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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
Results.



A total of 745 teeth were scored clinically and radiographically in 228 subjects, i.e. an average number of 3.3 root-canal treatments per subject. A total of 242 (32.5%) of the teeth had signs of apical periodontitis, including 92 (12.3%) teeth exhibiting a widened apical periodontal ligament and150 (20.1%) teeth a periapical radiolucency.

Coronal restoration and periapical condition.
An overview of the coronal status in relation to the periapical condition is presented in Table 2. Seventy- five percent of the coronal restorations were clinically acceptable. Radiographic signs of apical periodontitis were detected in 31.1% of teeth with acceptable restorations and 36.8% of teeth with unacceptable restorations; the difference was not statistically significant. This trend was repeated for the presence of marginal caries clinically as well as radiographically. When the coronal restorations were scored radiographically, 78.1% were found acceptable. Of these cases, 23.8% showed signs of apical periodontitis. Forty-nine percent of the restorations scored unacceptable on radiographs were associated with signs of apical periodontitis. In this respect, the radiographic coronal parameters had a statistically significant impact on the periapical health (w2 = 32.027, P < 0.001).When the clinical and radiographic criteria for the coronal restorations were combined, the acceptable restorations (67.4% of the total) had statistically significantly less apical periodontitis than the unacceptable ones (w2 ј4.054, P < 0.05, Odds ratio:1.008 <1.392 <1.921). The Spearman’s rS correlation between the coronal quality of restorations scored clinically and radiographically was 0.485. For the agreement of the presence of caries scored clinically or radiographically, k was 0.441.
Teeth with a base material under the restorations had significantly less apical periodontitis than those without (P < 0.005), as did teeth restored with amalgam as compared to composite (P < 0.01).

Table 2. Quality of the coronal restoration and the relation to periapical health (n = 745).

Quality of the coronal restoration and the relation to periapical health
AP: apical periodontitis.
no statistically significant difference (P > 0.05).
statistically significant difference (P < 0.05).
(a): acceptable.
(u): unacceptable.


Table 3. Quality of the endodontic treatment and the relation to periapical health (n = 745).

Quality of the endodontic treatment and the relation to periapical health
AP: apical periodontitis.
no statistically significant difference (P > 0.05).
statistically significant difference (P < 0.05).
(a): acceptable.
(u): unacceptable.

Root-canal treatment and periapical condition.
Table 3 shows data on the quality of root-canal treatment and its relation to the presence of apical periodontitis. A root-canal post was present in 59.5% of teeth, but its presence had no statistically significant influence on apical periodontitis (31.9% vs. 32.9% without post). Forty-two percent of the root canals were filled to an acceptable length (0-2 mm from the radiographic apex), with apical periodontitis in 27.2% of cases. Of the 58.0% of teeth not filled to adequate length (short or overfilled),36.4%had apical periodontitis; this difference was statistically significant (w2 ј6.983, P < 0.01, Odds ratio:1.115 <1.531 <2.103).The homogeneity of the root filling also had a statistically significant influence on the presence of apical periodontitis, i.e.27.5% apical periodontitis for a homogeneous root filling as opposed to 47.1% for those that were not homogeneous (w2 = 99.304, P < 0.001, Odds ratio: 4.595 <6.898 < 10.354). There was no correlation between the length and the homogeneity of root fillings (rS = 0.140).When length and homogeneity were considered, acceptable (homogeneous root filling ending 0-2 mm from the radiographic apex) root fillings were present in only 34.4% of cases. Apical periodontitis was evident in 23.0 and 37.4% of the root fillings scored, respectively, as acceptable and unacceptable; this difference was statistically significant (w2 ј15.835, P < 0.001, Odds ratio: 1.416 < 1.997 <2.816).

Table 4. Regression table of the periapical condition explained by explanatory variables (all teeth (n = 745))

Regression table of the periapical condition explained by explanatory variables

Table 5. Regression table of the periapical condition explained by explanatory variables (filled teeth only (n = 420)).

Regression table of the periapical condition explained by explanatory variables

Coronal restoration and root-canal quality combined.
The periapical condition was analyzed using the logistic regression model. Table 4 shows the results of this analysis performed on all teeth. The following parameters had a significant influence on the periapical condition: the homogeneity of the root filling (P < 0.001), the radiographic appearance of the coronal restoration (P < 0.001) and the length of the root filling (P < 0.05). Table 5 shows the results of the same analysis, but only on filled teeth (all crowned teeth excluded). The homogeneity of the root filling (P < 0.005) and the radiographic appearance of the coronal restoration (P < 0.005) also had a significant influence on the periapical condition, as well as the presence of a base (P < 0.05). Table 8 presents the results of the combination of the parameters poor and good for coronal restorations and root fillings and is similar to the Tables in the studies of Ray & Trope (1995) (Table 6) and Tronstad et al. (2000) (Table 7). Table 9 shows the parameters for the combined clinical and radiographic quality of the coronal restoration and for the quality of the root filling regarding length and homogeneity. When both qualities were acceptable (group A), apical periodontitis was present in 22.5%of cases. When the coronal restoration was good and the endodontic treatment poor (group B), 34.4% of the teeth exhibited apical periodontitis. The difference between these two groups was statistically significant (w2 = 7.743, P < 0.01, Odds ratio: 1.187 <1.801 <2.734). The combination of poor coronal restoration and good endodontic treatment (group C) resulted in a 24.3% failure rate. This was not statistically significantly different from group A, or from group B. When the coronal restoration and the root filling were poor (group D), 43.2% of the endodontically treated teeth had apical periodontitis. This was statistically significantly different from the results in groups A and C, but not from the results in group B.
Table 10 depicts the data on comparison of the presence of a coronal base and the quality of the root filling. When no base was placed above the root-canal filling, the quality of the root filling had a statistically significant influence on the presence of apical periodontitis. In the presence of a base, there was still a difference amongst groups C and D, but this was not statistically significant.

Table 6. Periapical status of endodontically treated teeth according to Ray & Trope1995.

Quality of the coronal restoration and the relation to periapical health
AP: number of teeth with signs of apical periodontitis.

Table 7. Periapical status of endodontically treated teeth according to Tronstad et al.2000.

Quality of the endodontic treatment and the relation to periapical health
AP: number of teeth with signs of apical periodontitis.