Factors associated with the outcome of root canal treatment : a cohort study conducted in a private practice

Jurič, Rok (author), Vidmar, Gaj (author), Blagus, Rok (author), Jan, Janja (author)

Aim: To investigate the association of various pre-, intra- and post-operative factors on root canal treatment outcome. Methodology: In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1-4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra- and post-operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. Results: 1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7-82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01-0.24]), root PAI (OR = 0.29[0.20-0.42], 0.21[0.13-0.34] and 0.22[0.12-0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21-0.43] and 0.24[0.16-0.37] for diameters of 1-5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27-0.97] and OR = 0.45[0.24-0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43-0.94]) and two canals per root (OR = 0.67[0.54-0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08-0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26-0.75] and 0.62[0.40-0.97] respectively), resin sealer (OR = 0.58[0.39-0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21-0.75] against multiple visits). One factor was post-operative: defective coronal restoration (OR = 0.35[0.21-0.56]). Conclusion: The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.

• Language: English
• Keywords: outcome assessment, periapical periodontitis, root canal therapy, treatment outcome
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2024
• Number of pages: Str. 377-393
• Numbering: Vol. 57, iss. 4
• PID: 20.500.12556/RUL-156057
• UDC: 616.31
• ISSN on article: 0143-2885
• DOI: 10.1111/iej.14022
• COBISS.SI-ID: 189884675
• Publication date in RUL: 06.05.2024

Record is a part of a journal

• Title: International endodontic journal
• Shortened title: Int. endod. j.
• Publisher: Wiley, British Endodontic Society
• ISSN: 0143-2885
• COBISS.SI-ID: 14468825

Licences

• License: CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
• Link: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Description: The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

Secondary language

• Language: Slovenian
• Keywords: ocena izida, periapikani periodontitis, zdravljenje koreninskih kanalov, izid zdravljenja

Projects

• Funder: ARRS - Slovenian Research Agency
• Project number: P3-0374
• Name: Preiskovanje orofacialnega področja za izboljšanje oralnega zdravja

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P3-0154
• Name: Metodologija za analizo podatkov v medicini