Endodontic Outcome Predictors Identified with Periapical Radiographs and Cone-beam Computed Tomography Scans

doi:10.1016/j.joen.2010.11.032

Journal of Endodontics

Volume 37, Issue 3, March 2011, Pages 326-331

https://doi.org/10.1016/j.joen.2010.11.032 Get rights and content

Abstract

Introduction

The outcome predictors identified with data from periapical radiographs (PA) and cone-beam computed tomography (CBCT) scans might not be the same. This retrospective study evaluated various factors that might affect the outcome of root canal therapy.

Methods

In total, 115 teeth (143 roots) with vital pulps were endodontically treated and followed up 2 years after treatment. Multivariate logistic regression was performed on the data from PA or CBCT to analyze outcome predictors.

Results

At recall, PA detected periapical lesions in 18 roots (12.6%), as compared with 37 on CBCT images (25.9%). The length and density of root filling determined by PA and CBCT were often different (p < .001). Overall, 20 of the 25 short root fillings (80%) diagnosed by PA appeared as flush fillings on CBCT images. PA revealed 23 root fillings (16.1%) with voids, as compared with 66 on CBCT images (46.2%). When findings from PA were analyzed, density and apical extent of root filling were identified as predictors (p < .05). When findings from CBCT were analyzed, density of root filling and quality of coronal restoration influenced the outcome significantly (p ≤ .001), whereas gender, tooth type, root curvature, number of visits, CBCT-determined apical extent of root filling, and use as abutment did not (p > .1).

Conclusions

Treatment outcome, length and density of root fillings, and outcome predictors as determined with CBCT scans might not be the same as corresponding values determined with PA.

Section snippets

Materials and Methods

This study protocol was approved by the ethics committee at the Peking University School of Stomatology. Patients who had received vital pulpectomy and root canal treatment in at least 1 tooth in the Department of Operative Dentistry and Endodontics of Peking University School of Stomatology between January and September 2007 were consecutively recalled between October and December 2009. Thus, the follow-up period was 2 years. An invitation letter was sent to 204 subjects. Seventy-four subjects

Clinical and Radiographic Examination

At the recall examination, pain, swelling, tenderness to apical and gingival palpation and percussion, as well as the quality of coronal restorations were recorded.

Two radiographic methods, intraoral PA and CBCT, were used to detect post-treatment periapical lesions. Straight projection intraoral PA were obtained with the digital imaging system Digora Optime (Soredex, Helsinki, Finland) with a parallel technique. Exposures (0.16–0.25 seconds) were obtained with a MinRay dental x-ray unit

Gender

Although a significant association between gender and success rate was not found in the majority of previous clinical studies (1), this factor was included in our analysis.

Tooth Type

The treatments performed in the anterior teeth, premolars, and mandibular molars were included.

Canal Curvature

The method of Schneider (15) was used to measure root canal curvature on PA or CBCT images. The greatest degree of curvature in either the coronal or sagittal plane was recorded for each root. All roots were divided into 3

Statistics

The recordings for apical extent and density of root fillings determined by PA and CBCT were compared with the χ² test. Multivariate logistic regression analysis was performed on the pooled data from PA or from CBCT separately to identify factors affecting treatment outcome. The presence of periapical lesions was the dependent variable; gender, tooth type, canal curvature, apical extent and density of root filling, number of treatment visits, coronal restoration, and use as abutment were

Results

A total of 130 subjects did not respond. The exact reasons for loss to follow-up were unknown.

All teeth were asymptomatic at recall. In clinical examination, 5 teeth were slightly tender to percussion.

Assessment of the PA and CBCT scans revealed interexaminer agreement of 0.60 and 0.75 (Cohen kappa), respectively. In case of disagreement, 2 observers reached agreement after discussion in all cases.

In 116 roots (81%), the observations made for both methods were in agreement; either a periapical

Discussion

The recall rate was 36% (74 of 204), which is low but comparable to those reported in previous clinical studies (18). Ørstavik et al (19) reported that dropouts had more symptoms and perceived that treatment had failed. Marquis et al (18) reported that the attending and lost-to-follow-up populations differed significantly with regard to age. In the present study, the subjects could have declined the invitation to follow-up because of relocation, refusal to undergo CBCT, or the above-mentioned

Acknowledgments

The authors deny any conflicts of interest related to this study.

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Clinical ResearchEndodontic Outcome Predictors Identified with Periapical Radiographs and Cone-beam Computed Tomography Scans

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Materials and Methods

Clinical and Radiographic Examination

Gender

Tooth Type

Canal Curvature

Statistics

Results

Discussion

Acknowledgments

J Dent

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

J Endod

J Endod

J Endod

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

Clinical Research
Endodontic Outcome Predictors Identified with Periapical Radiographs and Cone-beam Computed Tomography Scans