Saudi Endodontic Journal

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 10  |  Issue : 3  |  Page : 194--198

Radiographic evaluation of the technical quality of root canal filling in Riyadh government and private hospitals


Mohammad I Al-Obaida1, Khaled M Alwehaiby2, Omar H Al-Hindi3, Khalid Merdad4, Ebtissam M Al-Madi1,  
1 Department of Restorative Dental Sciences, King Saud University, Riyadh, Saudi Arabia
2 IbnShuraim Primary Health Care Center, Ministry of Health, Riyadh, Saudi Arabia
3 Department of Restorative Dental Sciences, College of Dentistry, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
4 Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Address:
Dr. Ebtissam M Al-Madi
Department of Restorative Dental Sciences, King Saud University, P O Box: 68004, Riyadh 11527
Saudi Arabia

Abstract

Introduction: The aim of this study is to evaluate radiographically the quality of root filling in endodontically treated teeth among a Riyadh population in governmental and private hospitals. Materials and Methods: Four hundred radiographs or obturated root canals in government and private hospitals were evaluated with regard to length, taper, and density of the root canal filling. The criterion-based number of adequate fill was identified and the root canal obturations were categorized as adequate or inadequate. Results: There were a statistically significant higher percentage of adequately obturated root canals in terms of length, density, and taper in government hospitals as compared to private hospitals. Moreover, the proportion of adequate length and taper of root canal was significantly higher in anterior teeth when compared with premolar and molar teeth in both private and governmental hospitals. There was no statistically significant association between the assessment of density of root canal and the type of tooth. Conclusion: The overall quality of the root canal filling in endodontically treated teeth in governmental hospitals was higher than in private hospitals and higher than some reported studies around the world.



How to cite this article:
Al-Obaida MI, Alwehaiby KM, Al-Hindi OH, Merdad K, Al-Madi EM. Radiographic evaluation of the technical quality of root canal filling in Riyadh government and private hospitals.Saudi Endod J 2020;10:194-198


How to cite this URL:
Al-Obaida MI, Alwehaiby KM, Al-Hindi OH, Merdad K, Al-Madi EM. Radiographic evaluation of the technical quality of root canal filling in Riyadh government and private hospitals. Saudi Endod J [serial online] 2020 [cited 2020 Sep 25 ];10:194-198
Available from: http://www.saudiendodj.com/text.asp?2020/10/3/194/293572


Full Text



 Introduction



The root-filling phase is the most critical step of root canal therapy (RCT) and is the major cause of most failure.[1] Reports have shown that the development of or lack of healing of periapical radiolucencies postendodontic treatment is closely associated with poor-quality endodontic treatment.[2],[3],[4] The limited number of endodontists, as well as limited access to endodontists due to lack of eligibility of patients for treatment in the government sector, in addition to the relatively high cost of endodontic treatment performed by an endodontist in the private sector, encourages general practitioners to perform the majority of RCTs in Saudi Arabia. Some studies confirm that many general dental practitioners in Saudi Arabia are not following quality guidelines for endodontic treatment.[5] Appraising the technical quality of root canal treatment and obturation provided to patients by general dentists is important to increase the awareness of optimum RCT, regulate the treatment provided, and remedy any complications. Through systematic and scientific gap analysis, solutions can be found to improve the current situation.[6],[7],[8] Judging the technical quality of obturation through periapical radiographic assessment to determine the quality of root canal filling has proven its validity throughout the years. Moreover, the approachability and reliability of radiographs make them suitable for epidemiological studies.[9] The aim of this study was to evaluate radiographically the quality of root filling of endodontically treated teeth among a Riyadh population in governmental and private hospitals.

 Materials and Methods



The study was registered with the College of Dentistry and Research Center, and the design and protocol were deemed exempt by the Institutional Internal Review Board of King Saud University (FR-0359). The sample size was defined at 400 periapical radiographs (anterior, premolars, and molars), by assuming that 50% of the root filling would be adequate in endodontically treated teeth, with a precision of ±5% and with a 0.05 level of significance. An evaluation form was designed to record the information collected from radiographs. Any radiographs with processing errors were excluded. The quality of root canal filling was assessed based on three criteria: length, shape, and density, based on the American Association of Endodontics (AAE) crite.[10] With regard to the length of the root canal filling, the RCT was classified to adequate if the filling is within 2 mm from the radiographic apex, underfilling if the root canal filling ended more than 2 mm from the radiographic apex, or overfilling if it the root canal filling extruded beyond the radiographic apex. With regard to the density, the RCT was subdivided into either adequate if no voids were present in the root filling or between root filling and root canal walls or inadequate if voids were present in the root filling or between root filling and root canal walls. Finally, the root canal filling was subdivided with regard to taper into adequate if there was a consistent and continuous taper from the orifice to the apex or inadequate if there was no consistent and continuous taper from the orifice to the apex. Viewing conditions were standardized between evaluators using an illuminated viewing box for analog radiographs with the assistance of magnifying lenses or high-resolution screen for digital radiographs with a zoom.

Two operators evaluated the quality of the root canal filling for all cases. Descriptive statistics (frequencies and proportions) were used to describe the categorical variables. Twenty randomly chosen radiographs were used initially to test the inter- and intra-examiner reliability by Cohen's kappa test and to measure inter- and intra-reliability of three measures of root canal assessment between two evaluators. Each evaluator evaluated the same radiograph independently, and in case of disagreement on a radiograph, the evaluators discuss the radiograph together to reach a consensus.

The periapical radiographs were collected from dental departments of five governmental hospitals and five private hospitals/private dental clinics in Riyadh city. The radiographs were randomly obtained from the patient files, and no attempt was made to identify the level of the dentist who performed the root canal (General Dentists, specialist, or endodontist).

Statistical analysis was carried out using SPSS (SPSS Inc., Chicago, IL, USA). Pearson's Chi-square test was used to assess the association between the three measures of root canal assessment across the three types of teeth (anterior, premolars, and molars) and to compare the distribution of the three measures of root canal assessment between private and government hospitals. P ≤ 0.05 was used to define the statistical significance of results.

 Results



Of the 400×-rays of root canal treatment assessed, 200 were from government and 200 were from private hospitals/clinics.

Inter- and Intra-observer agreement

There was a high agreement between the two evaluators with relation to their assessment of length, density, and taper (mean Cohen's kappa values were 0.65–0.75 for test and 0.72–0.85 for retest). There was a high assessment agreement regarding length, density, and taper at different times by the first evaluator (mean Cohen's kappa: 0.61–0.79), as well as the second evaluator (mean Cohen's kappa: 0.60–0.68).

The distribution of tooth type (anterior, premolars, and molars) in private and governmental hospital is shown in [Table 1].{Table 1}

In private and governmental hospitals, the proportion of adequate length of root canal was significantly higher in anterior teeth when compared with premolar and molar teeth (P < 0.025). In addition, the proportion of adequate taper of root canal was significantly higher in anterior teeth when compared with premolar and molar teeth (P < 0.038). However, there was no statistically significant association between the assessment of density of root canal and the type of tooth [Table 2].{Table 2}

There was a statistically significant higher percentage of adequately obturated root canals in terms of length, density, and taper in government hospitals as compared to private hospitals (P < 0.022), as shown in [Table 3].{Table 3}

 Discussion



Different criteria have been used in previous epidemiological studies for categorizing root canal fillings as adequate or inadequate. In the present study, the quality of root canal filling was assessed based on the AAE criteria.[10] Some studies have focused merely on the length of the root canal filling, considering the apical termination of the root filling 2 mm from radiographic apex as the gold standard for an adequate root filling.[11],[12],[13],[14] In the present study, 51.5% of teeth were filled within 2 mm of the radiographic apex, higher than found in Portuguese population which was 46% of teeth,[15] Polish population which was 48.9% of teeth,[16] Swedish population which had 30% of teeth,[14] and a German population which had 14% of teeth.[17] The number of adequate root canal fillings based on this criterion was higher than that of a population in Al-Madinah Al-Munora, which was 32.7%.[18] This could be because Riyadh is the capital city with a larger population and several dental schools, as compared to Al-Madinah. The percentage of the present study was lower than that found in a Nigerian population, which was 71%.[19] This could be due to the high number of required root canal treatments during training in most curriculum in Saudi Arabia or due to the high number of cases presented in government and private hospitals leading to increased the experience of the dentists in general. In the present study, the frequency of adequate treatment, based on the criteria set at hand, in governmental dental hospitals (58.3%) was significantly higher than private dental hospitals (41.7%). This result was in agreement with similar comparisons between Taiwanese governmental hospitals and private clinics.[20] This could possibly be due to the higher level of quality control and monitoring in government hospitals as compared to private sectors.

The length and the density of the root canal filling were used in studies for evaluating the radiographic quality of RCT.[15],[17],[21],[22],[23],[24],[25],[26] According to the European Society of Endodontology, the root canal should be tapered in the instrumentation phase from crown to apex;[27] however, not many studies have used this criterion, since the evaluation of taper is very subjective. In the present study, the number of teeth with adequate taper of the root canal filling was 65.7%. Anterior teeth had a significantly adequate taper (81.2%) compared to premolars (63.6%) and molars (46.5%). It is well known that anterior teeth are easier to treat endodontically, and this could be the reason for the better results in anterior teeth. This finding was higher than that of a Taiwanese population which had only 40.4% in anterior teeth, premolars (33%), and molars (18.4%).[20] This might be due to differences in training or in the judgment of the evaluators. In the present study, 62.5% of teeth had adequate density; on the contrary, it was lesser than the Taiwan density of root canal filling, in which they had adequate obturation density 38%. Once again, since density is a highly subjective criterion, this could be due to the difference in the examiner evaluation.

The higher presence of civil employed endodontists, as a result for the need for specialists in the government hospitals, and availability of free dental service from these specialized endodontists may be the reason why the percentage of adequately filled root canals in government hospitals is higher than private institutions.

 Conclusion



Within the limitations of this study, it seems that the overall quality of the root canal filling in endodontically treated teeth among a population in Riyadh was found to be more adequate in governmental hospitals than private hospitals and higher than some reported studies around the world. However, these findings suggest that further investigations needed to figure out the actual reasons of the difference.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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