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Periapical status of root-filled teeth restored with composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0003-4332-7962
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0001-7425-1038
Malmö högskola, Faculty of Odontology (OD).
2016 (English)In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 42, no 9, p. 1326-1333Article in journal (Refereed)
Abstract [en]

INTRODUCTION: The aim was to compare the periapical status of root-filled teeth restored with resin composite, laboratory-fabricated crowns, or amalgam in a Swedish adult population. METHODS: The subjects consisted of 440 individuals from a randomly selected sample of 1000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all root-filled teeth by using clinical examination and intraoral clinical photographs. Periapical status, root-filling quality, and marginal bone loss were evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed by using the χ2 test and logistic regression. RESULTS: No difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite, laboratory-fabricated crowns, or amalgam (29.7%, 26.2%, and 43.1%, respectively) of adequate quality was found. No association between AP and resin composite restorations was disclosed; however, there was an association between AP and inadequate root-filling quality and marginal bone loss >1/3 of the root length. CONCLUSIONS: The results did not indicate any association between AP and resin composite restorations. Neither the type nor the material of the restoration was of significance for periapical status as long as the quality was adequate.

Place, publisher, year, edition, pages
Elsevier, 2016. Vol. 42, no 9, p. 1326-1333
Keywords [en]
Apical periodontitis, cross-sectional study, crowns, dental amalgam, endodontics, resin composite
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-15359DOI: 10.1016/j.joen.2016.06.008ISI: 000392563500005PubMedID: 27452294Scopus ID: 2-s2.0-84994817337Local ID: 21692OAI: oai:DiVA.org:mau-15359DiVA, id: diva2:1418880
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
In thesis
1. Coronal restoration in root-filled and non root-filled teeth: studies on periapical status, tooth survival, subsequent treatments and treatment decisions
Open this publication in new window or tab >>Coronal restoration in root-filled and non root-filled teeth: studies on periapical status, tooth survival, subsequent treatments and treatment decisions
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the following aspects ofdirect and indirect coronal restoration, primarily of root-filled teeth, withspecial reference to:• periapical health• the natural course of root-filled teeth, particularly furtherclinical intervention• the dentist´s decision-making process for root-filled teeth.The aims of coronal restoration are to restore the function and aestheticsof the tooth, with a tight marginal seal as protection from microbialleakage. A coronal restoration may be either direct, i.e. a direct chairsidecomposite or amalgam filling, or indirect, whereby the restoration,ceramic or a combination of metal and ceramic, is fabricated in alaboratory and then permanently cemented. For the root-filled tooth, acoronal restoration of adequate quality is an important factor for asuccessful outcome of the endodontic treatment, in terms of periapicalstatus. While indirect restoration is often advocated as the treatment of choice for a root-filled tooth, the procedure is nevertheless more timeconsumingand 3 – 4 times more expensive than a direct restoration. InSweden, composite is the predominant material for direct restorationand the majority of root-filled teeth are directly restored. However,some reports suggest an association between composite restoration andan increased risk of periapical disease. In terms of tooth survival, thereare also reports of less favorable endodontic treatment outcomes forteeth with direct restorations than for those with indirect restorations.In Studies I and II clinical and radiographic examinations wereundertaken in a random sample of 440 subjects, living in the county of Skåne, Sweden. No association was disclosed between apicalperiodontitis (AP) and direct composite restorations. In non root-filledteeth, a relationship was found between the type of restoration and AP.Those restored with direct restoration by both composite and amalgamcombined, and indirect restoration were associated with increased riskof AP, indicating that the extent of tooth substance removal rather thanthe type or material of the restoration, was an important factor ofinfluence on periapical status. For root-filled teeth, however, the qualityof the restoration and of the root-filling was more important toperiapical health than the type or material used for the coronalrestoration. In Study III, data from the Swedish Social InsuranceAgency on dental treatments were analyzed. Only minor differences inthe frequency of additional endodontic treatment for root-filled teethrestored with direct versus indirect restoration was disclosed. Theindirectly restored teeth also had a more favorable natural course duringthe 5-year follow-up period. In comparison, teeth restored with directrestorations required further clinical intervention (nonsurgical retreatment, extraction and additional restorations) significantly morefrequently.In Study IV, in-depth semi-structured interviews were conducted withgeneral dental practitioners. Data from 14 interviews were analyzed byQualitative Content Analysis. Study IV revealed that dentists´ decisionmakingprocess underlying the choice of coronal restoration for a rootfilledtooth, was based not only on clinical factors; contextual factorsand patient´s views, if in conflict, were decisive. Thus, despite theindications for an indirect restoration, a direct restoration wasoccasionally chosen. Accordingly, the context in which the dentistmakes decisions may be a factor influencing the fate of the root-filledtooth.It is concluded that concerns that composite restoration poses a riskfor periapical disease are not supported clinically, i.e. the use ofcomposite seems to be safe. While in non root-filled teeth, AP tended tobe associated with extensive restorations, in root-filled teeth the type ofrestoration was not an important factor of periapical health. For teethdirectly restored after root canal treatment, further clinical interventionsmay be expected, especially for restorative failures. This may beattributable in part to the dentist´s decision-making process with respectto the choice of coronal restoration.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2019. p. 92
Series
Doctoral Dissertation in Odontology
Keywords
Endodontics, Coronal restoration, Indirect restoration, Direct restoration, Root canal treatment, Decision process, Apical periodontitis, Qualitative Content Analysis
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7749 (URN)10.24834/isbn.9789178770441 (DOI)30013 (Local ID)9789178770441 (ISBN)9789178770434 (ISBN)30013 (Archive number)30013 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2023-10-17Bibliographically approved

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Dawson, VictoriaPetersson, KerstinWolf, EvaÅkerman, Sigvard

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