Apical periodontitis in root filled teeth associated with the quality of root fillings.

UNLABELLED: The aim of this study was to investigate the technical quality of root fillings in root filled teeth, their association with periapical status and prevalence of apical periodontitis.

MATERIAL AND METHODS: The sample consisted of 83 subjects, presenting consecutively as new patients seeking dental care (prosthetic, endodontic and cariologic treatment) in the years 2005/2006. Clinical and radiographic examination on each patient was performed using the scoring system (Periapical index (PAI)) proposed by Ørstavik et al. From the periapical radiographs status of endodontically treated teeth was recorded. For each tooth the following items were surveyed: the presence of a root filling, its quality (lateral seal and length in the root canal) and the periapical status.

RESULTS: Of the 2186 functional teeth, 283 had undergone root canal treatment (13%). Amongst 283 root filled teeth, 122 teeth (43.1%) had radiological signs of a periapical lesion (PAI>2). Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. Inadeguate lateral seal of root filling was observed in 165 (58.3%) of 283 endodontically treated teeth. Inadequate length of endodontic treatment was discovered in 183 (64.7%) out of 283 teeth. Root filled teeth without voids had apical periodontitis in 25 (21.0%) out of 118 of cases, whereas if voids were detected, disease was present in 97 (58.8%) out of 165 teeth (p<0.001). Apical periodontitis was found in 23 (23.0%) out of 100 teeth with adequate length of root filling, whereas if the filling was too short or long, periapical lesions were present in 99 (54.0%) out of 183 teeth (p<0.001).

CONCLUSIONS: Apical periodontitis was present in 43,1% of root filled teeth. Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. The results of this study indicate that inadequate root fillings were more often associated with an increased prevalence of apical periodontitis. On the contrary, adequate root fillings significantly reduced the prevalence of disease. Many root canal treatments were technically unsatisfactory and substantial efforts must be made to improve the standard of endodontic treatment.