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 »  Home  »  Endodontic Articles 9  »  Periapical status, prevalence and quality of endodontic treatment in an adult French population
Periapical status, prevalence and quality of endodontic treatment in an adult French population
Introduction - Materials and methods.



L. Lupi-Pegurier, M.-F. Bertrand, M. Muller-Bolla, J. P. Rocca & M. Bolla
Department of Public Health, Department of Conservative Dentistry and Endodontics, and Department of Biomaterials, Laboratory of Dental Biomaterials and Experimental Odontology, University of Nice, Sophia, Antipolis, France.

Introduction.
According to the European Society of Endodontology (1994), the assessment of endodontic treatment requires clinical as well as radiographical follow-ups at regular intervals. The radiographic evidence of a success is the presence of a normal periodontal ligament space around the root. If radiographs reveal that a lesion has remained the same or has only diminished in size, the treatment is not considered a success (European Society of Endodontology 1994). The prevalence and technical quality of root fillings are difficult to access epidemiologically (Imfeld1991), because the taking of radiographs for epidemiological reasons only is not accepted in many countries. The available studies dealing with this topic show large numbers of poorly executed root fillings, resulting in either the development, persistence or recurrence of periapical pathology. Results of these studies are shown in Table 1. Attention has been focused on the prevalence and the technical quality of root fillings  through the evaluation of intraoral (Odesjoet al. 1990, Eriksen & Bjertness 1991, Imfeld 1991, Soikkonen 1995, Saunders et al. 1997,Weiger et al.1997, Sidaravicius et al.1999) or panoramic radiographs (De Cleen et al. 1993, Marques et al. 1998, De Moor et al. 2000).
Information about the prevalence and technical standard of root-canal treatment, and the occurrence of periapical lesions in France are scarce. This study was designed to determine retrospectively the periapical status, the prevalence and the quality of root-canal fillings in individuals seeking examination and treatment in a French dental school.

Table 1. Prevalence and radiographic quality of root-canal treatment and the prevalence of periapical radiolucencies according to previous studies.

Prevalence and radiographic quality of root-canal treatment and the prevalence of periapical radiolucencies according to previous studies

Materials and methods.

Study population.
A comprehensive epidemiological survey involved each adult (>20-year-old) who attended the dental school in Nice, France for the first time in1998. Patients with nine or less remaining natural teeth and those who received dental care in the last 2 years were excluded. The teeth with a root resection or hemisection were also discarded. This resulted in a total of 344 orthopantomograms that created the basis for detection of root-filled teeth and periapical pathosis.

Radiographs.
The panoramic radiographs used in this study were taken by a trained radiology assistant using an orthopantomograph machine (PM 2002 CC Proline, Planmeca, Helsinki, Finland) and Kodak dental films (T - MATG, Kodak, NewYork, USA).All films were processed in a XR 24Novamachine (DuurDental, Bietigheim, Germany) using Duur Dental developer and fixer.

Evaluation of root fillings and periapical condition.
The viewing conditions were standardized, using a view box with fixed light intensity. The incidence of root fillings was recorded along with the periapical status of all teeth with the exception of third molars. Teeth were categorized as root  filled if there was radiopaque material in the pulp chamber and/or in one or more root canals. A widening of the periodontal ligament space of twice the width of the lateral periodontal space or a radiolucency in connection with the apical part of the root was considered as a periapical lesion. The length of root filling was judged as ‘adequate’ if the root filling was 2 mm or less from the radiographic apex. When it was more than 2 mm from the apex, it was considered as an ‘under filling’ and when excess filling was beyond the radiographic apex it was categorized as an ‘over filling’. The density of root filling was judged as ‘adequate’ if the radiodensity of fill was uniform and appeared to be radiographically adapted to the root-canal walls. It was scored as ‘inadequate’ if the canal space was visible or if the radiodensity was not uniform. Because of superimposition of anatomical structures, teeth that could not be properly categorized were excluded. Multirooted teeth were scored according to the root with the most severe periapical status. If this tooth had been root filled, the quality of the corresponding root filling was assigned to the tooth. The data collected were examined by age, gender, tooth type and technical quality of root filling and compared to the frequency of radiographically visible periapical disease.
The interpretation of radiographs was performed independently by two examiners. Prior to this study, 20 panoramic radiographs not included in the survey were used to calibrate the two examiners. The examiner variability was determined by calculating Kappa (k) values for detecting a periapical radiolucency and for evaluating the density and periapical extension of the rootcanal filling. In case of disagreement, the two observers came to a consensus. Intraexaminer agreement was determined by rescoring 20 radiographs at least 3 months after the original examination anova, Fisher’s PLSD and Chi-square tests were used for statistical evaluation of the results. A P < 0.05was considered statistically significant.