Journal of Isfahan Dental School

Prevalence of Apical Periodontitis and Its Associated Factors in Endodontically Treated Teeth: A CBCT Study

Document Type : مقاله‌های پژوهشی

Authors

1 Department of Endodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran

2 Post Graduate Student, Dental Students’ Research Committee, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

3 Oral and Maxillofacial Radiologist, Shiraz University of Medical Sciences, Shiraz, Iran

4 Post Graduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran

Abstract

Introduction: The aim of this study was to investigate the prevalence of apical periodontitis and some associated factors in endodontically treated teeth among an Iranian population using Cone-Beam Computed Tomography (CBCT).
Materials and Methods: In this cross-sectional study, 470 CBCT scans (including 1287 root-filled teeth) were randomly selected from patients referred to a maxillofacial radiology center in Shiraz. Iran, during 2017-2020. Cone-Beam Computed Tomography Periapical Index (CBCTPAI) was used to assess the presence of apical periodontitis. In root-filled teeth with apical periodontitis, the length of the root filling and the presence of missed canals were investigated. Chi-square analysis was used to assess the relationship between apical periodontitis, age, gender of the patients, tooth type, and tooth location. A p value < 0.05 was considered significant.
Results: Apical periodontitis was observed in 23.5% of the root-filled teeth. The prevalence of apical periodontitis in males (26.3%) was significantly higher than females (21.2%) (p value = 0.035). Also, the prevalence of apical periodontitis in root-filled teeth in patients under 50 years old (26.2%) was significantly higher than patients over 50 years old (20.3%) (p value = 0.012). The most common teeth with apical periodontitis were maxillary and mandibular first molars. Among the root-filled teeth with apical periodontitis, under-filling, over-filling and missed canals were observed in 37.6%, 16.2% and 13.9% of cases, respectively.
Conclusion: The prevalence of apical periodontitis in root-treated teeth is relatively high (23.5%). Patients’ age, gender, and type of tooth are among the factors that affect the prevalence of apical periodontitis in endodontically treated teeth. 
Keywords: Apical periodontitis; Cone-beam computed tomography; Root canal therapy.

1. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965; 20: 340-9.
2. Weber M, Ries J, Büttner-Herold M, Geppert CI, Kesting M, Wehrhan F. Differences in inflammation and bone resorption between apical granulomas, radicular cysts, and dentigerous cysts. J Endod 2019; 45(10): 1200-8.
3. Braz-Silva PH, Bergamini ML, Mardegan AP, De Rosa CS, Hasseus B, Jonasson P. Inflammatory profile of chronic apical periodontitis: a literature review. Acta Odontol Scand 2019; 77(3): 173-80.
4. Tibúrcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J 2021; 54(5): 712-35.
5. Chugal N, Mallya SM, Kahler B, Lin LM. Endodontic treatment outcomes. Dent Clin North Am 2017; 61(1): 59-80.
6. Ali AH, Mahdee AF, Fadhil NH, Shihab DM. Prevalence of periapical lesions in non-endodontically and endodontically treated teeth in an urban Iraqi adult subpopulation: A retrospective CBCT analysis. J Clin Exp Dent 2022; 14(11): e953-8.
7. Bürklein S, Schäfer E, Jöhren HP, Donnermeyer D. Quality of root canal fillings and prevalence of apical radiolucencies in a German population: a CBCT analysis. Clin Oral Investig 2020; 24(3): 1217-27.
8. Dutta A, Smith-Jack F, Saunders WP. Prevalence of periradicular periodontitis in a Scottish subpopulation found on CBCT images. Int Endod J 2014; 47(9): 854-63.
9. Lemagner F, Maret D, Peters OA, Arias A, Coudrais E, Georgelin-Gurgel M. Prevalence of apical bone defects and evaluation of associated factors detected with cone-beam computed tomographic images. J Endod 2015; 41(7): 1043-7.
10. Pak JG, Fayazi S, White SN. Prevalence of periapical radiolucency and root canal treatment: a systematic review of cross-sectional studies. J Endod 2012; 38(9): 1170-6.
11. Jakovljevic A, Nikolic N, Jacimovic J, Pavlovic O, Milicic B, Beljic-Ivanovic K, et al. Prevalence of apical periodontitis and conventional nonsurgical root canal treatment in general adult population: an updated systematic review and meta-analysis of cross-sectional studies published between 2012 and 2020. J Endod 2020; 46(10): 1371-86. e8.
12. Craveiro MA, Fontana CE, de Martin AS, Bueno CE. Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod 2015; 41(6): 836-40.
13. Moreno JO, Alves FR, Gonçalves LS, Martinez AM, Rôças IN, Siqueira JF Jr. Periradicular status and quality of root canal fillings and coronal restorations in an urban Colombian population. J Endod 2013; 39(5): 600-4.
14. Alves Dos Santos GN, Faria-E-Silva AL, Ribeiro VL, Pelozo LL, Candemil AP, Oliveira ML, et al. Is the quality of root canal filling obtained by cone-beam computed tomography associated with periapical lesions? A systematic review and meta-analysis. Clin Oral Investig 2022; 26(8): 5105-16.
15. Chandra A. Discuss the factors that affect the outcome of endodontic treatment. Aust Endod J 2009; 35(2): 98-107.
16. Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pecora JD. A new periapical index based on cone beam computed tomography. J Endod 2008; 34(11): 1325-31.
17. Timmerman A, Calache H, Parashos P. A cross sectional and longitudinal study of endodontic and periapical status in an Australian population. Aust Dent J 2017; 62(3): 345-54.
18. Georgopoulou MK, Spanaki‐Voreadi AP, Pantazis N, Kontakiotis EJ. Frequency and distribution of root filled teeth and apical periodontitis in a Greek population. Int Endod J 2005; 38(2): 105-11.
19. Mostafapoor M, Hemmatian S. Evaluation of the accuracy values of cone-beam CT regarding apical periodontitis: a systematic review and meta-analysis. Oral Radiol 2022; 38(3): 309-14.
20. Jimenez C, Garrido M, Pussinen P, Bordagaray MJ, Fernandez A, Vega C, et al. Systemic burden and cardiovascular risk to Porphyromonas species in apical periodontitis. Clin Oral Investig 2022; 26(1): 993-1001.
21. Garrido M, Cardenas AM, Astorga J, Quinlan F, Valdes M, Chaparro A, et al. Elevated systemic inflammatory burden and cardiovascular risk in young adults with endodontic apical lesions. J Endod 2019; 45(2): 111-5.
22. Torabinejad M, Rice DD, Maktabi O, Oyoyo U, Abramovitch K. Prevalence and size of periapical radiolucencies using cone-beam computed tomography in teeth without apparent intraoral radiographic lesions: a new periapical index with a clinical recommendation. J Endod 2018; 44(3): 389-94.
23. Esmaeili F, Johari M, Rahbar M, Molaei S, Entezari P. Frequency of periapical radiolucency in CBCTs of Iranian patients. J Res Med Dent Sci 2018; 6(3): 427-35.
24. Shakiba B, Hamedy R, Pak JG, Barbizam JV, Ogawa R, White SN. Influence of increased patient age on longitudinal outcomes of root canal treatment: a systematic review. Gerodontology 2017; 34(1): 101-9.
25. Pereira RS, Rodrigues VAA, Furtado WT, Gueiros S, Pereira GS, Avila-Campos MJ. Microbial analysis of root canal and periradicular lesion associated to teeth with endodontic failure. Anaerobe 2017; 48: 12-8.
26. Nair PNR. On the causes of persistent apical periodontitis: a review. Int Endod J 2006; 39(4): 249-81.
27. Lee YP, Hwang MJ, Wu YC, Lang MJ, Wu YH, Chiang CP. Clinicopathological study of periapical scars. J Dent Sci 2021; 16(4): 1140-5.
28. Saatchi M, Mohammadi G, Vali Sichani A, Moshkforoush S. Technical quality of root canal treatment performed by undergraduate clinical students of Isfahan Dental School. Iran Endod J 2018; 13(1): 88-93.
Journal of Isfahan Dental School
Volume 19, Issue 3 - Serial Number 3
October 2023
Pages 219-226