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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 379-382  

Evaluation of quality of endodontic re-treatment and changes in periapical status


1 Department of Endodontics, University of Sharjah, UAE
2 Department of Prosthodontics and Crown and Bridge, Vananchal Dental College and Hospital (VDCH), Garhwa, Jharkhand, India
3 Department of Restorative Dentistry, College of Dentistry in Alrass, Qassim University, KSA
4 Huntly Dental Practice, AB54 8DT, Aberdeenshire, Scotland, United Kingdom

Date of Submission08-Dec-2020
Date of Acceptance09-Dec-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Nausheen Aga
Department of Endodontics, University of Sharjah, Sharjah
UAE
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_814_20

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   Abstract 


Background: The present study was conducted to assess quality of root canal (RC) filling before and after RC re-treatment. Materials and Methods: Two hundred and thirty-eight radiographs of failed endodontic treatment were assessed. The periapical status of the endodontic treatment was evaluated with periapical index (PAI) scoring system. PAI <3 showed absence and PAI >3 showed presence of periapical lesion. Results: There was a statistically significant increase in scores 1 and 3 and decrease in scores 2, 4, 5, and 6 after treatment (P < 0.05). PAI score >3 was seen in 37% before which decreased to 16% after endodontic retreatment. 34.6% obturation was homogenous and 65.4% was nonhomogenous before endodontic retreatment. After endodontic retreatment, 95.2% became homogenous and 4.8% nonhomogenous. The reason for endodontic failure was furcation in 2%, iatrogenic causes in 3%, loss of coronal seal in 16%, periapical pathology in 25%, and inadequate root filling in 54%. Conclusion: There was significant improvement and decrease in size of periapical lesions in re-endodontic cases as compared to primary RC treated teeth.

Keywords: Apical periodontitis, re-treatment, root canal therapy


How to cite this article:
Aga N, Thakur MK, Agwan MA, Eisa M, Habshi AY, Azeem S. Evaluation of quality of endodontic re-treatment and changes in periapical status. J Pharm Bioall Sci 2021;13, Suppl S1:379-82

How to cite this URL:
Aga N, Thakur MK, Agwan MA, Eisa M, Habshi AY, Azeem S. Evaluation of quality of endodontic re-treatment and changes in periapical status. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 27];13, Suppl S1:379-82. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/379/317703




   Introduction Top


Apical periodontitis (AP) may result from dental caries, fracture tooth, traumatic occlusion, etc. The main treatment for AP is root canal treatment (RCT).[1] It is evident from numerous studies that the quality of endodontic treatment performed in general practice in less superior than those performed in specialized dentistry.[2] Hence, the success rate of RCT is obviously high. In spite of better treatment outcome, failure rate cannot be completely avoided. The presence of tenderness in RC treated tooth and radiological evidence of periodontal ligament widening and loss of lamina dura in indicative of failed RCT.[3]

There is a high prevalence of AP that ranged from 8%–72%. Numerous studies have done so far depicting prevalence of AP using various intraoral radiographs such as intraoral peri-apical radiographs (IOPAR) and panoramic radiographs. These radiographic aids helped in assessing the periapical region as well as in detecting quality of the RCT.[4],[5]

Recently, newer radiographic diagnostic aid such as cone-beam computed tomography (CBCT) has emerged with better image quality as compared to intraoral radiographs such as IOPARs. AN accuracy of 0.54 with panoramic radiographs and 0.70 with peri-apical radiographs has been found. The only drawback of CBCT is high radiation exposure as compared to single intraoral peri-apical radiograph.[6] The present study was conducted to assess the quality of RC filling before and after RC re-treatment.


   Materials and Methods Top


This retrospective study was initiated in the department of endodontics which comprised of 238 radiographs of failed endodontic treatment. Ethical committee of the institute was approached for the approval and after explaining the utility of the study approval was taken.

Radiographs which were of poor quality, nondiagnostic, and with radiographic errors were not considered to be involved in the study. Digital IOPARs were taken with Schick sensor using Gnatus intraoral radiographic unit operating at 72 kVp, 8mA tube current and exposure time ranged from 0.30–0.50 sec. Rinn X tension C-one P-arallelying (XCP) holder was used for holding sensor. The periapical status of the endodontic treatment was evaluated with periapical index (PAI) scoring system. Scoring ranged from 1 to 5 was opted. The PAI sores were based on absence and presence of periapical lesion where score 0 was indicative of absence of pathology and 1 suggested presence of pathology. PAI <3 showed absence and PAI >3 showed presence of periapical lesion.

Baseline and follow-up radiographs at 6 months were compared. Density of the filling and the distance between the end of the filling and the radiographic apex indicated the quality of RC filling that scored from 1 to 6 based on scoring suggested in study by Unal et al.[6] The absence of voids and the condensation of the filling material in the RC indicated of homogenous RC filling. A RCT with an acceptable filling length and a homogenous root filling was defined as being an adequate RCT. The results were clubbed together and were compared statistically using the Mann–Whitney U-test where P < 0.05 was mentioned as significant.


   Results Top


[Table 1] shows that out of 238 patients, males were 128 and females were 110. The mean age of males was 41.2 years and females were 40.5 years. AP was seen in 57.4% males and 48.6% females.
Table 1: Distribution of patients

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[Table 2] and [Graph 1] shows that score 1 was seen I in 14.1% before and 72.2% after endodontic retreatment, score 2 was 25.4% before and 6.2% after, score 3 was 2% before and 10.7% after, score 4 was seen in 17.1% before and 2.4% after, score 5 was seen in 40.2% before and 8.5% after and score 6 was seen in 1.2% before and 0% after endodontic retreatment. There was a statistically significant increase in scores 1 and 3 and decrease in scores 2, 4, 5, and 6 after treatment (P < 0.05).
Table 2: Comparison of quality of obturation before and after endodontic retreatment

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[Table 3] and [Graph 2] shows that PAI score >3 was seen in 37% before which decreased to 16% after endodontic retreatment. The difference was statistically significant (P < 0.05).
Table 3: Comparison of periapical index before and after endodontic retreatment

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[Table 4] shows that 34.6% obturation was homogenous and 65.4% was nonhomogenous before endodontic retreatment. After endodontic retreatment, 95.2% became homogenous and 4.8% nonhomogenous. The difference was statistically significant (P < 0.05)
Table 4: Homogeneity of obturation before and after endodontic retreatment

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[Graph 3] shows that reason for endodontic failure was furcation in 2%, iatrogenic causes in 3%, loss of coronal seal in 16%, periapical pathology in 25%, and inadequate root filling in 54%.




   Discussion Top


It is evident in few studies that a short homogenous RC filling result in highest success rate of 90%–94%. It is also observed and suggested in literature that RC filling must terminate at 0.5 to 1 mm short of radiographic apex. It is further ascertained that over instrumentation and overfilling results in extrusion of micro-organisms into periapical area and hence must be prevented.[7] As suggested by Abbot,[8] the presence of symptomatic teeth, evidence of periapical radiolucency and increase in size radiographically is suggestive of failed RCT and no signs and symptoms of pain and reduction in size of periapical lesion is indicative of successful RCT. Inadequate aseptic control, poor access cavity design, missed or accessory canals, inadequate instrumentation, leaking temporary or permanent fillings, and procedural errors are among few causes of endodontic failures.[9] The present study was conducted to assess quality of RC filling before and after RC re-treatment.

In the present study, out of 238 patients, males were 128 and females were 110. AP was seen in 57.4% males and 48.6% females. Mean age of males was 41.2 years and females were 40.5 years. Alharmoodi and Al-Salehi[10] assessed endodontic retreatment outcomes based on quality of obturation and healing in 199 radiographs of patients who had received endodontic retreatment. The results showed that 78.9% of the endodontic re-treatments were both homogeneity and length acceptable. Homogeneity and length unacceptable before endodontic retreatment was 47.2% reduced to 2.5% after retreatment.

We found that there was significant increase in scores 1 and 3 and decrease in scores 2, 4, 5, and 6 after treatment. Score 1 was seen I in 14.1% before and 72.2% after endodontic retreatment, score 2 was 25.4% before and 6.2% after, score 3 was 2% before and 10.7% after, score 4 was seen in 17.1% before and 2.4% after, score 5 was seen in 40.2% before and 8.5% after and score 6 was seen in 1.2% before and 0% after endodontic retreatment. It is found that micro-organisms found in endodontic re-treatment are more resistant to antiseptics as compared to those found in primary RCT.[11]

In the present study, 34.6% obturation was homogenous and 65.4% was nonhomogenous before endodontic retreatment. After endodontic retreatment, 95.2% became homogenous and 4.8% nonhomogenous. The reason for endodontic failure was furcation in 2%, iatrogenic causes in 3%, loss of coronal seal in 16%, periapical pathology in 25% and inadequate root filling in 54%. It is known that the main cause for failure of RCT is insufficient disinfection and the inability to prevent recolonization of residual microorganisms. Nonsurgical retreatment is often considered the treatment of choice if a previously treated tooth has persistent AP. The presence and size of the apical lesion, the root end filling material, type and quality of the coronal restoration, the status of previous RCT etc., helps in deciding whether surgical or nonsurgical treatment is to be planned.[12]

The shortcoming of the present study is small sample size and short follow-up. Postoperative IOPARs were considered rather than advanced radiographic method such as CBCT images.


   Conclusion Top


The authors found that there was significant improvement and decrease in size of periapical lesions in re-endodontic cases as compared to primary RC treated teeth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Barrieshi-Nusair KM, Al-Omari MA, Al-Hiyasat AS. Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan. J Dent 2004;32:301-7.  Back to cited text no. 1
    
2.
Fezai H, Al-Salehi S. The relationship between endodontic case complexity and treatment outcomes. J Dent 2019;85:88-92.  Back to cited text no. 2
    
3.
Bierenkrant DE, Parashos P, Messer HH. The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontists. Int Endod J 2008;41:561-70.  Back to cited text no. 3
    
4.
Siqueira JF Jr. Aetiology of root canal treatment failure: Why well-treated teeth can fail. Int Endod J 2001;34:1-10.  Back to cited text no. 4
    
5.
Covello F, Franco V, Schiavetti R, Clementini M, Mannocci A, Ottria L, et al. Prevalence of apical periodontitis and quality of endodontic treatment in an Italian adult population. Oral Implantol 2010;3:9-14.  Back to cited text no. 5
    
6.
Unal GC, Kececi AD, Kaya BU, Tac AG. Quality of root canal fillings performed by undergraduate dental students. Eur J Dent 2011;5:324-30.  Back to cited text no. 6
    
7.
Chala S, Abouqal R, Abdallaoui F. Prevalence of apical periodontitis and factors associated with the periradicular status. Acta Odontol Scand 2011;69:355-9.  Back to cited text no. 7
    
8.
Abbott PV. Recognition and prevention of failures in clinical dentistry. Endodontics. Ann R Australas Coll Dent Surg 1991;11:150-66.  Back to cited text no. 8
    
9.
Hession RW. Long-term evaluation of endodontic treatment: Anatomy, instrumentation, obturation – The endodontic practice triad. Int Endod J 1981;14:179-84.  Back to cited text no. 9
    
10.
Alharmoodi R, Al-Salehi S. Assessment of the quality of endodontic re-treatment and changes in periapical status on a postgraduate endodontic clinic. J Dent 2019;92:103261.  Back to cited text no. 10
    
11.
Ng YL, Gulabivala K. Outcome of non-surgical re-treatment. Endod Top 2008;18:3-30.  Back to cited text no. 11
    
12.
Lambrianidis T, Tosounidou E, Tzoanopoulou M. The effect of maintaining apical patency on periapical extrusion. J Endod 2001;27:696-8.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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