filled short of the apex showed the highest percentage of correct readings by CBCT and CCD. For the overfilled canal treatment group, PSP images and conventional periapical film radiographs had the best scores.

Conclusion

CBCT was found to be successful in the assessment of teeth with ideal root canal treatment and teeth with canals filled short of the apex.