Evaluation of the periapical status and quality of endodontic treatment in a Turkish subpopulation

Abstract

The purpose of this study was to assess the prevalence of periapical radiolucencies in rootcanal–treated teeth in a Turkish subpopulation and evaluate the influence of the quality of rootcanal fillings on the periradicular status of these teeth.This study was undertaken by evaluating the periapical status of teeth on digital panoramicradiographs of clinic patients between the ages of 16 and 82 years, who visited the clinics ofFaculty of the Dentistry, Yeditepe University, Istanbul, Turkey between January 1st 2013 andJanuary 1st 2014.Patient files were selected from those who had visited the Department ofDentomaxillofacial Radiology, Yeditepe University, Faculty of Dentistry between January 1st,2013 and December 31th, 2013. From the 8512 files, each 10th patient file containing a digitalpanoramic radiograph was selected for evaluation, resulting in 100 panoramic x-rays to beevaluated. Evaluation was performed by a single observer under identical conditions, with respectto illumination.The panoramic x-rays were evaluated in terms of the number of remaining and extractedteeth, the number of previous root canals, the quality of endodontic treatment and the periapicalstatus of the existing teeth, including those with and without root canals. The teeth were classifiedas healthy or diseased according to the criteria proposed by De Moor et al the presence of apicalperiodontitis, and the prevalence and quality of root fillings were recorded. The relationshipbetween various parameters was evaluated using chi-square and Fischer reality test.Overall, 2581 teeth belonging to 100 patients were evaluated. The number ofendodontically treated teeth was 265 which comprised 10.26% of the evaluated teeth. Among theendodontically treated teeth, 101 (38.11%) belonged to males, whereas 164 (61.89%) belonged tofemales. In general, the number of patients who received endodontic treatment was determined as83 (83%) among all patient population. Among these, 36 (43.37%) were males whereas47(56.63%) were females. Mandibular 1st molars were the types of teeth that received endodontictreatment most frequently, followed by the maxillary second molars and maxillary secondpremolars. The group which underwent endodontic treatment least frequently was the mandibular Vcanines followed by mandibular lateral and central incisors. In general, maxillary molars were thetypes of teeth receiving endodontic treatment most frequently whereas mandibular anterior teethreceived endodontic treatment the least. Maxillary teeth received endodontic treatment morefrequently compared to the mandibular teeth (64.15% and 35.85%, respectively) with a statisticalsignificance (p=0.0001).Among all evaluated teeth, 265 (10.2%) had undergone root canal treatment. Eighty-threepercent of all the subjects had at least one root-filled tooth. A total of 2581 teeth belonging to 100patients were evaluated in the present study. 43 (43%) of the patients were males whereas 57(57%)were females.Periapical radiolucencies were visible on 149 (5.7%) of the examined teeth .Of these, 84(56%) were endodontically treated whereas 65 (44%) received no previous endodontic treatment.Among all endodontically treated teeth, 84 (31.6%) of root filled teeth presented apicalperiodontitis. 50 from 84 (59.5%) of root-filled teeth with periapical pathosis were determined tohave inadequate root fillings. Among 265 endodontically treated teeth, 172 (64.91%) had adequateroot fillings whereas 84 (31.7%) had underfillings and 9 (3.4%) had overfillings. The totalpercentage of inadequate endodontic treatments (under and overfillings) was 35.1%. Overall, 84(31.6%) of endodontically treated teeth (265) were associated with periapical lesions. Teeth withinadequate root fillings were more prone to developing a periapical lesion. There was a statisticallysignificant correlation between the quality of endodontic treatment and periapical health(p<0.0001).The study reconfirmed the relationship between periapical lesions and the quality ofendodontic treatment and necessity of improving the technical quality of endodontic treatment.Keywords: prevalence, endodontic treatment, success, periapical lesion.