Prognosis of root canal treatment in teeth with preoperative apical periodontitis: a study with cone‐beam computed tomography and digital periapical radiography

Abstract

Aim This observational cohort study aimed: (i) to determine retrospectively after a 1‐ to 12‐year follow‐up period, the strength and independence of the association of various patient‐, tooth‐ and treatment‐related prognostic variables with the outcome of root canal treatment in patients with pre‐therapeutic apical periodontitis; and (ii) to establish the concordance between those predictors evaluated by both cone‐beam computed tomography (CBCT) and digital periapical radiography (DPR). Methodology The study cohort included 125 teeth in 84 individuals. The postoperative clinical signs/symptoms, plus DPR/CBCT‐PAI estimations, were used to determine the healing outcome. For statistical analysis, results were dichotomized into completely healed periapical structures versus persistent disease cases. The association between candidate predictor variables with persistent disease was analysed individually and adjusted for confounders using a multivariate binary logistic regression model. Results The success rate was 53.6%. After logistic regression analysis, mandibular tooth location, periapical lesion size >10 mm, poor quality of the coronal restoration, lack of magnification/illumination, lack of disinfection of gutta‐percha, time elapsed to definitive coronal restoration >1 week and poor density of root canal filling remained as robust predictors of failures. Concordance between DPR and CBCT scores varied from moderate to almost perfect agreement. Conclusions The findings of this study suggest that several tooth‐ and treatment‐related predictor variables, including tooth location, periapical radiolucency size, quality of the coronal restoration, magnification/illumination, disinfection of gutta‐percha, time elapsed to definitive coronal restoration, as well as, the density of root canal filling may act strongly and independently for determining the root canal treatment outcome in teeth with pre‐therapeutic apical periodontitis.

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

“…When considering the long-term success of root canal treatment, coronal leakage may play an important role, perhaps as important as any aspect or step of the root canal treatment itself (Ray & Trope 1995). Unfortunately, the quality of coronal restorations, although considered relevant (Restrepo-Restrepo et al 2019), is difficult to assess on CBCT scans due to several types of image artefacts. Clinical examination and intraoral radiographs may be more reliable methods of evaluating the quality of coronal restorations (Tyndall & Rathore 2008) than CBCT imaging.…”

Outcome of Root Canal Treatments Provided by Endodontic Postgraduate Students. A Retrospective Study

“…Factors selected for such an evaluation may be more or less restrictive. In general terms, various studies base their analyses on one to three factors [ 3 , 12 , 13 , 14 , 15 , 16 , 17 ], while others assess the influence of multiple factors, taking into account preoperative, intraoperative, and postoperative factors [ 7 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The latter is the case of the present study.…”

Sealing Ability of Endodontic Cements: An In Vitro Study

“…Restrepo-Restrepo et al reported that irrigation with 2.5% sodium hypochlorite results in a decrease in the microhardness of the dentin. is is due to the ability of this irrigation agent to dissolve the organic component of the dentin, in particular, the collagen which adversely affects the quality of the sealer's adhesion and contributes to the decrease of the micromechanical interaction between the resin sealing cement and the dentin [4]. e humid state of the root canal at the obturation time has a very significant effect on the microleakage of the root canals filled with resincoated gutta-percha/EndoREZ ® , leading to a significant increase in the sealing performance [18,25].…”

“…ese materials must be biocompatible and nonresorbable, so that they can act as a dressing in the transition zone between the obturation and the periapical tissue [3,4].…”