The relation between apical periodontitis and root-filled teeth in patients with periodontal treatment need.
OBJECTIVE
To investigate a number of clinical and treatment variables that might have influenced the prevalence of apical periodontitis in root-filled teeth in a population of periodontally compromised patients.


METHODS
This investigation was a retrospective cross-sectional study on data collected from periodontal charts in addition to intra-oral full-mouth radiographs from patients attending the Department of Periodontology of the Dental School of the Ghent University Hospital. Periodontal parameters (clinical attachment loss and the lowest marginal bone level, the history of periodontal treatment), endodontic treatment (length, homogeneity and overall quality of the root filling) and the quality of coronal restorations were related to the prevalence of apical periodontitis. A total of 272 root-filled teeth in 94 patients were evaluated.


RESULTS
The periapical condition was significantly influenced by the quality of the root filling and the coronal filling (P < 0.05). More apical periodontitis was seen when the coronal level of the root filling exceeded the marginal bone level (P < 0.005). The marginal periodontal condition seemed to influence the periapical status. Teeth with apical periodontitis were associated with significantly more extended marginal bone loss (P < 0.001). Significantly less apical periodontitis was seen in patients that had received marginal periodontal treatment (P < 0.005), compared with untreated periodontal patients.


CONCLUSIONS
Signs of periodontal disease, as reflected by marginal bone loss, are of importance for the periapical condition of root-filled teeth. Efforts should be taken in preventing spread of infection through the periodontal-endodontic pathway by periodontal infection control and a high quality of root filling and coronal filling. Care should also be taken to seal the coronal cavity up to the level of the root filling, where it is advisable to reduce the coronal level of the root filling below or at least at the level of the surrounding marginal bone.
Department of Operative Dentistry and Endodontology, Ghent University, Dental School, Ghent University Hospital, Ghent, Belgium.
I G K
IG
Stassen
G M G
GM
Hommez
H
H
De Bruyn
R J G
RJ
De Moor
D016301:Alveolar Bone Loss / Q000150:complications; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003763:Dental Leakage / Q000150:complications; D019232:Dental Restoration Failure; D006801:Humans; D016015:Logistic Models; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging / Q000209:etiology*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000150:complications*; D011859:Radiography; D012189:Retrospective Studies; D012390:Root Canal Therapy / Q000009:adverse effects*; D018709:Statistics, Nonparametric; D019553:Tooth, Nonvital / Q000150:complications*