Apical periodontitis found in 31.9% of endodontically treated teeth

Thirty per cent adequate fillings, thirty-two per cent lesions

A cross-sectional study carried out in 2023 in Jönköping covered a randomly selected adult population that was not recruited in a dental practice, that is, a cross-section of the general population rather than patients under treatment. Among them, 126 people had a total of 295 endodontically treated teeth, and their periapical radiographs were assessed by two calibrated examiners.

A filling was considered adequate if it ended 0.5 to 2 mm from the radiographic apex and had no radiolucent voids. Eighty-nine teeth, or 30.2 per cent, met that criterion. Periapical status was assessed with the PAI index and divided into healthy (PAI 1 to 2) and diseased (PAI 3 to 5): apical periodontitis was found in 94 teeth, or 31.9 per cent. Of those 94 teeth, 72, or 76.6 per cent, had an inadequate filling.

Molars are a separate story. Of 122 endodontically treated molars, 101, or 82.8 per cent, had an inadequate filling, and 57, or 46.7 per cent, had apical periodontitis, almost every second one. The authors conclude that a large proportion of endodontically treated teeth carry both poor filling quality and a periapical lesion, and that the causes and the strategies for improvement have yet to be investigated.

Limitations

A cross-sectional design describes the situation at a single point in time, not whether the lesions are healing or progressing. Radiographic assessment of filling quality does not show the three-dimensional seal or the year in which the procedure was performed.

For your practice

• The finding in molars justifies a stricter indication: if access to all canals and control of working length cannot be secured, a referral to a specialist is cheaper than a retreatment five years later.
• For every existing endodontically treated tooth in a prosthetic plan, take a periapical radiograph and assess the length and homogeneity of the filling before placing a crown or a bridge abutment on it.
• The combination of an inadequate filling and a lesion in three quarters of cases shows that the quality of execution is the main lever the clinician controls, more than the choice of material.