17 June 2020

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Prevalence of apical Periodontitis in endodontically treated teeth

Giulia Palandrani

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 Apical periodontitis is a local inflammatory response due to the presence of microorganisms within an infected root canal system . A systematic review by Ng et al. (2008) reported that four factors were associated with better outcomes following root canal treatment: preoperative absence of periapical radiolucency, root canal filling extending to 2 mm within the radiographic apex, root canal filling with no voids and a satisfactory coronal restoration. 

The aim of this study was to analyse in vivo using CBCT assessment the prevalence of periapical lesions according to several factors, including the type of teeth, quality of root filling and type of coronal restoration.  

Materials and methods  
 A global sample of 20 836 teeth, with a combined total of 27 046 roots, was analysed via CBCT assessment in eight health centres. Each tooth was classified according to the following parameters:
•       Tooth number,     
•       Presence/absence of periapical radiolucency,     
•       Length of root filling (classified as follows: ‘Short’ when 2 mm short of the radiographic apex; ‘Good’ when filled to within 0–2 mm of the radiographic apex; and ‘Overfilling’ when past the radiographic apex),
•        Presence/absence of lateral radiolucency, 
•        Presence/absence of root resorption, 
•        Type of coronal restoration (intact tooth, unrestored/cavitated, intracoronal restoration, crown and abutment).  

Results
 The overall prevalence of periapical lesions was 10.4%. The prevalence of periapical lesions was largest in first maxillary molars (21.2% [18.9%–23.6% CI 95%]) and first mandibular molars (18.8% [16.3%–21.3% CI 95%]), There was no significant difference in lesion prevalence between maxillary and mandibular first molars (P > 0.05). Teeth with short root fillings had a 3.1 higher odds of being associated with periapical lesions when compared to teeth with good root filling length . Good fillings and over-fillings were not significantly different (P > 0.05) and both had a significantly lower prevalence when compared to short root fillings (P < 0.05) There was a tendency for greater percentages of periapical lesions on mesiobuccal roots of maxillary molars and mesial roots of mandibular molars.

Conclusions
short root fillings had a significant impact on the presence of periapical lesions extra care should be taken when controlling apical length during root canal treatment. Teeth with root fillings and crowns should be regularly monitored because more at risk of developing periapical lesions .       

For additional information:  Prevalence of apical periodontitis and its association with previous root canal treatment, root canal filling length and type of coronal restoration – a cross-sectional study