|Year : 2016 | Volume
| Issue : 1 | Page : 31-35
A cross-sectional study of the quality of root canal treatment in Al-Madinah Al-Munawwarah
Mothanna Alrahabi, Hamzah Bani Younes
Department of Restorative Dental Science, College of Dentistry, Taibah University, Medina, Saudi Arabia
|Date of Web Publication||16-Dec-2015|
Department of Restorative Dental Science, College of Dentistry, Taibah University, Medina
Source of Support: None, Conflict of Interest: None
Objective: This study evaluated the quality of root canal treatment (RCT) and determined the prevalence of apical periodontitis (AP) in Al-Madinah Al-Munawwarah, Saudi Arabia. Materials and Methods: Panoramic radiographs of 630 patients (316 males and 314 females) who attended clinics at the Dental College of Taibah University seeking dental care for the first time between 2010and 2013 were assessed for the adequacy of RCT and presence of AP. Results: RCT of at least one tooth was found in 52.8% of the patients, with a significantly higher prevalence in females (28.4 vs. 24.4%; P = 0.012), and AP was found in 53.5% of the patients, with a significantly higher prevalence in females (31.9 vs 21.6%; P = 0.000). Conclusions: There was a significant correlation between AP and inadequate endodontic treatment. This study reveals the importance of improving RCT in Al-Madinah Al-Munawwarah.
Keywords: Apical periodontitis, periapical status, radiographic evaluation, root canal treatment, treatment outcome
|How to cite this article:|
Alrahabi M, Younes HB. A cross-sectional study of the quality of root canal treatment in Al-Madinah Al-Munawwarah. Saudi Endod J 2016;6:31-5
| Introduction|| |
The success rate of primary root canal treatment (RCT) for teeth without apical periodontitis (AP) is 90–95% when these teeth are treated under controlled clinical conditions , by endodontists or dental students under direct supervision at university clinics., By contrast, AP develops in 24.5–65.8% of endodontically treated teeth by general practitioners.,,
RCT consists of a combination of biomechanical instrumentation of the root canal system and obturation of the canals with an inert material designed to treat or prevent the development of AP in the periradicular tissue.
Obturation of the root canal seals it completely to prevent the ingress of bacteria and their toxins and their flow into the periapical tissues. Schilder wrote that the ideal root canal obturating material should be well adapted to the canal walls and its irregularities and that the entire length of the canal should be densely compacted with a homogeneous mass of gutta-percha. However, epidemiological studies of RCT revealed a high frequency of poor quality therapy in endodontically treated teeth. The initial endodontic therapy might fail due to the presence of a persistent infection. Several reports have discussed the correlation between poor-quality RCT and AP.,,,
AP is widespread among adult populations, with a prevalence of 27–70%. Several studies have reported that the high prevalence of this condition is associated with poorendodontic treatment.,
No study has evaluated endodontic treatment and AP in a Saudi population. Therefore, this study assessed the quality of the RCT and determined the frequency of RCT and the prevalence of AP in the treated teeth in a sample of Saudi adults who attended the clinics of the Dental College at Taibah University and Uhud Hospital in Al-Madinah Al-Munawwarah. This study should provide information on RCT in Saudi Arabia and lead to treatment recommendations.
| Materials and Methods|| |
This study examined the panoramic radiographs of patients who had attended the dental clinics of the Dental College of Taibah University seeking dental care for the first time between 2010 and 2013. The study examined the adequacy of the RCT and the prevalence of AP in endodontically treated teeth in males (College of Dentistry, Taibah University) and females (Dental Clinics, Uhud Hospital) in Al-Madinah Al-Munawwarah.
The age of the patients ranged from 16to more than76 years. The patients were divided into five age groups: (A) 16–25, (B) 26–35, (C) 36–45, (D) 46–55, and (E) >56 years.
The selection of the panoramic radiographs
Panoramic radiographs were selected randomly from each patient's dental records. The radiographs of patients younger than 16 years of age those with fewer than 10 standing teeth were excluded. After the exclusion criteria were applied, the sample consisted of 630 panoramic images (316 males and 314 females) captured with a Kodak 9000 extraoral imaging system. The image capture parameters were set at 73 kV and 12 mA, and the exposure time was 12.5 s. The digital images were analyzed using Kodak imaging software.
Examination of the radiographs
The radiographic images were evaluated by two endodontists from the Restorative Dentistry Department of the College of Dentistry at Taibah University and Uhud Hospital in Al-Madinah Al-Munawwarah. The teeth with radiopaque material in the pulp chamber or root canals were categorized as endodontically treated teeth.
The obturation of the endodontically treated teeth was assessed as adequate or in adequateas follows:
- Adequate obturation: The root canal obturation was 0–2 mm from the radiographic apex, with uniform radiopaque density and no voids or spaces between the filling and root canal wall
- Inadequate obturation: The root canal obturation was >2 mm from the radiographic apex orextruded beyond the radiographic apex into the periapical region; canals had been missed; teeth had radiopaque material in the pulp chamber; teeth were filled using silver cones; or teeth hadvoids or spaces between the filling and root canal wall.
The parameters used to categorize periapical status were:
- Healthy periodontal ligament: An intact periodontal ligament space with no signs of periapical pathosis
- AP: Widening of the periodontal ligament space (widening of the apical part) exceeding twice the width of the lateral periodontal ligament space, or obvious periapical radiolucency.
The data were analyzed using Statistical Package for Social Sciences (SPSS) version 20 (SPSS, Chicago, IL, USA). The Chi-square test was used to determine the relationships of gender with the quality of the root canal filling and the apical status and to evaluate teeth subgroups for the different parameters studied. A P < 0.05 was considered statistically significant.
| Results|| |
The study evaluated 15,686 teeth or an average of 24.9 ± 3.75 teeth per patient, and found no significant differences between females and males (P > 0.05).
The prevalence of patients with RCT to at least one tooth was 52.8%, and this was significantly higher in females (28.4 vs 24.4%, P = 0.012) [Table 1]. The prevalence of patients with AP was 53.5%, also with a significantly higher prevalence in females (31.9 vs 21.6%, P = 0.000) [Table 1].
|Table 1: Distribution of patients with root canal treatment and apical periodontitis|
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Endodontic treatment was found in 6.3% of all teeth: 2.7% were adequately treated, and 3.6% were inadequately treated [Table 2]. AP was present in 4.2% of all teeth, including2.2% that had been endodontically treated and 2.0%that had not [Table 2].
|Table 2: Distribution of teeth with root canal treatment and apical periodontitis|
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The percentage of endodontic treatment of all teeth was higher in the maxilla than the mandible (59.2 vs 40.8%) [Table 3]. The mandibular first molar had the highest frequency of endodontic treatment and AP among all teeth types in both jaws [Table 3] and [Table 4].
The distribution of AP and RCT according to the patient's age was analyzed [Table 5]. The prevalence of patients with at least one tooth with AP increased with age, with the maximum prevalence in the 46–55-year group (65.5%); the highest frequency of patients with at least one tooth with endodontic treatment was in the 36–45-year group.
| Discussion|| |
The number of participants in this study (50.2% males and 49.8% females) is high compared with other studies.,,,, The inclusion of participants from both genders should also reduce recruitment bias.
This study confirmed that gender was correlated with the number of root canal-treated teeth and the presence of AP, both of which were significantly higher in females.
The age distribution of the sample was balanced, with the largest group of patients being in the 36–45-yearage group; whereas, younger patients made up most of the samples of other studies.,,,
The average number of teeth remaining per patient was 24.9 ± 3.75, which is consistent with other studies.,,,
In this study, two endodontists used panoramic radiographs to assess the periapical tissues and quality of root canal therapy. It has been suggested that periapical radiographs are more accurate than panoramic ones for assessing periapical pathology. However, the difference is not significant. Note that it is impossible to determine whether an apical radiolucency is developing or healing. However, Petersson et al., demonstrated that after a 10-year period, the number of healed periapical lesions was equal to the number of newly developed lesions.
The present study found more endodontically treated teeth in the maxilla 590 (59.2%) than the mandible 407 (40.2%), consistent with other studies.,,,,, The mandibular central incisors were the least often endodontically treated teeth, comprising only 0.50%of the teeth treated. The mandibular first molar was the most often endodontically treated tooth, comprising13.7%of the treated teeth. This is probably because of their early eruption in the oral cavity and the complexity of the anatomical surfaces of their crowns and occlusal surfaces.
The prevalence of teeth with endodontic treatment in this study was 6.3% of 15,686 teeth. The reported prevalence of endodontically treated teeth in other studies ranged from 3 to 22.8%.,,,,, The difference might be attributable to differences in the radiological techniques used to assess the periapical status.
This study found that 32.7% of the endodontically treated teeth were adequately treated, whereas 39% were inadequately treated. These results were higher than those of Al-Omari et al.,(27.6%) and Toure et al.,(17.7%), but were consistent with most other published studies (30–50%).,,
Furthermore, in this study population, the prevalence of at least one tooth with AP was53.5%, which is much higher than that in many other studies, which have reported prevalence rates of 0.6–0.9%.,, This indicates a low level of dental health and poor-quality endodontic treatment. This was consistent with the findings for Jordanian  and adult Belarusian  populations, which had higher prevalence of AP (83.7 and 80%, respectively).
There were 651 teeth with AP or 4.15% of the total number of teeth. This was higher than in some studies ,, and lower than in others.,,,,,
In the present study, 28.3% of patients had AP with inadequate endodontic treatment, and 5.9%had AP with adequate treatment. There was a significant correlation between AP and inadequate endodontic treatment (P = 0.00), but not between AP and adequate endodontic treatment (P = 0.997). Of the inadequately treated teeth, 52% also had AP, whereas only 10.7% of the adequately treated teeth had AP. This is consistent with other reports.,,,
| Conclusion|| |
This study found a significant correlation between AP and inadequate endodontic treatment. This reveals the importance of improving RCT in Al-Madinah Al-Munawwarah by emphasizing the training of undergraduate students; more continuing dental education, courses, and hands-on workshops for general practitioners; and the critical need for endodontic specialists.
| References|| |
Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod 1979;5:83-90.
Friedman S, Mor C. The success of endodontic therapy--healing and functionality. J Calif Dent Assoc 2004;32:493-503.
Eriksen HM, Bjertness E. Prevalence of apical periodontitis and results of endodontic treatment in middle-aged adults in Norway. Endod Dent Traumatol 1991;7:1-4.
Al Shareef AA, Saad AY. Endodontic therapy and restorative rehabilitation versus extraction and implant replacement. Saudi Endod J 2013;3:107-13.
Asgary S, Shadman B, Ghalamkarpour Z, Shahravan A, Ghoddusi J, Bagherpour A, et al
. Periapical status and quality of root canal fillings and coronal restorations in Iranian population. Int Endod J 2010;5:74-82.
Kirkevang LL, Vaeth M, Horsted-Bindslev P, Bahrami G, Wenzel A. Risk factors for developing apical periodontitis in a general population. Int Endod J 2007;40:290-9.
Chakravarthy P, Moorthy J. Radiographic assessment of quality of root fillings performed by undergraduate students in a Malaysian Dental School. Saudi Endod J 2013;3:77-81.
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: Systematic review of the literature - Part 2. Influence of clinical factors. Int Endod J 2008;41:6-31.
Hammad M, Qualtrough A, Silikas N. Evaluation of root canal obturation: A three-dimensional in vitro
study. J Endod 2009;35:541-4.
Schilder H. Filling root canals in three dimensions. 1967. J Endod 2006;32:281-90.
Kabak Y, Abbott PV. Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population. Int Endod J 2005;38:238-45.
Salehrabi R, Rotstein I. Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment. J Endod 2010;36:790-2.
Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S. Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations. Int Endod J 2003;36:181-92.
Lupi-Pegurier L, Bertrand MF, Muller-Bolla M, Rocca JP, Bolla M. Periapical status, prevalence and quality of endodontic treatment in an adult French population. Int Endod J 2002;35:690-7.
Siqueira JF Jr, Rocas IN, Alves FR, Campos LC. Periradicular status related to the quality of coronal restorations and root canal fillings in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:369-74.
Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol 2000;16:218-21.
Toure B, Kane AW, Sarr M, Ngom CT, Boucher Y. Prevalence and technical quality of root fillings in Dakar, Senegal. Int Endod J 2008;41:41-9.
Al-Omari MA, Hazaa A, Haddad F. Frequency and distribution of root filled teeth and apical periodontitis in a Jordanian subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e59-65.
Lopez-Lopez J, Jane-Salas E, Estrugo-Devesa A, Castellanos-Cosano L, Martin-Gonzalez J, Velasco-Ortega E, et al
. Frequency and distribution of root-filled teeth and apical periodontitis in an adult population of Barcelona, Spain. Int Dent J 2012;62:40-6.
Sidaravicius B, AlekSEJuniene J, Eriksen HM. Endodontic treatment and prevalence of apical periodontitis in an adult population of Vilnius, Lithuania. Endod Dent Traumatol 1999;15:210-5.
De Cleen MJ, Schuurs AH, Wesselink PR, Wu MK. Periapical status and prevalence of endodontic treatment in an adult Dutch population. Int Endod J 1993;26:112-9.
De Moor RJ, Hommez GM, De Boever JG, Delme KI, Martens GE. Periapical health related to the quality of root canal treatment in a Belgian population. Int Endod J 2000;33:113-20.
Gulsahi K, Gulsahi A, Ungor M, Genc Y. Frequency of root-filled teeth and prevalence of apical periodontitis in an adult Turkish population. Int Endod J 2008;41:78-85.
Jimenez-Pinzon A, Segura-Egea JJ, Poyato-Ferrera M, Velasco-Ortega E, Rios-Santos JV. Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Spanish population. Int Endod J 2004;37:167-73.
Georgopoulou MK, Spanaki-Voreadi AP, Pantazis N, Kontakiotis EG. Frequency and distribution of root filled teeth and apical periodontitis in a Greek population. Int Endod J 2005;38:105-11.
Rohlin M, Kullendorff B, Ahlqwist M, Stenstrom B. Observer performance in the assessment of periapical pathology: A comparison of panoramic with periapical radiography. Dentomaxillofac Radiol 1991;20:127-31.
Ahlqwist M, Halling A, Hollender L. Rotational panoramic radiography in epidemiological studies of dental health. Comparison between panoramic radiographs and intraoral full mouth surveys. Swed Dent J 1986;10:73-84.
Petersson K, Hakansson R, Hakansson J, Olsson B, Wennberg A. Follow-up study of endodontic status in an adult Swedish population. Endod Dent Traumatol 1991;7:221-5.
Kirkevang LL, Horsted-Bindslev P, Orstavik D, Wenzel A. Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J 2001;34:198-205.
Loftus JJ, Keating AP, McCartan BE. Periapical status and quality of endodontic treatment in an adult Irish population. Int Endod J 2005;38:81-6.
Tsuneishi M, Yamamoto T, Yamanaka R, Tamaki N, Sakamoto T, Tsuji K, et al
. Radiographic evaluation of periapical status and prevalence of endodontic treatment in an adult Japanese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:631-5.
Eriksen HM, Berset GP, Hansen BF, Bjertness E. Changes in endodontic status 1973–1993 among 35-year-olds in Oslo, Norway. Int Endod J 1995;28:129-32.
Allard U, Palmqvist S. A radiographic survey of periapical conditions in elderly people in a Swedish county population. Endod Dent Traumatol 1986;2:103-8.
Petersson K, Petersson A, Olsson B, Hakansson J, Wennberg A. Technical quality of root fillings in an adult Swedish population. Endod Dent Traumatol 1986;2:99-102.
Buckley M, Spangberg LS. The prevalence and technical quality of endodontic treatment in an American subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:92-100.
Marques MD, Moreira B, Eriksen HM. Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population. Int Endod J 1998;31:161-5.
Tavares PB, Bonte E, Boukpessi T, Siqueira JF Jr, Lasfargues JJ. Prevalence of apical periodontitis in root canal-treated teeth from an urban French population: Influence of the quality of root canal fillings and coronal restorations. J Endod 2009;35:810-3.
Boucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J 2002;35:229-38.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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