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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
Discussion - References.



Discussion.
The design of the present study repeated that of Ray & Trope (1995), but also included the clinical evaluation of the coronal restoration. It is not possible to score the quality of a coronal restoration from a radiograph with certainty, as it provides only a two-dimensional image. In the present study, only a weak correlation existed between radiographic and clinical coronal parameters (rS = 0.485 for quality of restoration and rS = 0.441 for the presence of caries). Because of this weak correlation, the need to score restorations radiographically as well as clinically in order to assess the impact of coronal leakage was obvious. It was, therefore, essential to complement radiographic information with clinical data.
The current study is a cross-sectional design. It is, therefore, not possible to determine whether a periapical lesion is healing or expanding, although Petersson et al. (1991) found that after a 10-year period the number of healed periapical lesions was equal to the number of newly developed lesions, indicating the reliability of cross-sectional studies for scoring the long-term success of endodontic treatments. This is also supported by data from Hugoson et al. (1995).
The incidence of apical periodontitis associated with root-filled teeth in this study was 32.5%. In a previous epidemiological study (DeMoor et al.2000), an incidence of apical periodontitis was 40.4%, based on panoramic radiographs. This figure is comparable to that of other studies, with data ranging from 20 to 60% (Bergstrom et al.1987, Eckerbomet al.1987, Odesjoet al.1990,Eriksen & Bjertness 1991, Imfeld 1991, De Cleen et al.1993, Buckley & SpLngberg1995, Eriksen et al.1995, Saunders et al. 1997,Weiger et al.1997, Marques et al.1998, Sidaravicus et al. 1999, Kirkevang et al. 2001). Seventy-eight percent of the coronal restorations were found acceptable on the radiographs. This is higher than in the studies by Tronstad et al. (2000) (66.2%), Ray & Trope (1995) (62.7%) and Kirkevang et al. (2000) (73.5%).When the coronal restoration was scored radiographically and clinically (Table 2), 67.4% were found acceptable. Adequate restorations (a) showed signs of apical periodontitis in 30.1% of the teeth. This was statistically different from the 37.4% apical periodontitis in endodontically treated teeth with inadequate restorations (u). When restorations were only scored radiographically (Table 2), this difference was more pronounced (23.8% (a) vs. 49.1% (u)). This difference was statistically significant, as indicated by the w2 test and the logistic regression. Other percentages were found by Tronstad et al. (2000) (30% (a) and 37% (u), respectively) and Ray & Trope (1995) (20%(a) and 69.8%(u), respectively) for these relationships.
In the present study, the prevalence of apical periodontitis was not influenced by the presence of a root-canal post. This is in agreement with other studies (Kvist et al. 1989,Tronstad et al. 2000). Eckerbom et al. (1991) found the opposite, but their study only included crowned teeth.
Root-canal treatment performed to high technical standards remains a prerequisite for long-term success (Strindberg1956, Bergenholtz et al.1979, Eckerbom et al. 1987,Odesjoet al. 1990, Sjogren et al. 1990). Agreement exists in the literature that the length of the root filling is an important factor in endodontic treatment success (Sjogren et al.1990, De Moor et al. 2000, Wu et al. 2000) and this is confirmed by the results of the present study. There is still some disagreement, however, about the effect of the homogeneity of the root filling on the periapical status. Odesjoet al. (1990), Sjogren et al. (1990) and Eriksen et al. (1995) found no difference between compact and poorly compacted root fillings in relation to periapical lesions. We found the homogeneity of the root filling to have a statistically significant influence on the prevalence of apical periodontitis (Tables 3-5). This is supported by others (Bergstromet al.1987, Petersson et al.1991, Kirkevang et al. 2000).
Twenty-three percent of the adequate root fillings (a) and 37.4% of the inadequate ones (u) had apical periodontitis (Table 3). Similar figures were presented by Tronstad et al. (2000) (22% (a) and 44% (u), respectively). Ray & Trope (1995) (24.3%(a) and 51.4%(u), respectively) found a more pronounced difference.
As in the studies of Ray & Trope (1995) and Tronstad et al. (2000), the lowest prevalence of apical periodontitis (22.5%) was found in teeth with both a good root filling and a good coronal restoration (Table 7). A comparable figure was found when the quality of the coronal restoration was poor and the quality of the root-canal treatment was good (24.3%).When the two groups with poor endodontics were compared, there was a better result when a good restoration was present, but this difference was not statistically significant. On the basis of the present data, it became clear that the quality of the coronal restoration (scored clinically and radiographically) did not have a statistically significant influence on the periapical status when it was combined with the endodontic quality (Table 9: Avs. C and B vs. D). This is in contrast to the findings of Ray & Trope (1995). Tronstad et al. (2000) found the quality of the coronal restoration scored radiographically only to be significant when combined with good endodontics.

Table 8. Periapical status of endodontically treated teeth as related to the radiographic quality of the coronal restoration combined with the quality of the root-canal treatment determined by the length and homogeneity of the root filling (n = 745)

RPeriapical status of endodontically treated teeth as related to the radiographic quality of the coronal restoration combined with the quality of the root-canal treatment determined by the length and homogeneity of the root filling

Table 9. Periapical status of endodontically treated teeth determined by the radiographic and clinical quality of the coronal restorations combined with the quality of the root-canal treatment determined by the length and the homogeneity of the root filling (n = 745).

Periapical status of endodontically treated teeth determined by the radiographic and clinical quality of the coronal restorations combined with the quality of the root-canal treatment determined by the length and the homogeneity of the root filling

Table 10. Periapical status of endodontically treated teeth determined by the presence of a base combined with the quality of the root-canal treatment determined by the length and the homogenity of the root filling (n = 745).

Periapical status of endodontically treated teeth determined by the presence of a base combined with the quality of the root-canal treatment determined by the length and the homogenity of the root filling

When the endodontic status of the teeth in the present study was combined with the quality of the coronal restorations (Table 9: Avs. B and C vs. D), a statistically significant influence on the periapical status was seen. An explanation for the difference in findings in this study, as compared to the findings of Ray & Trope (1995) and Tronstad et al. (2000), is not obvious. In the latter studies, there was no information on the use and the influence of bases and filling materials. Coronal leakage of a restoration can be prevented by the placement of a base (Saunders & Saunders 1990, Heys & Fitzgerald 1991, Guerra et al. 1994). Our results confirm that the use of bases under coronal restorations is beneficial for the long-term outcome of root-canal fillings (Tables 2 and 5). Also more apical periodontitis was detected in teeth filled with composite material than with amalgam. This was confirmed by Buckley & SpLngberg (1995). Gap formation at gingival margins and subsequent bacterial colonization under the restoration is a common problem when composites are utilized (Qvist 1980, Qvist1993, Retief1994, Ciucchi et al.1997).
The technical quality of a root filling, as scored on a radiograph, can be taken as an indication of the care taken for the overall quality of treatment (especially cleaning of the root canal). Canal cleanliness cannot be scored on a radiograph, although it is very important for endodontic success. Bacteria left in the root canal at the time of canal obturation influence the success of treatment (Nair et al.1990, Sjogren et al.1997, Molander et al.1998, Sundqvist et al.1998).
A limitation of the present and other studies remains the incomplete diagnostic value of radiographs. It is commonly known that lesions limited to the cancellous bone are almost impossible to detect with conventional radiographic techniques (Le Quire et al. 1977, Bender 1982, van der Stelt1985); moreover, the microbiological status of the root canals cannot be derived from a radiograph.
The question remains as to how important a well sealed coronal restoration is for the long-term success of endodontic treatment. Studies by Ray & Trope (1995) and Kirkevang et al. (2000) found the coronal restoration to be of relatively greater importance than the root-canal filling. Tronstad et al. (2000) found the quality of rootcanal treatment to be more important; the present study found both to be of equal importance. The Odds ratios in Tables 4 and 5 for the radiographic appearance of the coronal restoration and the homogeneity of the root fillings are of the same magnitude, indicating an equal effect on the periapical condition. This is in contrast with the study by Ray&Trope (1995) who found the Odds ratio for quality of restoration to be four times higher than for endodontic quality. Ricucci et al. (2000) found no statistically different prevalence of apical periodontitis in root fillings exposed to the oral environment compared with a control group. It is clear that bacterial ingress should be avoided, but the importance of both the coronal restoration and the root filling should be emphasized as good technical quality of both is a prerequisite for long-term success.

References.

Adenubi JO, Rule DC (1976) Success rate of root fillings in   young patients (a retrospective analysis of treated cases). British Dental   Journal141, 237-41.
Bender IB (1982) Factors influencing the radiographic appearance of bony   lesions. Journal of Endodontics 8, 161-70.
Bergenholtz G, Lekholm U, Milthon R, Heden G, Odesjo B, Engstrom B (1979) Retreatment   of endodontic fillings. Scandinavian Journal of Dental Research 87, 217-24.
BergstromJ, Eliasson S, Ahlberg KF (1987) Periapical status in subjects with   regular dental care habits. Community of Dental and Oral Epidemiology15,   236-9.
BuckleyM, SpLngberg LSW (1995) The prevalence and technical quality of endodontic   treatment in an American subpopulation. Oral Surgery, Oral Medicine and   Oral Pathology 79, 92-100.
Ciucchi B, Bouillaguet S, DelaloyeM, Holz J (1997) Volume of the internal   gap formed under composite restorations in-vitro. Journal of Dentistry 25,   305-12.
Cohen S, Burns C (1998) Pathways of the Pulp, 9th edn. St. Louis, USA: CV Mosby,   258-9.
De Cleen MJH, Schuurs AHB, Wesselinck PR, Wu MK (1993) Periapical status   and prevalence of endodontic treatment in an adult Dutch population. International   Endodontic Journal 26, 112-9.
De Moor RJG, Hommez GMG, De Boever JG, Martens GEI, Delme KIM (2000) Periapical   health related to the quality of root canal treatment in a Belgian population.   International Endodontic Journal 33,113-20.
Eckerbom M, Andersson J-E, Magnusson T (1987) Frequency and technical standard   of endodontic treatment in a Swedish population. Endodontics and Dental   Traumatology 3, 245-8.
Eckerbom M, Magnusson T, Martinsson T (1991) Prevalence of apical periodontitis,   crowned teeth and teeth with posts in a Swedish population. Endodontics   and Dental Traumatology 7, 214-20.
Eriksen HM(1991) Endodontology- epidemiological considerations. Endodontics   and Dental Traumatology 7, 189-95.
EriksenHM, Bjertness E (1991) Prevalence of apical periodontitis and results   of endodontic treatment in middle-aged adults in Norway. Endodontics and   Dental Traumatology 7, 1-4.
Eriksen HM, Berset GP, Hansen BF, Bjertness E (1995) Changes in endodontic   status 1973-1993 among 35-year-olds in Oslo, Norway. International Endodontic   Journal 28, 129-32.
Friedman S (1998) Treatment outcome and prognosis of endodontic therapy.   In:Nrstavik D, Pitt Ford TR, eds. Essential endodontology: prevention and treatment   of apical periodontitis, 1st edn. Oxford, UK: Blackwell Science Ltd, 367-401.
Grossman LI, Shepard LI, Pearson LA (1964) Roentgenological and clinical   evaluation of endodontically treated teeth. Oral Surgery, Oral Medicine   and Oral Pathology 17, 368-74.
GuerraJA, Skribner JE, Lin LM (1994) Influence of a base on coronal microleakage   of post-prepared teeth. Journal of Endodontics 20, 589-91.
Harty FJ, Parkins BJ, Wengraf AM (1970) Success rate in root canal therapy:   a retrospective analysis of treated cases. British Dental Journal128, 65-70.
Heys RJ, Fitzgerald M(1991) Microleakage of three cement bases. Journal   of Dental Research 70, 55-8.
Hugoson A, Koch G, Bergendal T et al. (1995) Oral health of individuals aged   3-80 years in Jonkoping, Sweden in 1973, 1983, 1993. Swedish Dental Journal   19, 243-60.
Hunt RJ (1986) Percent agreement, Pearson's correlation, and kappa as measures   of inter-examiner reliability. Journal of Dental Research 65, 128-30.
Imfeld TN (1991) Prevalence and quality of endodontic treatment in an elderly   urban population of Switzerland. Journal of Endodontics17, 604-7.
Ingle JI, Beveridge EE, Glick DH,Weighman JA, Abourass M (1985) Modern endodontic   therapy. The Washington Study. In: Endodontics. Philadelphia, USA: Lea &   Feniger, 27-49.
Khayat A, Lee S-J, Torabinejad M (1993) Human saliva penetration of coronally   unsealed obturated root canals. Journal of Endodontics 19, 458-61.
Kirkevang L-L, Nrstavik D, Hordted-Bindslev P, Wenzel A (2000) Periapical   status and quality of root fillings and coronal restorations in a Danish population.   International Endodontic Journal 33, 509-15.
Kirkevang L-L, Horsted-Bindslev P, Nrstavik D, Wenzel A (2001) Frequency   and distribution of endodontically treated teeth and apical periodontitis in   an urban Danish population. International Endodontic Journal 34, 198-205.
Kvist T, Rydin E, Reit C (1989) The relative frequency of periapical lesions   in teeth with root canal-retained posts. Journal of Endodontics 15, 578-80.
Le Quire AK, Cunningham CJ, Pelleu GB (1977) Radiographic interpretation   of experimentally produced osseous lesions of the human mandible. Journal   of Endodontics 3, 274-6.
Marques MD, Moreira B, Eriksen HM(1998) Prevalence of apical periodontitis   and results of endodontic treatment in an adult, Portuguese population.   International Endodontic Journal 31, 161-5.
Marshall FJ, Massler M (1961) The sealing of pulp less teeth evaluated with   radioisotopes. Journal of Dental Medicine 16, 172-84.
Molander A, Reit C, Dahle' n G, Kvist T (1998) Microbiological status of   root-filled teeth with apical periodontitis. International Endodontic Journal   31,1-7.
Nair R, Sjogren U, Krey G, Kahnberg K-E, Sudqvist G (1990) Intraradicular   bacteria and fungi in root filled, asymptomatic human teeth with therapy-resistant   periapical lesions: a long-term light and electron microscopic follow-up study.   Journal of Endodontics 16,580-8.
Odesjo B, Hellde n L, Salonen L, Langeland K (1990) Prevalence of previous   endodontic treatment, technical standard and occurrence of periapical lesions   in a randomly selected adult, general population. Endodontics and Dental   Traumatology 6, 265-72.
Petersson K, HLkansson R, HLkansson J, Olsson B,Wennberg A (1991) Follow-up   study of endodontic status in an adult Swedish population. Endodontics and   Dental Traumatology 7,221-5.
Qvist V (1980) Correlation between marginal adaptation of composite resin   restorations and bacterial growth in cavities. Scandinavian Journal of Dental   Research 88, 296-300.
Qvist V (1993) Resin restorations: leakage, bacteria, pulp. Endodontics   and Dental Traumatology 9, 127-52.
Ray HA,Trope M (1995) Periapical status of endodontically treated teeth in   relation to the technical quality of the root filling and the coronal restoration.   International Endodontic Journal 28, 12-8.
Retief DH (1994) Do adhesives prevent microleakage? International Dental   Journal 44, 19-26.
Ricucci D, Grondahl K, Bergenholtz G (2000) Periapical status of root-filled   teeth exposed to the oral environment by loss of restoration or caries.   Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics   90, 354-9.
Ryge G (1980) Clinical criteria. International Dental Journal 30, 347-58.
Saunders WP, Saunders EM(1990) Assessment of leakage in the restored pulp   chamber of endodontically treated multirooted teeth. International Endodontic   Journal 23, 28-33.
Saunders WP, Saunders EM (1994) Coronal leakage as a cause of failure in   root-canal therapy: a review. Endodontics and Dental Traumatology 10, 105-8.
Saunders WP, Saunders EM, Sadiq J, Cruickshank E (1997) Technical standard   of root canal treatment in an adult Scottish population. British Dental   Journal 183, 383-6.
Schilder H (1967) Filling root canals in three dimensions. Dental Clinics   of North America 11, 723-44.
Sidaravicus B, Aleksejuniene J, Eriksen HM (1999) Endodontic treatment and   prevalence of apical periodontitis in an adult population of Vilnius, Lithuania.   Endodontics and Dental Traumatology 15, 210-5.
Sjogren U, Figdor D, Persson S, Sundqvist G (1997) Influence of infection   at the time of root filling on the outcome of endodontic treatment of teeth   with apical periodontitis. International Endodontic Journal 30, 297-306.
Sjogren U, Hagglund B, Sundqvist G, Wing K (1990) Factors affecting the long-term   results of endodontic treatment. Journal of Endodontics 16, 498-504.
Strindberg LZ (1956) The dependence of the results of pulp therapy on certain   factors. An analytic study based on the radiographic and clinical follow-up   examinations. Acta Odontologica Scandinavia14, 1-174.
Sundqvist G, Figdor D, Persson S, SjogrenU (1998) Microbiologic analysis   of teeth with failed endodontic treatment and the outcome of conservative re-treatment.   Oral Surgery, Oral Medicine and Oral Pathology 85, 86-93.
Swanson K, Madison S (1987) An evaluation of coronal microleakage in endodontically   treated teeth. Part I. Time periods. Journal of Endodontics13, 56-9.
Torabinejad M, Ung B, Kettering JD (1990) In vitro bacterial penetration   of coronally unsealed endodontically treated teeth. Journal of Endodontics16,   566-9.
Tronstad L, AsbjSrnsen K, DSving L, Pedersen I, Eriksen HM (2000) Influence   of coronal restorations on the periapical health of endodontically treated teeth.   Endodontics and Dental Traumatology 16, 218-21.
Trope M, Chow E, Nissan R (1995) In-vitro endotoxin penetration of coronally   unsealed endodontically treated teeth. Endodontics and Dental Traumatotlogy   11, 90-4.
alachovic RW, Douglass CW, Berkey CS, McNeil BJ, Chauney HH (1986) Examiner   reliability in dental radiography. Journal of Dental Research 65, 432-6.
an der Stelt PF (1985) Experimentally produced bone lesions. Oral Surgery,   Oral Medicine and Oral Pathology 59, 306-12.
Weiger R, Hitzler S, Hermle G, Lost C (1997) Periapical status, quality of   root canal fillings and estimated endodontic treatment needs in an urban German   population. Endodontics and DentalTraumatology13, 69-74.
WuM-K, Wesselinck PR, Walton RE (2000) Apical terminus location of root canal   treatment procedures. Oral Surgery, Oral Medicine, Oral Pathology, Oral   Radiology and Endodontics 89, 99-103.