Is Coronal Restoration a Predictor of Posttreatment Apical Periodontitis?

Objectives To investigate the posttreatment apical periodontitis (AP) in endodontically treated teeth through a multivariate approach and to analyze the relative importance of quality and type of coronal restoration as predictors of periapical disease. Materials and Methods The present study sample was drawn within 2-year period from the 1,072 consecutive patients older than 18 years, first time attending the Dental Clinic of the Clinical Hospital Center Rijeka, Croatia. A total of 1,350 endodontically treated teeth were included in the study. For each tooth, the periapical status, root filling quality, intracanal post, separated file presence, marginal bone loss, and quality and type of coronal restoration were recorded. Statistical Analysis Chi-square tests were used to analyze the variations in the periapical status, quality of root canal filling, and quality of coronal restoration in different tooth types. The effect of explanatory variables on periapical status was explored using univariate and multivariate logistic regression models. The outcome variable was set as the presence versus absence of AP in the tooth. Results Multivariate logistic regression analysis revealed statistically significant associations and increased risk for AP presence in molars (odds ratio [OR] = 2.15; p < 0.001), teeth positioned in mandible (OR = 1.49; p = 0.007), teeth with short length of root filling (OR = 4.08; p < 0.001), overfilled teeth (OR = 2.99; p = 0.001), and teeth with inadequate density of root filling (OR = 4.14; p < 0.001). Considering variables related to coronal restoration, neither coronal restoration type nor quality was found to be predictive for posttreatment AP. Merely, the presence of intracanal post significantly increased the odds of AP presence (OR = 1.57; p = 0.009). Conclusion The results of the present study did not indicate that type or quality of coronal restoration may be predictors of posttreatment AP. Periapical disease was significantly associated with molars, mandibular teeth, substandard quality of root fillings, and intracanal post presence.

Underestimated Risk Factor of Osteonecrosis of the Jaw, Pulp and Periapical Disease: A National Cohort-Based Study in Korea

Background: Osteonecrosis of the jaw (ONJ) is one of the complication of bisphosphonate (BP). Despite being a major risk factor for ONJ, tooth extraction cannot explain all cases of ONJ. However, disease that induce inflammation in the jawbone, such as pulp and periapical disease is underestimated, and studies suggesting relationship are arising. This necessitates the determination of the relationship between ONJ and inflammatory disease, which would contribute to the understanding and treatment of ONJ.Methods: We analyzed the relationship between ONJ and pulp and periapical disease, and caries in women aged over 50 years who were administered BP for over 1 year from 2010 to 2015, based on a nationwide cohort study. ONJ, pulp and periapical disease, and caries were defined according to the Korean Standard Classification of Diseases and Causes of Death-7 and claims data. ONJ was operationally defined into definite ONJ and possible ONJ because of the ambiguity of population-based ONJ diagnosis.Results: Pulp and periapical disease significantly increased ONJ development [hazard ratio 2.21 (95% CI 1.40-3.48) and 2.22 (95% CI 1.65-2.98) in definite ONJ and possible ONJ, respectively]. Additionally, the risk of ONJ development increased when caries addition to pulp and periapical disease [hazard ratio 2.28 (95% 1.50-3.47) and 2.05 (95% 1.55-2.70) in definite ONJ and possible ONJ, respectively]. Nonetheless, those in the caries were not significant. Root canal treatment in most cases did not increase ONJ development significantly, but the pulp and periapical disease or caries significantly increased possible ONJ development [hazard ratio 2.17 (95% CI 1.04-4.52)].Conclusions: It is necessary to focus on pulp and periapical disease resulting in inflammation as a major risk factor for ONJ. Future studies should determine the role of low-grade inflammation for ONJ on other ONJ-inducing drugs as anti-resorptive agents.

Quality of Endodontic Treatment and Prevalence of Apical Radiolucencies in a Bulgarian Subpopulation: a CBCT Analysis

Introduction: The advent of Cone Beam Computed Tomography (CBCT) in endodontics has enhanced the diagnosis of periapical radiolucencies and the assessment of endodontically treated teeth.&nbsp; Aim: The purpose of this study was to assess the prevalence of periapical radiolucencies in a Bulgarian subpopulation and the quality of previous endodontic treatment using CBCT scans. Materials and methods: This study included 2795 roots from 160 Large FOV CBCT which were evaluated by two independent examiners using two scoring systems: CBCT-PAI and PESS.&nbsp; Results: The inter-examiner agreement spanned from strong to almost perfect (0.892 and 0.983). The prevalence of periapical lesions according to the two scoring systems was 23.1% and 12.9 %, respectively. The prevalence of endodontically treated teeth was high (34.1%). Sixty-five percent of them presented with signs of periapical radiolucencies, while only 1.4% of all non-treated roots had a periapical lesion. A significant association between periapical disease, poor quality of the root canal filling and inadequate coronal seal was found (p<0.001).&nbsp; Conclusions: The prevalence of periapical disease in endodontically-treated teeth in the Bulgarian subpopulation was high. Poor qual-ity of the root canal filling and inadequate coronal seal were assessed as prognostic determinants of treatment failure. CBCT techniques can augment conventional diagnostic techniques in the field of endodontics.&nbsp;

Successful Use of MTA Fillapex as a Sealant for Feline Root Canal Therapy of 50 Canines in 37 Cats

Intentional or unintentional pulp exposure of cat canines can lead to periapical disease, osteomyelitis, and oral pain. Root canal therapy (RCT) allows the retention of cat canines with pulp exposure by removing the infected pulp and replacing it with an inert material. This study used MTA Fillapex™ as a root canal sealant with gutta percha single cone obturation in 37 cats (50 canine teeth). Roots were classified as “successful,” “no evidence of failure (NEF),” or “failed” at 6-month radiographic reviews. Therapy was considered “successful” if a preoperative periapical lucency had healed or not formed after treatment and any preoperative external inflammatory root resorption (EIRR) had stabilized without progression. Therapy was categorized as “NEF” if a periapical lucency had remained the same or decreased in size but not completely resolved and any preoperative EIRR had stabilized without progression. “Failed” if a periapical lucency had occurred or increased in size posttreatment or if EIRR had developed or progressed posttreatment. Thirty-two canine teeth (64%) were classified as “successful,” 14 canine teeth (28%) were classified as “NEF,” and 4 canine teeth (8%) were classified as “failed”. The study concluded that RCT using MTA Fillapex as a root canal sealant is a suitable endodontic treatment for fractured cat canines, especially those that are periodontally or endodontically challenged.