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 »  Home  »  Endodontic Articles 3  »  Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation
Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation
Introduction - Materials and methods.



Y. Boucher, L. Matossian, F. Rilliard & P. Machtou
Unite de Formation et de Recherche (UFR) d’Odontologie de l’Université Paris 7, Service d’Odontologie de l’Hôtel Dieu, AP-HP, Paris, France.

Introduction.
The success rate of root canal treatment is a public health problem that has medical, economic, and ethical repercussions. The establishment of treatment objectives, the codification of procedures and the improvement of techniques enable the modern practitioner to expect a high success rate (Strindberg 1956, Kerekes & Tronstad 1979, Byström et al . 1987 Sjögren et al . 1997). However, these high rates of success were obtained with well-trained practitioners under strict operating conditions that do not reflect the situation found within the average dental clinic. Therefore, in order to evaluate the endodontic status of populations rather than that of controlled patient groups, numerous studies have focused on the prevalence and quality of root canal treatment. Various studies from Sweden reported that the prevalence of endodontic treatment was about 13% of teeth (Petersson et al . 1986, Eckerbom et al . 1987). Many subsequent studies published in international journals substantiated these initial findings, both in Europe (Allard & Palmqvist 1986, Ödesjö et al . 1990, Imfeld 1991, Eriksen & Bjertness 1991, De Cleen et al . 1993, Eriksen et al . 1995, Soikkonen 1995, Saunders et al . 1997, Weiger et al . 1997, Marques et al. 1998, De Moor et al . 2000) and in the USA (Buckley & Spångberg 1995).
Overall, these reports indicated that the prevalence of root canal treatment varies from 1.3% to 20% and increases with age (see De Moor et al . 2000 for review). They also show that when these root canal treatments are evaluated radiographically, they are judged to be insufficient, in a large proportion of cases (Ödesjö et al . 1990). In addition, 18 to 61% of the cases were associated with radiographic signs of periapical lesions.
Studies which attempt to analyse the prevalence and quality of root canal treatment in France are rare and consist of internal studies of the Caisse Nationale d’Assurance Maladie (CNAM) (Gérard 1989, Hess & Mace 1994). They indicate a high prevalence of periapical lesions associated with root canal treatment and confirm the high demand for retreatments experienced by specialized endodontic practitioners. In view of the potential local and general consequences of periapical pathology (Simon 1998), it is important to gather data about the endodontic status of the population.
The aim of this study was to determine the prevalence and assess the quality of root canal treatment in a sample of the French population.

Materials and methods.
The sample consisted of patients seeking treatment at the dental service of the Hôtel Dieu, in Paris. The criteria for inclusion in the study were that the patients should be attending for the first time, had no dental treatment during the previous year, had not been referred by colleagues and must not have consulted the dental service for orthodontic reasons. The patients were at least 18 years old, and were accepted in the order of their attendance during a period of 1 year. A student strike interrupted data collection for 3 months. The scientific committee of the Dental Faculty approved the study, and patient anonymity was strictly respected.
Periapical radiographs were taken by two experienced radiographers using the long-cone paralleling technique with Rinn angulators. Double Kodak Ektaspeed Plus films (Kodak, Rochester, NY, USA) were used, which were automatically developed and fixed (XR24, Dürr Dental, Germany), and then mounted on black holders. The X-ray films were then evaluated by four examiners, divided into two groups of two, with negatoscope light using a magnifier ( 2) and the Mattson viewer (Mattson 1953) in difficult cases. The examiners were three members of the Restorative Dentistry and Endodontics Department who participated in the predoctoral and postgraduate endodontic teaching programmes of the Dental School, and a resident in the last year of study who was trained both in endodontics and in the analysis of radiographs. The scoring system proposed by Ørstavik et al . (1986) was used for evaluating the periapical conditions of each root. Two sessions, with a one-month interval between them, were spent in calibrating the examiners before radiographic analysis. The radiographs were examined in a two-month period in order to limit the variations between observers. To reduce these variations to a minimum, the radiographs were systematically examined by both observers of each group (Reit & Hollender 1983, Reit & Gröndahl 1983).
For each tooth and root the following items were surveyed: the presence of intracoronal or extracoronal (crowns) restorations; the presence of a root filling; the presence of posts; the periapical status (PAI 1–5). A score greater than 2 (PAI > 2) was considered to be a sign of periapical pathology (Ørstavik et al . 1986). The quality of root canal treatment was evaluated according to the density of the filling and the distance between the end of the filling and the radiological apex. A filling without any voids or defects along the walls of the canal and located between 0 and 2 mm from the radiographic apex, was considered to be an acceptable filling.
Observations of the teeth and the roots were analysed using the Excel® (Microsoft Corporation, Redmond, WA, USA) software. The chi-squared test was used to determine if the periapical status was affected by the technical quality of the root filling and the type of coronal restoration.