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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 82-85

Prevalence of apical periodontitis in root canal-treated teeth from an urban Saudi female population: Influence of root canal fillings and coronal restorations


Department of Conservative Dentistry, College of Dentistry, Qassim University, Qassim, Saudi Arabia

Date of Web Publication8-Jan-2018

Correspondence Address:
Dr. Durre Sadaf
Department of Conservative Dentistry, College of Dentistry, Qassim University, Mullaydha, Buraydha 51452, Qassim
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_46_17

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  Abstract 


Aim: The aim of this study is to determine the prevalence of apical periodontitis (AP) in root canal-treated teeth in females in Qassim region, Saudi Arabia and to evaluate the correlation of quality of the root canal fillings, coronal restorations (CRs), and cast restorations with the AP.
Study Design: Cross-sectional retrospective study.
Place and Duration: Female Dental Clinics at College of Dentistry at Qassim University, Saudi Arabia from January 2014 to February 2017.
Materials and Methods: A total of 400 orthopantomograms were evaluated out of which root canal treatment (RCT) had been performed in 1108 teeth. Frequencies and percentages of quality of RCT, CR, and periapical status were recorded. Their association was recorded by Chi-square test and Pearson correlation was computed at significance level of 5%.
Results: A total of 813 (73.4%) endodontically treated teeth presented with AP radiographically. The percentages of teeth which fulfilled the criteria of an acceptable RCT, CR, and cast restoration radiographically were 8.8%, 64%, and 93.6%, respectively. The incidence of AP among teeth with acceptable RCT (35.1%) was significantly lower than those with unacceptable RCT (77.1%) (P < 0.001). Moreover, adequate CR demonstrated a significantly better periapical status (60.2%) compared to teeth with inadequate CR (95%) (P < 0.001). The incidence of AP ranged from 24.1% (in acceptable RCT and CR cases) to 96.6% (in unacceptable RCT and CR cases) (P < 0.001). Adequate cast restoration demonstrated a better periapical status (76%) compared to teeth with inadequate cast restoration (87.5%). The incidence of AP ranged from 15.6% (in acceptable RCT and cast restoration cases) to 86.7% (in unacceptable RCT and cast restorations cases) (P < 0.001). Pearson correlation coefficient was computed. Length of obturation, density of root filling, quality of CR and quality of cast restoration were found to have highly significant positive correlation with AP (r = −0.375, r = −0.162, r = −0.118, r = −0.079, respectively).
Conclusion: The prevalence of AP has been found 73.4% in root treated teeth. Quality of RCT, CR, and of cast restoration is significantly associated with periapical status in root-filled teeth.

Keywords: Apical periodontitis, cast restoration, coronal restoration, density of root fillings, length of root fillings


How to cite this article:
Sadaf D, Alsalhy H, Alrothy R, Ahmad MZ. Prevalence of apical periodontitis in root canal-treated teeth from an urban Saudi female population: Influence of root canal fillings and coronal restorations. Int J Oral Health Sci 2017;7:82-5

How to cite this URL:
Sadaf D, Alsalhy H, Alrothy R, Ahmad MZ. Prevalence of apical periodontitis in root canal-treated teeth from an urban Saudi female population: Influence of root canal fillings and coronal restorations. Int J Oral Health Sci [serial online] 2017 [cited 2019 Dec 9];7:82-5. Available from: http://www.ijohsjournal.org/text.asp?2017/7/2/82/222401




  Introduction Top


Despite high success rate of root canal treatment (RCT) up to 95%, high prevalence of apical periodontitis (AP) has been reported in many studies.[1],[2] AP is a result of microbial contamination of periapical tissues that originates from a necrotic dental pulp or inadequately treated root canals.[2]

High prevalence of AP indicates a health problem associated with medical, economical, and ethical repercussion.[3],[4]

So far no study has been conducted in Qassim region of Saudi Arabia on the prevalence of AP in endodontically treated teeth and its correlation with RCT and final coronal restoration (CR). This information will help to assess overall need of dental care in females in Qassim region of Saudi Arabia.


  Materials and Methods Top


The study was started after approval from Ethical Review Committee of Qassim University (EA/73/2014). Total of 1068 digital orthopantomogram (OPG) radiographs of female patients attended Dental Clinics of Qassim University seeking routine dental care aged from 18 to 70 years were evaluated. A total of 400 OPG met the inclusion criteria and 668 OPG were excluded. RCT was done by general practitioners. OPG radiographs with 10 or more remaining natural teeth were included. Third molars teeth were excluded. Radiographs were evaluated by two calibrated, independent and expert examiners. Inter-examiner agreement was determined by computing Cohen's kappa (κ = 0.82). Disagreement between the examiners was resolved by the third examiner (Supervisor).

Root treated teeth were evaluated for the presence of periapical radiolucency, quality of root canal therapy and the quality of CRs.

SPSS 20. (SPSS Inc., Chicago, IL 60606, USA) was used for statistical analysis. Chi-square test was used to see the association of AP with quality of endodontic treatment, coronal, and cast restoration. Pearson correlation coefficient was computed to assess the correlation of quality of RCT and final restoration with AP. A 95% confidence interval was established. Significance level was established at 5%.


  Results Top


The average patient age was 30 ± 2 years. In total, 1108 root-treated teeth have AP in 73.3% (n = 813). Maxillary molars and mandibular molars presented with high prevalence of AP (79.78%, 78.85%) [Table 1].
Table 1: The prevalence of endodontically treated teeth and those with apical periodontitis based on tooth type

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Quality of RCT has been found to affect the periapical status of teeth. Teeth with unacceptable RCT were 91.2% (1011) out of which 77.1% (n = 779) presented with AP.

Teeth with inadequate CR have AP in 95% (n = 379) teeth as compared to teeth with adequate CRs 64% (n = 709) presented with AP in 60.2% (n = 427) [Table 2].
Table 2: Distribution of apical periodontitis of endodontically treated teeth in relation to the quality of root canal therapy, coronal restoration, cast restoration and their combination

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Pearson correlation coefficient was computed. Length of obturation (r = −0.375), density of root filling (r = −0.162), quality of CR (r = −0.118), and quality of cast restoration (r = −0.079) were found to have highly significant correlation with AP [Table 3].
Table 3: Correlation between periapical radiolucency and length of obturation, density of root filling material, quality of coronal restoration and quality of cast restoration

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  Discussion Top


Primary objective of this study was to assess the prevalence of AP in root treated teeth and to determine the effect of quality of treatment on the periapical status.

In this study, OPG radiographs were used for evaluating the quality of endodontically treated teeth. Two-dimensional radiographs have many limitations regarding size of the lesion and actual nature of the lesion whether it is increasing in size or healing. Other drawback of this radiographic assessment is inability to examine voids due to superimposition of filling material.[5],[6],[7]

Unfortunately, the criteria for judging the quality of RCT have not been well defined. Acceptable RCT was defined as having “adequate length and density of root filling.” These subjective assessments have not been standardized or calibrated; however, the results of these subjective assessments showed that “acceptable RCT” had significantly lower AP than those judged “unacceptable.”[8],[9] Furthermore, it has been contended that periapical diagnosis from OPGs may result in underestimation of the real prevalence of AP. However, the validity of recording AP based on OPGs is satisfactory.[10]

In 279 cases of endodontically treated mandibular molars, 78.85% presented with AP. The highest number of cases with AP was seen in mandibular first molars. This tooth is the first to erupt in permanent dentition and therefore more prone to caries, trauma, operative intervention, and pulp/periapical diseases.

High prevalence of AP (73%) associated with root treated teeth as compared to other populations is an indication of overall treatment needs of patients in this region. One of the reasons could be due to inadequate and inaccessibility to dental care to the females in this region due to cultural reasons. The absence of programs such as caries prevention and caries control at school level can also be responsible for such advances dental problems.

This figure is higher than the previous findings of several epidemiologic studies from different countries: Denmark (52%),[11] Germany (61%),[12] Japan (40%),[13] Lithuania (39%),[14] Scotland (51%),[15] Spain (64.5%)[16] Turkey (40.5%),[17] and USA (39%).[18]

Two-dimensional radiographs have many limitations regarding size of the lesion and actual nature of the lesion whether it is increasing in size or healing. Other drawback of this radiographic assessment is inability to examine voids due to superimposition of filling material.


  Conclusion Top


The study provides a baseline data for overall dental needs of patients in this region. High prevalence of AP associated with poor quality of RCT and CR s necessitates better education and training of health-care providers in this field.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflflicts of interest.



 
  References Top

1.
Ricucci D, Siqueira JF Jr. Biofilms and apical periodontitis: Study of prevalence and association with clinical and histopathologic findings. J Endod 2010;36:1277-88.  Back to cited text no. 1
    
2.
Boucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J 2002;35:229-38.  Back to cited text no. 2
    
3.
Marques MD, Moreira B, Eriksen HM. Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population. Int Endod J 1998;31:161-5.  Back to cited text no. 3
    
4.
De Moor RJ, Hommez GM, De Boever JG, Delmé KI, Martens GE. Periapical health related to the quality of root canal treatment in a Belgian population. Int Endod J 2000;33:113-20.  Back to cited text no. 4
    
5.
Altman DG. Practical Statistics for Medical Research. London: Chapman & Hall; 1991.  Back to cited text no. 5
    
6.
Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS, et al. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 1988;14:261-6.  Back to cited text no. 6
    
7.
Tavares PB, Bonte E, Boukpessi T, Siqueira JF Jr., Lasfargues JJ. Prevalence of apical periodontitis in root canal-treated teeth from an urban French population: Influence of the quality of root canal fillings and coronal restorations. J Endod 2009;35:810-3.  Back to cited text no. 7
    
8.
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: Systematic review of the literature – Part 2. Influence of clinical factors. Int Endod J 2008;41:6-31.  Back to cited text no. 8
    
9.
Kayahan MB, Malkondu O, Canpolat C, Kaptan F, Bayirli G, Kazazoglu E, et al. Periapical health related to the type of coronal restorations and quality of root canal fillings in a Turkish subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e58-62.  Back to cited text no. 9
    
10.
De Cleen MJ, Schuurs AH, Wesselink PR, Wu MK. Periapical status and prevalence of endodontic treatment in an adult Dutch population. Int Endod J 1993;26:112-9.  Back to cited text no. 10
    
11.
Weiger R, Hitzler S, Hermle G, Löst C. Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population. Endod Dent Traumatol 1997;13:69-74.  Back to cited text no. 11
    
12.
Tsuneishi M, Yamamoto T, Yamanaka R, Tamaki N, Sakamoto T, Tsuji K, et al. Radiographic evaluation of periapical status and prevalence of endodontic treatment in an adult Japanese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:631-5.  Back to cited text no. 12
    
13.
Sidaravicius B, Aleksejuniene J, Eriksen HM. Endodontic treatment and prevalence of apical periodontitis in an adult population of Vilnius, Lithuania. Endod Dent Traumatol 1999;15:210-5.  Back to cited text no. 13
    
14.
Saunders WP, Saunders EM. Prevalence of periradicular periodontitis associated with crowned teeth in an adult Scottish subpopulation. Br Dent J 1998;185:137-40.  Back to cited text no. 14
    
15.
Segura-Egea JJ, Jiménez-Pinzón A, Poyato-Ferrera M, Velasco-Ortega E, Ríos-Santos JV. Periapical status and quality of root fillings and coronal restorations in an adult Spanish population. Int Endod J 2004;37:525-30.  Back to cited text no. 15
    
16.
Kayahan MB, Malkondu O, Canpolat C, Kaptan F, Bayirli G, Kazazoglu E, et al. Periapical health related to the type of coronal restorations and quality of root canal fillings in a Turkish subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e58-62.  Back to cited text no. 16
    
17.
Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J 1995;28:12-8.  Back to cited text no. 17
    
18.
Siqueira JF Jr., Rôças IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod 2008;34:1291-301.e3.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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