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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 8  »  Periapical health related to the quality of coronal restorations and root fillings
Periapical health related to the quality of coronal restorations and root fillings
Introduction - Materials and methods.



G. M. G. Hommez, C. R. M. Coppens & R. J. G. De Moor
Department of Operative Dentistry and Endodontology, Ghent University, Dental School, Ghent University Hospital, Ghent, Belgium.

Introduction.
Follow-up studies on root-canal treatment (Grossman et al. 1964, Sjogren et al. 1990, Eriksen 1991, Friedman 1998) have reported the impact of the quality of the root-canal filling on the prognosis of root-canal treatment. In addition, several authors have described the importance of apical leakage on the treatment outcome of root-canal treatment (Strindberg 1956, Schilder 1967, Harty et al. 1970, Adenubi & Rule 1976, Ingle et al. 1985, Cohen & Burns 1998). The first to point out the effect of coronal leakage were Marshall & Massler (1961), although it was some time before this failure mode was discussed again in the literature (Swanson & Madison 1987).
Apical leakage is still considered as a factor in the failure of endodontic treatment, but in recent years, more attention has been paid to coronal leakage (Saunders & Saunders 1994). Several authors have reported that even with satisfactory root fillings, leakage of bacteria and bacterial products along the length of the root canal is inevitable (Swanson & Madison 1987, Torabinejad et al. 1990, Khayat et al. 1993, Trope et al. 1995). Recent radiographic studies have further investigated the importance of coronal leakage. Ray & Trope (1995) and Kirkevang et al. (2000) found that the technical quality of coronal restorations scored only on radiographs had a significantly greater impact on periapical health than the technical quality of the root filling. Tronstad et al. (2000) found that the technical quality of the coronal restoration was significantly less important than the technical quality of the root filling. It remains unclear whether radiographic evaluation is effective when assessing coronal leakage owing to the limitations of radiographs, or whether clinical inspection of the coronal restoration is also necessary.
No study has yet investigated the impact of the technical quality of coronal fillings radiographically and intraorally, and the technical quality of rootcanal treatment on periapical health. The aim of the present study was, therefore, to evaluate the quality of both root fillings and coronal restorations, using radiographic and clinical criteria, as related to the prevalence of periapical radiolucencies in a Belgian subpopulation.

Materials and methods.

Patient selection and clinical examination.
Root-filled teeth were selected on panoramic radiographs of randomly selected patients attending the Dental School, Ghent University Hospital, Ghent, Belgium, for dental treatment. Only those teeth that were not treated in the preceding year (according to the patient-file or the patient’s recollection) were included in the study. A periapical radiograph was taken of each selected tooth using an Endo Ray film holder (Rinn Corp., Elgin, IL, USA). The coronal status clinically was scored according to a modification of Ryge’s criteria for marginal adaptation (Ryge 1980) (Table 1).

Table 1. Parameters scored on endodontically treated teeth.

Parameters scored on endodontically treated teeth
Only root-canal fillings terminating 0-2 mm from the radiographic apex and homogeneous were listed acceptable if data were grouped for further analysis.

Radiographic examination.
All periapical radiographs were evaluated using an X-ray viewer with 5x magnification. The coronal restoration, the presence of a post in the canal, the root-canal treatment and the periapical condition were scored according to the criteria listed in Table 1 (multirooted teeth were classified according to the root exhibiting the most severe periapical condition).
Two examiners were calibrated before the start of the study and at regular intervals during the study. Interobserver (51 teeth were double scored clinically and radiographically) and intraobserver agreement were assessed by computing Cohen’s Kappa (Hunt 1986, Valachovic et al.1986).AllKappa (k) valueswerebetween 0.70 and 0.96. Because of the good interobserver k values, the teeth selected were only scored on each occasion by one of the examiners. The data were then pooled.

Statistical analysis.
SPSS software was used for data processing and statistical analysis. w2 test and Odds ratio were used as the univariate approach to detect statistically significant differences between groups. Logistic regression (multivariate approach) was used to explain the periapical condition by explanatory variables. Spearman’s rS values were calculated to detect correlations between clinical and radiographic parameters.