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Objective: The aim of this cross-sectional study was to assess the prevalence of apical periodontitis in root canal treated teeth in Turkish subpopulation and to evaluate the effects of both coronal restoration quality and root canal treatment (RCT) quality on apical periodontitis., Materials and Methods: Panoramic images of individuals who applied to our department for different diagnostic reasons were randomly and retrospectively scanned. Total RCT number, RCT quality, type of coronal restoration, restoration quality, periapical status, and total number of teeth were recorded. The criteria used for coronal restorations quality and RCT quality were defined by De Moor et al. and slightly modified by Gunduz et al. Periapical status was assessed by the periapical index developed by Orstavik et al. Pearson's Chi-square test was used for statistical analysis, and the intraobserver agreements were assessed by Kappa coefficients. Values of P < 0.05 were accepted to be meaningful., Results: The total examined teeth number was 6064, of which had 541 (8.9%) RCT. The prevelance of apical periodontitis was 40.5%. The number of adequate RCT was 178 (32.9%), and 138 (77.5%) of them were healthy. The number of adequate coronal restoration was 334, and 62.3% of them were healthy. For the cases that have adequate coronal restorations, there was statistically significant relationship between adequate RCT and periapical status (P < 0.001)., Conclusion: The prevelance of apical periodontitis was 40.5% and there was statistically significant relationship between adequate RCT and periapical status., Competing Interests: None

Objectives: To determine the health status of periradicular tissue and the quality of root canal fillings in an adult Saudi population attending dental clinics for the first time. Methods: This cross sectional study was conducted  in the dental clinics at King Saud University, Riyadh and other dental centers (Jeddah, Najran, and Albaha City), Kingdom of Saudi Arabia between year 2010   and 2012. Good-quality panoramic radiographs of 926 Saudi subjects (540 males and 386 females)were analyzed based on the gender, age, health status, smoking habits, periapical status of the endodontically treated teeth, technical quality of the root canal fillings, and the presence or absence of coronal restoration. Data were calibrated and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 17.  Results: Of the 25,028 teeth examined, 1,556 teeth (6.2%) had apical periodontitis (AP). Male subjects aged over 55 years and females between 36 and 45 years had higher AP. A total of 36 diabetic and 87 smokers subjects had AP. The AP was more common in male diabetics than female (p=0.383), and in female smokers more than male (p=0.44). Only 42.2% of male and 57.7% of female teeth had adequate root canal treatment.  Conclusions: Apical periodontitis was significantly related to diabetes, smoking, and inadequate endodontic treatment.

Aim: To assess the prevalence of apical periodontitis in the Finnish population aged 30 years and older and relate it to the technical quality of root filling by the type of tooth., Methodology: As part of the Finnish nationwide Health 2000 study, panoramic radiographs were used of the dentate subjects (n = 5335) aged 30-95 years (mean 50.2 years) to assess the apical and endodontic status of their teeth (n = 120635). Apical periodontitis (AP) was recorded when the periodontal ligament space was more than double in width, or loss of lamina dura or a periapical radiolucent lesion was seen. Technically, adequate root fillings had a gap of 0-3 mm from the apex; all others were defined as inadequate. Statistical methods included chi-square tests and anova. Risk of AP was estimated as cross-product odds ratio and its 95% confidence interval., Results: Teeth with AP occurred in 27% of the dentate subjects being more prevalent in subjects with root filled teeth than in those without (39% vs. 9%; P < 0.001; OR = 6.3; 95% CI 5.3, 7.4). AP was more prevalent in men than in women (31% vs. 23%). At a tooth level, AP was most frequent in mandibular molars with inadequate root fillings. For all root filled teeth, an inadequate root filling doubled the risk of AP for both women (OR = 2.0; 95% CI 1.7, 2.4) and men (OR = 2.5; 95% CI 2.1, 2.9)., Conclusions: AP occurred principally in subjects and teeth with root fillings. Inadequate root fillings doubled the risk of AP. An improvement in the technical quality of root canal treatment is essential., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Introduction: The purpose of this study was to evaluate the relationship between periapical status and the quality of coronal restoration and of root canal filling, assessed both clinically and radiographically, in a cohort of Brazilian patients., Methods: A total of 523 teeth from 337 patients submitted to endodontic treatment were clinically and radiographically reexamined 2-10 years postoperatively. Restoration and root canal filling quality were classified according to modified criteria from Tronstad et al. Periapical status was evaluated according to periapical index scores. Mann-Whitney and Friedman tests were used to conduct the descriptive analysis. Correlations were analyzed by using simple and multivariate logistic regression analysis., Results: No significant difference was observed between the rates of apical periodontitis for adequate or inadequate coronal restorations assessed clinically (12.8% versus 19.4%), whereas these rates were significantly different when the restoration quality was assessed radiographically (11.6% versus 28.7%, P < .001). The rates of apical periodontitis in teeth with inadequate root canal filling, with or without adequate restoration, were significantly higher than in teeth with adequate canal filling, with or without adequate restoration (38.6% and 48.4% versus 6.5% and 14.6%, respectively; P < .0001)., Conclusions: Using either a radiographic or clinical assessment alone was not a reliable method to ascertain whether restoration quality could be correlated with postoperative periapical status. Poor root canal filling quality was a prognostic determinant of endodontic treatment failure, whereas coronal restoration quality had a lesser impact on the outcome of the endodontic treatment., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To study the association between type of restoration and apical periodontitis (AP) in root filled teeth., Materials and Methods: The present study used data from surveys conducted in 1983, 1993 and 2003. In 1983, 130 randomly selected subjects aged 3-80 years in the city of Jönköping, Sweden, were invited for a clinical and radiological examination. The study was repeated in 1993 and 2003. New participants were, thus, recruited with the same sampling criteria and sample size in the same geographical area in 1993 and 2003, respectively. In the present study, only dentate individuals aged 20-70 years with ≥1 root filled tooth were included, yielding a sample of 788 subjects with 2634 root filled teeth. Apical periodontitis on the tooth level was the dependent variable. Periapical status was assessed according to Periapical Index (PAI). Independent variables were root filling quality, recurrent caries, type of restoration, number of teeth with apical periodontitis, age and gender. Root fillings appearing homogenous and ending within 2 mm from radiographic apex were regarded as adequate, otherwise inadequate. All radiographs were re-studied by one observer regarding periapical status and root filling quality. Risk was analyzed by means of a GEE model., Results: Type of restoration, root filling quality, number of teeth with apical periodontitis within the individual and age were found to be predictors of AP in root filled teeth. Presence of recurrent caries and gender were not found to be associated with AP., Conclusions: According to the present study, root filling quality and type of restoration may be predictive of AP in root filled teeth.

Purpose: To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis., Materials and Methods: The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'under-filled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2., Results: Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of root-filled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were under-filled teeth (P < 0.001 and P < 0.05, respectively)., Conclusions: The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment.

Objective: To study the periapical status of root-filled permanent teeth of 9-17-year-olds in Møre & Romsdal county, Norway., Materials and Methods: All permanent teeth with endodontic treatment in patients born in 1994-2001 were identified in the dental records of the Public Dental Service. The data collected consisted of chart entries and radiographs. Of 1182 teeth, 174 teeth in 155 patients met further inclusion criteria, i.e. completed endodontic treatment and a follow-up with a readable radiograph of at least 1 year. Periapical status was assessed with the Periapical Index (PAI) and the technical quality of the root fillings was also quantified on a 4-grade visual scale., Results: Apical periodontitis was found on follow-up radiographs in 25% of all teeth and in 48% of the teeth with pre-operative apical periodontitis. Forty-two per cent of root fillings were of adequate technical quality. Adequate technical quality of the root filling was significantly correlated with radiographic success., Conclusions: About one fourth of all root-filled teeth and almost half of the teeth with pre-operative apical periodontitis showed clear signs of the disease at recall.

Introduction: This cross-sectional study determined the prevalence of apical periodontitis in 1086 root canal-treated teeth from an urban Colombian population and evaluated the association of several factors with the periradicular status., Methods: Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periradicular status. Other factors were also evaluated for their association with the periradicular conditions, including gender, quality of both endodontic treatment and coronal restoration, apical level of filling, and presence of post restoration., Results: Fifty-one percent of the treated teeth were classified as healthy. Only 33% of the teeth had endodontic treatment rated as adequate. The quality of both endodontic treatment and coronal restoration significantly influenced the periradicular conditions (P < .001). Combined data revealed that teeth with both adequate endodontic treatment and adequate restorations showed significantly better periradicular status than the other combinations (P < .01), except for teeth with adequate treatment and inadequate restoration (P = .08). Canals filled up to 0-2 mm short of the apex had a significantly higher number of teeth rated as healthy than overfilled or underfilled cases (P = .02). Regression analysis showed that the quality of endodontic treatment was the most significant factor influencing the periradicular status (P < .001). Gender and presence of post restoration had no association with the periradicular conditions., Conclusions: Data from this Colombian population showed a relatively high prevalence of apical periodontitis in root canal-treated teeth. This was largely due to an equally high prevalence of treatments performed under substandard technical quality. The quality of the endodontic treatment was the most determinant factor for healthy periradicular status., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to assess the prevalence of periapical lesions in root canal-treated teeth in a Turkish Cypriote population and to investigate the influence of the quality of root canal fillings and coronal restorations on the prevalence of periapical lesions., Subjects and Methods: The sample for this cross-sectional study consisted of 1,006 adult patients seeking routine dental care. Patients who had received dental care in the last 2 years were excluded. Radiographs of 2,200 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. Periapical status was assessed using periapical index (PAI) scores., Results: Of the 2,200 root canal-treated teeth, 1,364 (62%) had apical periodontitis as compared with 1,364 (5.5%) of the total sample. Root-filled teeth classified as adequately treated had apical periodontitis in 223 (26.6%) cases compared with 1,192 (87.7%) in teeth classified as inadequately root filled. PAI 1 scores of adequate root canal treatment were significantly higher than in inadequate root canal treatment, regardless of the quality or presence of coronal restorations (p < 0.01)., Conclusion: Our findings showed a high prevalence of periapical pathology with or without endodontic treatment and poor technical standard of both root fillings and coronal restorations of root-treated teeth. Hence, we suggest the need for better education for dental health providers so that they can perform better root canal treatments and coronal restorations., (Copyright © 2012 S. Karger AG, Basel.)

Aim: The aim of the study was to assess the prevalence of apical periodontitis and quality of root canal fillings in an adult Riga subpopulation., Materials and Methods: Panoramic radiographs of Latvian adults 35-44 year old attending a private dental clinic for the first time during the period of 2004-2008 were included in the study. Totally, 312 out of 1248 panoramic radiographs were randomly selected and examined for periapical conditions and endodontic treatment quality. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. The periapical status was assessed using the PAI index. The data were analyzed using SPSS 14 computer software program. Statistical significance was assessed by the chi-squared (Pearson's) test., Results: Out of the 312 individuals examined 224 (72%) had one or more teeth with apical periodontitis (PAI 3-5) and 272 individuals (87%) had one or more endodontically treated teeth. Amongst 7065 teeth evaluated 1255 (18%) were endodontically treated. Only 285 teeth (23%) of the root canal treated teeth were with complete root canal fillings. There was a statistically significant relationship between quality of root canal fillings and apical periodontitis (p<0.0001). In teeth with complete fillings only 15% were with apical periodontitis, but apical periodontitis were detected in 342 teeth (35%) with incomplete root fillings., Conclusion: The results from this study indicates a high prevalence of apical periodontitis and low quality of root fillings in a selected adult Riga population.

Purpose: To examine the possible association between the presence of apical periodontitis (AP) and the quality of endodontic treatment and coronal restoration over a time period of 14 years., Materials and Methods: 1781 panoramic radiographs of freshmen cadets, taken between the years 1995-2008 were included in this study. The periapical status was evaluated using the Periapical Index (PAI) scoring system. The chisquare test and logistic regression analysis were used to examine associations between apical disease and the quality of both the root filling and the coronal restoration., Results: 62.3% of the examined teeth demonstrated AP. The number of root-filled teeth and the prevalence of AP were found to be higher in OPGs taken between 1995 and 2001 than those taken between 2002 and 2008. Both the quality of the coronal restoration and the quality of the root filling (length and lateral seal) were found to be correlated with the presence of AP, but the factor most significantly associated seemed to be the coronal restoration (OR = 0.404, 95% CI: 0.174-0.940)., Conclusion: The quality of the endodontic treatment in young Greek adults was poor but improved over the years. Both the quality of the endodontic treatment and coronal restoration appeared to affect the periapical status of the treated teeth. The factor that probably most determined the periapical health was the quality of the coronal restoration.

Aim: To determine the prevalence of apical periodontitis and assess the quality of endodontic fillings in the population of the city of Zagreb, Croatia., Methods: A total of 1462 orthopantomograms from new patients at 6 different dental practices was analyzed during 2006 and 2007. The presence of periapical lesions was determined by using the periapical index score (PAI). The quality of endodontic fillings was assessed according to the filling length and homogenicity. Data were analyzed using t test and ANOVA with Scheffe post-hoc test., Results: There were 75.9% of participants with endodontically treated teeth and 8.5% of all teeth were endodontically treated. Only 34.2% of endodontically treated roots had adequate root canal filling length, while 36.2% of root canal fillings had homogenous appearance. From the total number of teeth with intracanal post, 17.5% had no visible root canal filling. Using PAI 3 as a threshold value for apical periodontitis, periapical lesions were detected in 8.5% of teeth. Adequate quality of root canal fillings was associated with a lower prevalence of periapical lesions., Conclusion: We found a large proportion of endodontically treated teeth with apical periodontitis and a correlation between the quality of endodontic filling and the prevalence of periapical lesions. This all suggests that it is necessary to improve the quality of endodontic treatment in order to reduce the incidence and prevalence of apical periodontitis.

Background: Despite numerous studies on the prevalence of apical periodontitis (AP) and endodontic treatment in diverse geographical populations, there are currently no data on the prevalence of these conditions in populations of adults native to Kosovo. Therefore, little is known about how widespread these conditions are, and whether there is any correlation between root canal treatment and AP. The purpose of our research was to address this anomaly by investigating AP and endodontic treatment in an adult Kosovar population based on radiographic examination., Methods: The sample used for this study consisted of randomly selected individuals referred to the University Dentistry Clinical Center of Kosovo in the years 2006-2007. Orthopantomographs of 193 patients were evaluated. The periapical status of all teeth (with the exception of third molars) was examined according to Ørstavik's Periapical Index. The quality of the root canal filling was rated as 'adequate' or 'inadequate' based on whether all canals were filled, the depth of fill relative to the radiographic apex and the quality of compaction (absence/presence of voids). Data were analyzed statistically using the Chi-square test and calculation of odds ratios., Results: Out of 4131 examined teeth, the prevalence of apical periodontitis (AP) and endodontic treatment was 12.3% and 2.3%, respectively. Of 95 endodontically-treated teeth, 46.3% were associated with AP. The prevalence of AP increased with age. The prevalence in subjects aged over 60 years old (20.2%) was higher than in other age groups. A statistically significant difference was found for the frequency of endodontically-treated teeth associated with AP in the 40-49 year age group (P < 0.001). Of some concern was the discovery that only 30.5% of the endodontically-treated teeth examined met the criteria of an acceptable root canal filling. Inadequately root-filled teeth were associated with an increased AP risk., Conclusions: The prevalence of AP and the frequency of endodontically-treated teeth with AP in this Kosovar population are higher than those found in other countries. Inadequate root canal fillings were associated with an increased prevalence of AP.

Aim: The present study aimed at assessing the prevalence of apical periodontitis and identifying the factors associated with apical periodontitis, particularly the influence of the quality of root canal fillings and coronal restorations on the periradicular status., Methodology: The study population consisted of adult patients, men and women, seeking routine dental care at the Endodontic Clinic in the school teaching hospital between September 2006 and July 2008. For each patient complete oral examination and periapical radiographs were made for pathological teeth. All teeth were assessed individually. AP was diagnosed according to defined criteria, other variables were root fillings, coronal fillings, trauma and caries. The odds ratio and 95% confidence interval were used to calculate the risk of apical periodontitis related to tooth-specific risk indicators on the presence of apical periodontitis. A multiple logistic regression model to control for confounders and to determine their independent association with apical periodontitis was used also., Results: AP was detected on teeth (63.79%). The prevalence of apical periodontitis in root canal-treated teeth was 39.5%. Of the dental variables caries, trauma, inadequate root fillings and inadequate restoration were significantly associated with AP., Conclusion: The prevalence of AP in this study group was higher than in other populations. The probability of AP increased significantly after root canal treatment and coronal filling and was closely associated with the quality of the filling.

Aim: To determine the technical quality of root fillings as well as the periapical status of root filled teeth and non-root filled teeth in young permanent dentitions using a retrospective analysis of orthopantomographs (OPTGs) in a Turkish subpopulation., Methodology: Included in this study were the digital OPTGs taken as a part of diagnostic and planning procedures for all 19-year-old adolescents who attended the Faculty of Dentistry, Marmara University (Istanbul, Turkey) for the first time during the period from June 2007 to May 2009. The periapical status of all teeth and the technical quality of the root fillings were assessed by radiographic criteria. Statistical analysis was performed by the Mann-Whitney U, chi-squared, Fisher's exact and Cohen's kappa tests., Results: The survey involved OPTGs of 1077 19-year-old adolescents: 663 (61.6%) women and 414 (38.4%) men. Of the 28974 teeth examined, 459 (1.6%) were root filled, of which 193 (42.0%) had radiological signs of apical periodontitis (AP), and 454 (1.6%) were non-root filled teeth with AP. No significant difference was found between women and men regarding the number of teeth present, the number of root filled teeth and the number of non-root filled teeth with AP (P>0.05). The most commonly treated teeth were molars (54.2%), followed by pre-molars (27.0%) and incisors (18.8%). Length was adequate in 57.3%, and homogeneity was adequate in 50.5% of the root fillings. Statistically, both the length and the homogeneity of the root fillings were significantly associated with periapical status individually (P<0.01). The overall technical quality was inadequate in 60.1% of the root fillings, and 67.0% of these were associated with signs of AP. Amongst root filled teeth, the frequency of AP in connection with molars was significantly higher (57.0%) than that for incisors (27.9%) and pre-molars (21.8%) (P<0.01)., Conclusions:   The results of this study indicated that the frequency of root filled teeth with AP, non-root filled teeth with AP and of technically inadequate root fillings amongst all root filled teeth was high in this selected adolescent Turkish population., (© 2011 International Endodontic Journal.)

Objective: We aimed to compare an Amsterdam subpopulation's current prevalence of root canal fillings and associated periapical radiolucencies with a similar patient sample from 1988., Study Design: An Amsterdam subpopulation was evaluated for missing teeth, restorations, quality of endodontic treatment, and periapical radiolucency., Results: A total of 178 radiographs were evaluated and 4594 teeth were examined. Of these, 324 (7%) exhibited widening of the apical periodontal ligament or periapical radiolucency and 224 (4.8%) had been endodontically treated. A total of 118 teeth (2.5%) had radiographic signs of apical periodontitis. Of these lesions, 54 (45.7%) were linked to endodontically treated teeth (24.1% of endodontically treated teeth). Inadequate root canal fillings were frequent (55.8%). Apical radiolucency was significantly higher in these teeth than in adequately root-filled teeth., Conclusion: Findings indicate that the periapical status in an Amsterdam subpopulation has not improved over almost 2 decades., (Copyright © 2011 Mosby, Inc. All rights reserved.)

The aim of this study was to assess the prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. A total of 1,372 periapical radiographs of endodontically treated teeth were analyzed based on the quality of root filling, status of coronal restoration and presence of posts associated with apical periodontitis (AP). Data were analyzed statistically using odds ratio, confidence intervals and chi-square test. The prevalence of AP with adequate endodontic treatment was low (16.5%). This percentage dropped to 12.1% in cases with adequate root filling and adequate coronal restoration. Teeth with adequate endodontic treatment and poor coronal restoration had an AP prevalence of 27.9%. AP increased to 71.7% in teeth with poor endodontic treatment associated with poor coronal restoration. When poor endodontic treatment was combined with adequate coronal restoration, AP prevalence was 61.8%. The prevalence of AP was low when associated with high technical quality of root canal treatment. Poor coronal restoration increased the risk of AP even when endodontic treatment was adequate (OR=2.80; 95%CI=1.87-4.22). The presence of intracanal posts had no influence on AP prevalence.

Pulpitis results in significant morbidity among the elderly, particularly in underserved communities. We collected panoramic oral radiographs from 244 (mean age 67) participants of the Northern Manhattan Study, a prospective cohort study of stroke risk in a multiethnic urban population. Radiographs were evaluated for missing teeth, caries, restorations, periodontal bone loss, adequacy of endodontic treatment, and periapical radiolucencies. In the study 206 subjects were dentate (mean 17.1 teeth). 5.1% of teeth had periapical radiolucencies, and 4.8% had been endodontically treated; 37.5% of endodontically treated teeth had periapical radiolucencies. Teeth with restorations, periodontal bone loss, pulpotomy, and inadequate root canal filling had a significantly higher occurrence of periapical radiolucency (p < 0.05). Among all root filled teeth, only 26% were deemed satisfactory. We conclude that apical periodontitis is widely prevalent and the technical standard of root fillings is poor in this cohort. There is a substantial need for improved dental care among the northern Manhattan elderly.

Aim: To investigate the prevalence of apical periodontitis and the quality of root canal treatment in an adult Turkish population who visited a university dental clinic., Summary: The periapical status of 8863 teeth belonging to 375 patients was evaluated by two pre-calibrated observers from panoramic radiographs. The presence of apical periodontitis, and the prevalence and quality of root fillings were recorded. The relationship between the radiographic quality of root fillings and apical periodontitis was examined by chi-squared statistical-analysis. Of 8863 teeth, 470 (5.3%) had undergone root canal treatment. Forty-seven per cent of all the subjects had at least one root-filled tooth. Periapical radiolucencies were visible on 4.2% of teeth examined, with 53.5% of root-filled teeth presenting apical periodontitis. Ninety-one per cent of root-filled teeth with periapical pathosis were determined to have inadequate root fillings. A statistically significant correlation was found between the quality of root fillings and the presence of apical periodontitis (P < 0.05)., Key Learning Points: The radiographic quality of root fillings correlated with periapical radiographic signs of pathosis in a selected population of Turkish adults. There is a need to improve the standards of root canal treatment in the study population.

The objectives of this thesis were to describe endodontic status in Swedish populations, to study clinical and socio-economic risk factors for apical periodontitis (AP) and to explore a possible association between AP and coronary heart disease (CHD). In papers I, II and IV the Prospective Study of Women in Göteborg (PSWG) was used. In paper I dentate women examined in 1968-69 (N=1220), 1980-81 (N=1023) and 1992-93 (N=867) were included for cross-sectional and longitudinal (N=586) analysis of endodontic status over 24 years in individuals aged 38-84 years. In papers III and IV a cross-sectional sample (N=844 and N=867, respectively) from 1992-93 was used for exploring associations between AP, socio-economic risk factors and CHD in multivariate logistic regression models. In paper II random samples of dentate individuals aged 20-70 years from the Population Study on Oral Health in Jönköping (PSJ) were used. The first examination in 1973 (N=498) was followed by new examinations in 1983 (N=530), 1993 (N=547) and 2003 (N=491). Full mouth radiographic examinations were restudied, yielding 3981 root filled teeth for the analysis. AP was recorded according to the Periapical Index (PAI) and the root filling quality was assessed with respect to length and seal. The association between root filling quality and AP was studied on the tooth-level as well as on the individual level. The results from multivariate logistic regression analysis did not reveal a significant association between AP and CHD and socio-economic risk factors and AP, respectively. The ratio of root filled teeth increased with age longitudinally and cross-sectionally, but decreased over time for comparable age groups. The ratio of AP increased with age cross-sectionally, but decreased with age longitudinally and for comparable age groups over time. Inadequate root filling quality was predictive of AP with an odds ratio of 4.5. The root filling quality was improved over time without a concomitant decrease in ratio of root filled teeth with AP.

Objectives: To determine the prevalence of periapical radiolucencies and endodontic treatment in an adult Japanese population., Study Design: Periapical status and length of root fillings of 672 adult patients attending Okayama University Hospital of Dentistry were evaluated using full mouth intraoral radiographs., Results: Overall, 87% of the subjects had root-filled teeth, and 70% exhibited an apical radiolucency. Of the 16,232 teeth examined, 21% had been root-filled, and, of these, 40% exhibited an apical radiolucency. Root-filled teeth that were overfilled or that were mandibular incisors had the highest prevalence of apical radiolucencies., Conclusions: The prevalence of root-filled teeth appears higher in this Japanese population than in Europe or America; however, the ratio of teeth with an apical radiolucency to root-filled teeth was within the range of that reported for other countries. Overfilled teeth and mandibular incisors are most likely to exhibit apical radiolucencies.

The correlation of root canal treatment quality and the probability of healing of apical periodontitis are discussed. Noted is the often large discrepancy between treatment outcomes observed in prospective studies and those obtained in cross-sectional studies of general populations. Looking for improvement of the latter, those treatment shortcomings are discussed which have a known or suspected negative impact on the probability of healing or preventing periapical pathology.

Aim: The prevalence of apical periodontitis (AP) and the quality of root fillings and restorations were determined in two Canadian populations differing in avail-ability of endodontists., Methodology: Radiographs of first-time university patients aged 25-40 years in Toronto and Saskatoon were examined for missing teeth, presence and standard of root fillings, standard of restoration, and AP according to the Periapical Index. Patients with root-filled teeth were invited for clinical examination and interview to inspect the restorations, and to reveal the providers of endodontic treatment and reasons for extractions of missing teeth. Chi-square and independent t-tests interpreted at the 5% significance level were used to examine associations between the prevalence of AP in root-filled teeth and the standard of the root filling, restoration, and providers of treatment., Results: Proportion of patients with root-filled teeth was significantly higher (P < 0.001) in Toronto than in Saskatoon (39 and 26%, respectively). Presence of AP about root-filled teeth (44% in Toronto, 51% in Saskatoon) was significantly associated with poor density (OR = 2.7) short (OR = 2.4) and long (OR = 2.8) root fillings, and with poor radiographic quality of the restoration (OR = 1.7) Prevalence of AP did not differ significantly between teeth treated by generalists and endodontists., Conclusions: The prevalence of AP in root-filled and untreated teeth was comparable to that reported in previous methodologically compatible studies. The quality of both the root filling and the restoration were found to impact on the periapical health of root-filled teeth, with the impact of the restoration being most critical when the quality of the root filling was adequate.

Aim: The aim of this study was to determine the periapical status and the quality of root-canal treatment amongst an adult population attending the dental school in Nice, France during 1998., Methodology: Patients who attended the dental school for the first time during 1998 were included. Panoramic radiographs, taken by a trained radiology assistant, were used in this study. The periapical areas of all teeth with the exception of third molars, were examined and the technical quality of root fillings were evaluated for both apical extension and density. Statistical analyses were conducted using anova, Chi-square, Fisher's PLSD and Cohen's Kappa tests., Results: The survey involved 344 patients: 180 females and 164 males. Males had significantly fewer natural remaining teeth than females (P<0.03). Similarly, the average number of root-filled teeth was lower for males (P<0.01). Nonroot-filled teeth (n=6126) had significantly fewer signs of periapical pathology than root-filled teeth (n=1429) (1.7% vs. 31.5%, P<0.0001). The majority of root fillings were poorly executed. There was a significant correlation between the presence of periapical pathology and inadequate root-canal fillings (P<0.001)., Conclusions: The results of the present study indicate that many root-canal treatments were technically unsatisfactory in terms of quality and treatment outcome. There is a need for endodontic retreatment in the population examined.

Aims: To evaluate the impact of the quality of coronal restorations scored on a clinical and radiographic basis and the quality of root fillings on periapical health., Methodology: Periapical radiographs were taken of 745 root-filled teeth, randomly selected from patients attending the Ghent University Dental School. The teeth had not received restorative treatment in the previous year. The coronal status was scored both clinically according to modified Ryge's criteria, and radiographically by evaluating the presence of signs of marginal leakage or decay. The quality of the root filling was scored according to criteria of length and homogeneity and the periapical status was categorized on the basis of presence or absence of radiographic signs of apical periodontitis. The relationship between coronal status, quality of root filling and periapical health was determined. The data were analyzed using Chi2 test, Odds ratio, Spearman's r(S) and logistic regression., Results: Thirty-three percent of the teeth had apical periodontitis as diagnosed radiographically. Teeth with good and poor coronal restorations scored clinically had apical periodontitis in 31.1 and 36.8%, respectively; this difference was not statistically significant. The quality of the coronal restorations scored radiographically had a statistically significant influence on the periapical condition (P<0.001) with apical periodontitis in 23.8 and 49.1%, respectively, for acceptable and unacceptable restorations. Marginal decay did not influence the periapical status. Teeth restored without a base under the coronal filling had apical periodontitis in 41.3%, whereas teeth with a base had significantly less (P<0.005) apical periodontitis (25.9%). Composite-restored teeth exhibited apical periodontitis in 40.5% of cases whilst amalgam-restored teeth had apical periodontitis in 28.4% of cases; this difference was statistically significant (P<0.01). Root-canal posts had no influence on periapical health. The length and homogeneity of the root-canal fillings had a significant influence (P<0.01 and P<0.001, respectively) on the presence of apical periodontitis, as well as the quality of the coronal restoration scored radiographically (P<0.001)., Conclusion: The importance of a good coronal restoration, as well as of a good root filling should be emphasized as the technical quality of both influencing the periapical status.

Aim: The aim of this study was to compare the quality of root canal treatment in two Danish subpopulations., Methodology: Group 1 (358 patients) was examined 1974-75 and group 2 (244 patients) 1997-98. All patients were more than 20 years old. All had undergone a full-mouth radiographic survey. In root-filled teeth the following parameters were assessed: the quality of the coronal restoration or crown, the lateral seal of the root filling, the length of the root filling, and the periapical status. Chi-squared tests were used for the evaluation of differences between the groups., Results: In group 1 there were 975 endodontically treated teeth, in group 2 there were 753. In group 1 the majority of root-filled teeth were premolars, in group 2 the majority were molars (P < 0.001). The quality of coronal restorations (P = 0.35) and crowns (P = 0.68) did not differ significantly between the groups. In group 2 more teeth had adequately sealed root canals (P < 0.001) and adequate length of root filling (P < 0.001). More root-filled molar teeth had apical periodontitis (AP) than root-filled premolar and anterior teeth (P < 0.001)., Conclusions: Whilst the technical quality of endodontic treatment had improved during the last 24 years, basic differences between the populations prevented assessment of the impact of this change on disease frequencies. The study indicates that great care should be taken when comparing different patient populations, in particular more emphasis should be placed on the selection and description of study groups.

Aim: The aim of this study was to collect data on the prevalence and technical standard of root canal treatment as well as the prevalence of apical periodontitis in Belgium., Methodology: The panoramic radiographs of 206 Belgian adults attending the Dental School of the University Hospital of Gent were examined for endodontic treatment, periapical conditions and coronal restorations., Results: Of the 4617 teeth examined, 6.8% were endodontically treated. Periapical radiolucencies were found in 6.6% of all teeth and in 40.4% of the endodontically treated teeth. More than half of the root-filled teeth (56.7%) were scored inadequate on the basis of a criterion evaluating the level of the root canal filling., Conclusion: The endodontic treatment need of this Belgian subpopulation was great and the technical standard of root canal treatment disappointing. The findings indicate that there is still a substantial need for postgraduate endodontic education in Belgium and a need for specialists in endodontology.

Apical periodontitis is prevalent in many Western populations and is frequently detected in connection with inferior quality of endodontic treatment. However, information about endodontic conditions from eastern European countries is limited. The aim of the present investigation was to study the prevalence of apical periodontitis and the quality of endodontic treatment in 35-44-year-old Lithuanians. The prevalence of apical periodontitis was 70%. An overall success rate of 65% was found for root-filled teeth while 56% of pulp amputations (pulpotomies) were considered successful based on a radiographic evaluation. The quality of the root fillings showed little impact on the treatment results, except for over-extended fillings, which were associated with a high number of failures.

The aims of this thesis were to study longitudinally the tooth mortality, prevalence and technical standard of endodontic treatment as well as the endodontic treatment need in a Swedish population. Furthermore, the prevalences of teeth with crowns and posts were studied as well as the prevalence of apical periodontitis in such teeth, to see if these treatments affected the apical status. Finally, the reasons for and incidence of tooth mortality were investigated to see if the reasons for extractions were correlated to endodontic status, crown or post therapy, respectively. The interobserver variation between the two observers taking part in the investigation was also studied and found to be acceptable. The material consisted of full mouth radiographic surveys from 200 patients examined twice with an interval of 5-7 years. It was found that tooth losses were evenly distributed in the different age-groups and that molars were lost more often than teeth in the frontal region. Furthermore, endodontically treated teeth were lost more often than other teeth and the quality of the root filling affected the risk of tooth losses. Teeth with screw posts were lost more frequently than other teeth, while crowned teeth did not run a higher risk of being lost than teeth without crowns. Caries, including pulpitis and apical periodontitis, was the main reason for tooth extractions. There was a great need for endodontic treatment in the population examined, and the technical standard of the root fillings was poor. A slight improvement in quality of endodontic treatment was evident at the second examination. However, the technical standard was still poor. It is concluded that it is important that dentists in general practice should be better trained in performing endodontic treatment, and that research efforts should be made to find better and simpler methods for endodontic treatment.