Medical and Dental Consultantsí Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 2836   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

  Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 8  |  Page : 1126-1131

Radiographic assessment of the relationship between root canal treatment quality, coronal restoration quality, and periapical status


1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
2 Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey

Date of Acceptance23-Apr-2019
Date of Web Publication14-Aug-2019

Correspondence Address:
Dr. H Tercanli Alkis
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya - 07058
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_129_19

Rights and Permissions
   Abstract 


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.

Keywords: Panoramic radiography, periapical diseases, root canal treatment


How to cite this article:
Alkis H T, Kustarci A. Radiographic assessment of the relationship between root canal treatment quality, coronal restoration quality, and periapical status. Niger J Clin Pract 2019;22:1126-31

How to cite this URL:
Alkis H T, Kustarci A. Radiographic assessment of the relationship between root canal treatment quality, coronal restoration quality, and periapical status. Niger J Clin Pract [serial online] 2019 [cited 2019 Oct 15];22:1126-31. Available from: http://www.njcponline.com/text.asp?2019/22/8/1126/264403




   Introduction Top


Root canal treatment (RCT) is a routine part of dental practice. Many factors, such as presence of postings, coronal restorations, periapical status, and RCT quality, may affect the treatment success.[1],[2],[3] The prevalence of RCT varies from 1.3% to 20% and increases with age.[4]

Apical periodontitis in root canal treated teeth (RCTT) is an important public health problem.[4] Epidemiological studies [5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] are conducted to investigate the frequency of the periapical status of RCTT in different populations. Many authors [1],[2],[3],[13],[14],[15],[21],[22],[23],[24],[25] have investigated the impact of RCT and coronal restoration qualities on the presence of apical periodontitis. While some researchers [21],[22],[23] showed that periapical health depended on coronal restorations quality, others [2],[13],[14],[15],[24],[25] showed that it depended on technical quality of RCT. On the other hand, some studies [1],[3],[18] have suggested that success depends on both of them.

Periapical radiography and panoramic radiography are used for evaluate periapical tissues. According to De Moor et al.,[10] if the canal filling is 0–2 mm below the radiographic apex, if there are no voids, and if all canals are obturated, it is considered to be adequate RCT; and if there are no signs of recurrent caries and margin adaptation of restorations is good, it is considered to be adequate coronal restoration.

For radiologic evaluation of apical periodontitis, the periapical index (PAI) was used in studies conducted in different populations.[1],[4],[5],[6],[7],[13],[14],[18],[24] There is limited information about the prevalence of apical periodontitis in RCTT in Turkish populations. Prevalence of apical periodontitis in RCTT varies between 18.2% and 73.9% among the studies [7],[13],[17],[18],[19],[24] conducted in Turkey.

The aim of this cross-sectional study was to assess the prevalence of apical periodontitis in RCTT in Turkish subpopulation (Antalya) and to evaluate the effects of both coronal restoration and RCT qualities on apical periodontitis.


   Materials and Methods Top


Study design

This study was approved by the Akdeniz University, Faculty of Medicine, Clinical Research Ethics Committee. Panoramic images of individuals who applied to Akdeniz. University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, for different diagnostic reasons between July 2017 and January 2018, were randomly and retrospectively scanned. The following exclusion criteria were used for the study: (1) panoramic images of individuals under the age of 18 years, (2) panoramic images suggestive of trauma, (3) existence of low image quality, especially in lower and upper anterior areas, and (4) third molars.

All images were obtained using Planmeca ProMax (Planmeca Oy, Helsinki, Finland) panoramic device in accordance with the manufacturer's instructions and with a voltage of 66 kV, a tube current of 7 mA, and an exposure time of 16 s. Images were evaluated by the same reseacher who was an expert in dental radiology and had 6 years of experience. All images were evaluated 40–50 cm away from the image and using the same monitor, in a reduced light room. Tonal adjustments were made on the images to maximize the view. A maximum of 10 panoramic images were assessed per day to prevent reseacher fatigue. After 8 weeks, all the images were reevaluated and intraobserver agreement was assessed.

This cross-sectional study samples consisted of 245 adult individuals. Total RCT number, RCT quality, type of coronal restoration, coronal restoration quality, periapical status, and total number of teeth were recorded. The criteria used for coronal restoration quality and RCT quality were defined by De Moor et al.[10] and slightly modified by Gunduz et al.[13] as given below.

Quality test

RCT quality: Adequate – The end of the canal fillings was 0–2 mm below the radiographic apex. There were no voids present and all canals were filled. Inadequate – The end of the canal fillings was more than 2 mm below the radiographic apex or extremly overfilled. Canal fillings had insufficient density, voids, poor condensation, and/or unfilled canals. Coronal restorations quality: Adequate – No signs of recurrent caries and margin adaptation of restorations is good. Inadequate – Restoration has open margins, overhangs, recurrent caries, or no restoration at all.

Type of coronal restoration

The type of coronal restoration was recorded as filling, crown, post + filling, and post + crown like Kayahan et al.[24] In addition, no restoration teeth were also recorded.

Periapical status

Periapical tissues was assessed by the PAI developed by Orstavik et al.,[26] and periapical status scored at the PAI was as follows: PAI 1. normal apical structures, PAI 2. minor changes in bone structure, PAI 3. changes in the bone structure with little mineral loss, PAI 4. periodontitis with a radiolucent, well-defined area, and PAI 5. severe periodontitis with aggravating features.

PAI 1 was accepted as healthy periapical tissue and all other PAI scores were assessed as apical periodontitis.

Statistical analysis

Data were statistically analyzed using SPSS version 23.0 software (SPSS Inc., Chicago, IL, USA). Differences between the two groups were examined using Pearson's Chi-square test and the intraobserver agreements were assessed by Kappa coefficients. Values of P < 0.05 were accepted to be meaningful.


   Results Top


The total number of examined images was 245. The study included 159 (64.9%) female and 86 (35.1%) male individual images, and the mean age was 37.83 ± 12.6 years. The total examined teeth number was 6064, of which had 541 (8.9%) RCT. RCT teeth were higher in females than males and this was statistically significant (P < 0.001). In all, 321 of the RCTT were in the maxilla and 220 were in the mandibula. While right mandibular first molar teeth were the most frequently treated teeth (n = 53), root canal–treated right mandibular lateral incisor tooth was not found. The distribution of RCTT according to the type of tooth is detailed in [Table 1]. According to the PAI scoring system, 322 (59.5%) teeth were healthy and the prevelance of apical periodontitis was 40.5% (n = 219). There was no relationship between apical periodontitis and gender (P = 0.721). Apical status of RCTT was classified as 322 (59.5%) PAI 1, 73 (13.5%) PAI 2, 78 (14.4%) PAI 3, 36 (6.7%) PAI 4, and 32 (5.9%) PAI 5.
Table 1: Distribution of RCTT according to the type of tooth

Click here to view


The number of adequate RCT was 178 (32.9%), and 138 (77.5%) of them were healthy. The number of inadequate RCT was 363 (67.1%), and 184 (50.7%) of them were healthy. Regardless of the coronal restoration quality, the healthy periapical rates in adequate RCT were higher than inadequate RCT (P < 0.001).

The number of adequate coronal restoration was 334, and 62.3% of them were healthy. The number of inadequate coronal restoration was 207, and 55.1% of them were healthy. Regardless of the RCT quality, there were no statistically relationship between the healthy periapical rates of adequate coronal restoration and the healthy periapical rates of inadequate coronal restoration (P = 0.097).

For the cases that have adequate RCT, there was no relationship between coronal restoration quality and periapical status (P = 0.931). The distribution of coronal restoration quality, periapical status, and P value in adequate RCT group is shown in [Table 2].
Table 2: Distribution of coronal restoration quality, periapical status, and P value in adequate RCT group

Click here to view


The healthy periapical rate was 48.6% for cases with adequate coronal restoration and adequate RCT. In cases of adequate coronal restoration and inadequate RCT, the apical periodontitis rate was 77%. For the cases that have adequate coronal restoration, there was statistically relationship between RCT quality and periapical status (P < 0.001). The distribution of RCT quality, periapical status, and P value in adequate coronal restorations group is shown in [Table 3].
Table 3: Distribution of root canal quality, periapical status, and P value in adequate coronal restorations group

Click here to view


According to the type of restoration, 309 teeth had filling, 160 teeth had crown, 8 teeth had post + filling, 25 teeth had post + crowns, and 39 teeth had no restoration. For the cases that have both adequate RCT and adequate coronal restorations, there was no statistically relationship between periapical status and coronal restoration type (P = 0.892).

There was no statistically significant relationship between apical periodontitis and post presence (P = 0.980), and there was no statistically significant relationship between apical periodontitis and coronal restoration presence (P = 0.345).

The Kappa coefficients were found to be greater than 0.95 in periapical status, RCT quality, and coronal restoration quality parameters.


   Discussion Top


Studies have been carried out in many countries to determine the frequency of endodontic treatment,[27],[28],[29] and the prevalence of RCT varies from 1.3% to 20%.[4],[10] In this study, this prevalence was found to be 8.9% in Turkish subpopulation (Antalya).

The prevalence of apical periodontitis in RCT varies from 25% to 64.5%.[1],[8],[11],[16],[20] Frequencies of apical periodontitis in RCTT have been reported in Spain (64.5%), Canada (44% and 51%), Belgium (40%), Lithuania (39%), Denmark (52%), the United States (39%), Germany (61%), and Scotland (51%).[10],[13],[27],[30],[31] Among the studies conducted in Turkey, while Gulsahi et al.[19] reported the frequency of apical periodontitis in RCTT as 18.2% in Ankara, Sunay et al.[17] found it as 53.5% and Gencoglu et al.[7] found it as 73.9% in Istanbul; Kalender et al.[18] reported this frequency as 62% in Turkish Cypriot population and Gunduz et al.[13] found this frequency as 67.9% in rural adult male population. This study is the first study in the Mediterranean region of Turkey and this frequency was found to be 40.5% in Antalya. This variability among the studies may be due to the different inclusion criteria and the different number of examined teeth.

The changes in bone density observed on radiography are the most accurate evidence for the presence, progression, and improvement of periapical inflammation in the apical periodontium.[32] The most important and reliable radiographic finding in the differentiation between the healthy teeth and periapical pathology is deterioration in the continuity of the lamina dura and an increase in the periodontal ligament range.[33] In addition, if at least 1 mm enlargement of the periodontal ligament in the apical 1/3 part of the tooth is present, this is considered to be periapical pathology.[34]

In 1986, Orstavik et al.[26] developed a scoring system for the classification of periapical lesions which is called PAI and in 1988 they proved the reliability of this index.[35] PAI is a scoring system that evaluates apical periodontitis on radiographs using a scale from 1 to 5 according to the radiographic image.[35] This scoring system is often used to detect the presence of apical periodontitis.[4],[13],[18],[24] While some researchers [13],[18],[24] accepted that PAI 1 is healthy and other PAI scores are apical periodontitis, Boucher et al.[4] accepted the scores greater than PAI 2 as a apical periodontitis. In this study, scores greater than PAI 1 are accepted as apical periodontitis.

Periapical radiography and panoramic radiography can be used to evaluate periapical tissues. According to some researchers,[1],[11],[36] periapical radiographs should be used because of the lower sensitivity especially in the anterior area on panoramic radiographs. On the other hand, Ahlqvist et al.[37] and Muhammad et al.[38] did not find significant difference between the periapical and panoramic radiography to evaluate periapical patology. In light of this information, panoramic radiography has often been used by some researchers [4],[7],[13],[18],[24] to assess periapical status, RCT quality, and coronal restoration quality. In addition to periapical and panoramic radiographs, an index defining apical periodontitis based on cone beam computed tomography (CBCT) has been proposed.[39] Pope et al.[40] suggested that attention should be paid to the use of PAI in CBCT images due to the presence of a periodontal ligament space larger in three-dimensional than two-dimensional images. In this study, panoramic images were preferred for evaluation of periapical status due to advantages such as being a standard, low-cost procedure that exposes the patient to relatively low levels of radiation. In addition to these advantages, panoramic data were used in this study because they are easy to use for retrospective analyses. The panoramic images that had low image quality, especially in the lower and upper anterior areas, were excluded from the study.

Torabinejad et al.[22] reported that direct exposure of a root canal filling to microorganisms and their products may facilitate reinfection in 3 weeks in their ex vivo study. Ray and Trope [21] stated that the well-sealing coronal restoration had a greater impact on periapical status than the RCT quality in their radiographic study, and Tavares et al.[23] reported that adequate coronal restorations had greater success rates for cases with inadequate or adequate RCT in their study. Our results indicated that there was no statistically significant relationship between adequate coronal restoration and periapical status for the cases that have adequate RCT (P = 0.931).

Tronstad et al.[2] found a correlation between periapical health and coronal restoration quality; however, they concluded that RCT quality was more effective than coronal restoration quality. In addition, Siqueira et al.[15] and Ricucci and Bergenholtz [25] repored that adequate RCTs show a good prognosis regardless of coronal restoration quality. Kirkevang et al.[1] and Hommez et al.[3] suggested that periapical health depends on both RCT quality and coronal restoration quality.

In studies conducted on panoramic radiographs in Turkey, Kayahan et al.,[24] Gunduz et al.,[13] and Kalender et al.[18] reported that the quality of RCTplays a key role, regardless of coronal restoration quality. Our results support these findings. On the other hand, for the cases that have adequate coronal restoration, this study showed statistically significant relationship between adequate RCT and periapical status (P < 0.001). Kalender et al.[18] also reported that the combination of inadequate coronal restoration and inadequate endodontic treatment was related to an increased incidence of apical periodontitis.

Kayahan et al.[24] found relationship between periapical status and adequate RCT in filling, crown, post + filling, and post + crown restorations. However, they ignored the coronal restoration quality. In this study, for the cases that have both adequate RCT and adequate coronal restoration, there was no statistically relationship between coronal restoration type and periapical status (P = 0.892).

Kalender et al.[18] showed that the RCTT that had no restoration had the highest incidence of apical periodontitis. In this study, we found this highest incidance in filling restoration. In addition, our results showed that there was no statistically significant relationship between apical periodontitis and coronal restoration existence (P = 0.345).

While some researchers [4],[24],[28] reported that teeth restored with posts are prone to apical periodontitis, Kalender et al.[18] suggested that the absence or presence of posts was not associated with the outcome of the RCT. De Moore et al.[10] stated that the post space may be irrigated between appointments to destroy possible microorganisms. In addition, Pappen et al.[41] reported that the preparation for the post can have a negative impact on the sealing ability of the canal filling material. These may be the causes of apical periodontitis related to posts. This study showed that there was no statistically relationship between apical periodontitis and post existence (P = 0.98). These results are thought to vary depending on the number of coronal restorations types included in the studies.

This study is a cross-sectional study. The main disadvantage of such a study is that the data analyzed are restricted to the available information.[23] On the other hand, misdiagnoses and misinterpretations in this type of studies are also known to be equally distributed.[13] The major limitation of this study is the lack of knowledge about time from endodontic treatment to the present. It is also not known whether the apical status has improved or not after RCT. However, these conditions are also unknown among the referenced studies, and the results from our study are largely harmonious with those of other studies in the literature.


   Conclusion Top


This study showed a 40.5% prevalence of apical periodontitiss in RCTT in Turkish subpopulation (Antalya). While there was no statistically relationship between periapical status and coronal restoration quality in adequate RCT group, there was significant relationship between periapical status and RCT quality in adequate coronal restoration group. In addition, for the cases that have both adequate coronal restoration and adequate RCT, there was not statistically relationship between coronal restoration type and periapical status.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kirkevang LL, Orstavik D, Horsted-Bindslev P, Wenzel A. Periapical status and quality of root fillings and coronal restorations in a Danish population. Int Endod J 2000;33:509-15.  Back to cited text no. 1
    
2.
Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol2000;16:218-21.  Back to cited text no. 2
    
3.
Hommez GM, Coppens CR, De Moor RJ. Periapical health related to the quality of coronal restorations and root fillings. Int Endod J 2002;35:680-9.  Back to cited text no. 3
    
4.
Boucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J 2002;35:229-38.  Back to cited text no. 4
    
5.
Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S. Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations. Int Endod J 2003;36:181-92.  Back to cited text no. 5
    
6.
Toure B, Kane AW, Sarr M, Ngom CT, Boucher Y. Prevalence and technical quality of root fillings in Dakar, Senegal. Int Endod J 2008;41:41-9.  Back to cited text no. 6
    
7.
Gencoglu N, Pekiner FN, Gumru B, Helvacioglu D. Periapical status and quality of root fillings and coronal restorations in an adult Turkish subpopulation. Eur J Dent 2010;4:17-22.  Back to cited text no. 7
    
8.
Lupi-Pegurier L, Bertrand MF, Muller-Bolla M, Rocca JP, Bolla M. Periapical status, prevalence and quality of endodontic treatment in an adult French population. Int Endod J 2002;35:690-7.  Back to cited text no. 8
    
9.
Marques MD, Moreira B, Eriksen HM. Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population. Int Endod J 1998;31:161-5.  Back to cited text no. 9
    
10.
De Moor RJ, Hommez GM, De Boever JG, Delme KI, Martens GE. Periapical health related to the quality of root canal treatment in a Belgian population. Int Endod J 2000;33:113-20.  Back to cited text no. 10
    
11.
Buckley M, Spangberg LS. The prevalence and technical quality of endodontic treatment in an American subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:92-100.  Back to cited text no. 11
    
12.
Tsuneishi M, Yamamoto T, Yamanaka R, Tamaki N, Sakamoto T, Tsuji K, et al. Radiographic evaluation of periapical status and prevalence of endodontic treatment in an adult Japanese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:631-5.  Back to cited text no. 12
    
13.
Gunduz K, Avsever H, Orhan K, Demirkaya K. Cross-sectional evaluation of the periapical status as related to quality of root canal fillings and coronal restorations in a rural adult male population of Turkey. BMC Oral Health 2011;11:20.  Back to cited text no. 13
    
14.
Segura-Egea JJ, Jimenez-Pinzon A, Poyato-Ferrera M, Velasco-Ortega E, Rios-Santos JV. Periapical status and quality of root fillings and coronal restorations in an adult Spanish population. Int Endod J 2004;37:525-30.  Back to cited text no. 14
    
15.
Siqueira JF Jr, Rocas IN, Alves FR, Campos LC. Periradicular status related to the quality of coronal restorations and root canal fillings in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:369-74.  Back to cited text no. 15
    
16.
Loftus JJ, Keating AP, McCartan BE. Periapical status and quality of endodontic treatment in an adult Irish population. Int Endod J 2005;38:81-6.  Back to cited text no. 16
    
17.
Sunay H, Tanalp J, Dikbas I, Bayirli G. Cross-sectional evaluation of the periapical status and quality of root canal treatment in a selected population of urban Turkish adults. Int Endod J 2007;40:139-45.  Back to cited text no. 17
    
18.
Kalender A, Orhan K, Aksoy U, Basmaci F, Er F, Alankus A. Influence of the quality of endodontic treatment and coronal restorations on the prevalence of apical periodontitis in a Turkish Cypriot population. Med Princ Pract 2013;22:173-7.  Back to cited text no. 18
    
19.
Gulsahi K, Gulsahi A, Ungor M, Genc Y. Frequency of root-filled teeth and prevalence of apical periodontitis in an adult Turkish population. Int Endod J 2008;41:78-85.  Back to cited text no. 19
    
20.
Sidaravicius B, Aleksejuniene J, Eriksen HM. Endodontic treatment and prevalence of apical periodontitis in an adult population of Vilnius, Lithuania. Endod Dent Traumatol 1999;15:210-5.  Back to cited text no. 20
    
21.
Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J 1995;28:12-8.  Back to cited text no. 21
    
22.
Torabinejad M, Ung B, Kettering JD. In vitro bacterial penetration of coronally unsealed endodontically treated teeth. J Endod 1990;16:566-9.  Back to cited text no. 22
    
23.
Tavares PB, Bonte E, Boukpessi T, Siqueira JF Jr, Lasfargues JJ. Prevalence of apical periodontitis in root canal-treated teeth from an urban French population: Influence of the quality of root canal fillings and coronal restorations. J Endod 2009;35:810-3.  Back to cited text no. 23
    
24.
Kayahan MB, Malkondu O, Canpolat C, Kaptan F, Bayirli G, Kazazoglu E. Periapical health related to the type of coronal restorations and quality of root canal fillings in a Turkish subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:58-62.  Back to cited text no. 24
    
25.
Ricucci D, Bergenholtz G. Bacterial status in root-filled teeth exposed to the oral environment by loss of restoration and fracture or caries--Ahistobacteriological study of treated cases. Int Endod J 2003;36:787-802.  Back to cited text no. 25
    
26.
Orstavik D, Kerekes K, Eriksen HM. The periapical index: Ascoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 1986;2:20-34.  Back to cited text no. 26
    
27.
Eriksen HM, Bjertness E, Orstavik D. Prevalence and quality of endodontic treatment in an urban adult population in Norway. Endod Dent Traumatol 1988;4:122-6.  Back to cited text no. 27
    
28.
Eckerbom M, Andersson JE, Magnusson T. Frequency and technical standard of endodontic treatment in a Swedish population. Endod Dent Traumatol 1987;3:245-8.  Back to cited text no. 28
    
29.
Petersson K. Endodontic status of mandibular premolars and molars in an adult Swedish population. A longitudinal study 1974-1985. Endod Dent Traumatol 1993;9:13-8.  Back to cited text no. 29
    
30.
Saunders WP, Saunders EM. Prevalence of periradicular periodontitis associated with crowned teeth in an adult Scottish subpopulation. Br Dent J 1998;185:137-40.  Back to cited text no. 30
    
31.
Weiger R, Hitzler S, Hermle G, Lost C. Periapical status, quality of root canal fillings and estimated endodontic treatment needs in an urban German population. Endod Dent Traumatol 1997;13:69-74.  Back to cited text no. 31
    
32.
Ridao-Sacie C, Segura-Egea JJ, Fernandez-Palacin A, Bullon-Fernandez P, Rios-Santos JV. Radiological assessment of periapical status using the periapical index: Comparison of periapical radiography and digital panoramic radiography. Int Endod J 2007;40:433-40.  Back to cited text no. 32
    
33.
Kaffe I, Gratt BM. Variations in the radiographic interpretation of the periapical dental region. J Endod 1988;14:330-5.  Back to cited text no. 33
    
34.
Huumonen S, Orstavik D. Radiological aspects of apical periodontitis. Endodontic Topics 2002;1:3-25.  Back to cited text no. 34
    
35.
Orstavik D. Reliability of the periapical index scoring system. Scand J Dent Res 1988;96:108-11.  Back to cited text no. 35
    
36.
Allard U, Palmqvist S. A radiographic survey of periapical conditions in elderly people in a Swedish county population. Endod Dent Traumatol 1986;2:103-8.  Back to cited text no. 36
    
37.
Ahlqwist M, Halling A, Hollender L. Rotational panoramic radiography in epidemiological studies of dental health. Comparison between panoramic radiographs and intraoral full mouth surveys. Swed Dent J 1986;10:73-84.  Back to cited text no. 37
    
38.
Muhammed AH, Manson-Hing LR, Ala B. A comparison of panoramic and intraoral radiographic surveys in evaluating a dental clinic population. Oral Surg Oral Med Oral Pathol 1982;54:108-17.  Back to cited text no. 38
    
39.
Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pecora JD. A new periapical index based on cone beam computed tomography. J Endod 2008;34:1325-31.  Back to cited text no. 39
    
40.
Pope O, Sathorn C, Parashos P. A comparative investigation of cone-beam computed tomography and periapical radiography in the diagnosis of a healthy periapex. J Endod 2014;40:360-5.  Back to cited text no. 40
    
41.
Pappen AF, Bravo M, Gonzalez-Lopez S, Gonzalez-Rodriguez MP. An in vitro study of coronal leakage after intraradicular preparation of cast-dowel space. J Prosthet Dent 2005;94:214-8.  Back to cited text no. 41
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed142    
    Printed2    
    Emailed0    
    PDF Downloaded51    
    Comments [Add]    

Recommend this journal