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  • 1.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Coronal restoration in root-filled and non root-filled teeth: studies on periapical status, tooth survival, subsequent treatments and treatment decisions2019Doctoral 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.

    List of papers
    1. Periapical status of non-root-filled teeth with resin composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population
    Open this publication in new window or tab >>Periapical status of non-root-filled teeth with resin composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population
    2014 (English)In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 40, no 9, p. 1303-1308Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Experimental studies show that dental pulp cells respond unfavorably to contact with resin composite restorative material. Hypothetically, in a random population, the frequency of apical periodontitis should be higher for teeth restored with resin composite than with amalgam. Therefore, the aim was to compare the periapical status of non-root-filled teeth restored with resin composite, amalgam, or laboratory-fabricated crowns in an adult Swedish population. METHODS: The subjects comprised 440 individuals from a randomly selected sample of 1,000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all non-root-filled teeth by clinical examination and intraoral clinical photographs. Periapical status was evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed using the chi-square test and logistic regression analysis. RESULTS: There was no significant difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite or amalgam (1.3% and 1.1%, respectively). The frequency of AP for teeth restored with laboratory-fabricated crowns was significantly higher (6.3%). Regression analysis showed no association between AP and resin composite restorations but a significant association with laboratory-fabricated crowns. CONCLUSIONS: The results indicate that the risk of damage to the pulp-dentin complex from exposure to resin composite material and dentin bonding agents shown in experimental studies is not reflected in the clinical setting. However, in the study sample, AP was diagnosed in a significantly higher proportion of teeth restored with laboratory-fabricated crowns.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    apical periodontitis, cross-sectional study, crowns, dental amalgam, dental pulp, epidemiology, periapical status, resin composite
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-15620 (URN)10.1016/j.joen.2014.05.002 (DOI)000341620300004 ()25043330 (PubMedID)2-s2.0-85027929278 (Scopus ID)18604 (Local ID)18604 (Archive number)18604 (OAI)
    Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
    2. Periapical status of root-filled teeth restored with composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population
    Open this publication in new window or tab >>Periapical status of root-filled teeth restored with composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population
    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
    Keywords
    Apical periodontitis, cross-sectional study, crowns, dental amalgam, endodontics, resin composite
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-15359 (URN)10.1016/j.joen.2016.06.008 (DOI)000392563500005 ()27452294 (PubMedID)2-s2.0-84994817337 (Scopus ID)21692 (Local ID)21692 (Archive number)21692 (OAI)
    Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
    3. Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations
    Open this publication in new window or tab >>Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations
    Show others...
    2017 (English)In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 43, no 9, p. 1428-1432Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: The aim of this study was to evaluate the frequencies of nonsurgical retreatment, root-end surgery, extraction, and further restoration of root-filled teeth in Sweden in 2009 during a follow-up period of 5 years and to compare the outcomes in teeth restored with direct or indirect restorations. METHODS: Data from the Swedish Social Insurance Agency were analyzed, and the frequencies of nonsurgical retreatment, root-end surgery, extractions, and further restoration were calculated for all teeth registered as root filled during 2009. Chi-square tests were applied to detect any significant differences in the frequency of further treatment in teeth registered as restored with either a direct or an indirect restoration within 6 months of root filling. RESULTS: Of the 248,299 teeth reported root filled in Sweden in 2009, nonsurgical retreatment was registered in 2.2%, root-end surgery in 1.0%, and extractions in 9.2% during the follow-up period. Of the teeth restored with a direct restoration within 6 months after the root filling, 30.3% were registered as having undergone at least 1 further direct restoration; the corresponding percentage of teeth with indirect restorations was 6.4%. A statistically significant difference in the frequency of nonsurgical retreatment, extraction, and further restoration was found; teeth restored with an indirect restoration within 6 months of root filling had fewer of these treatments than those restored by direct restoration. CONCLUSIONS: Low frequencies of nonsurgical retreatment and root-end surgery were reported 5 years after root filling, whereas extraction was more common. Fewer additional treatment procedures were registered for teeth with indirect restorations than for those with direct restorations.

    Place, publisher, year, edition, pages
    Elsevier, 2017
    Keywords
    Apicoectomy, endodontics, epidemiology, permanent dental restoration, root canal therapy, tooth extraction
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-7094 (URN)10.1016/j.joen.2017.03.030 (DOI)000410720400007 ()28673492 (PubMedID)2-s2.0-85021447116 (Scopus ID)23677 (Local ID)23677 (Archive number)23677 (OAI)
    Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-10-09Bibliographically approved
    4. Coronal restoration of the root filled tooth: a qualitative analysis of the dentists' decision-making process
    Open this publication in new window or tab >>Coronal restoration of the root filled tooth: a qualitative analysis of the dentists' decision-making process
    2021 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 4, p. 490-500Article in journal (Refereed) Published
    Abstract [en]

    AIM: To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth.

    METHODOLOGY: GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semi-structured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27 - 64 (mean age 46 years), were included and analyzed according to Qualitative Content Analysis.

    RESULTS: A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven sub-categories (manifest content), were identified. The categories were clinical factors, contextual factors and patient´s views. Clinical factors underlying the GDPs´ decision included the current dental status and the estimated longevity of the intended restoration. In certain cases contextual factors were also of importance, either supporting the GDPs´ decision or modifying it. However, the patient´s views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient´s economic status and opinions.

    CONCLUSIONS: With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2021
    Keywords
    Crowns, Decision making, Dental Restoration, Endodontics, Permanent, Qualitative Research
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:mau:diva-36770 (URN)10.1111/iej.13442 (DOI)000595471100001 ()33159810 (PubMedID)2-s2.0-85097049632 (Scopus ID)
    Available from: 2020-11-11 Created: 2020-11-11 Last updated: 2024-06-17Bibliographically approved
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  • 2.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Amjad, Shwan
    Malmö högskola, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review2015In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, no 7, p. 627-638Article, review/survey (Refereed)
    Abstract [en]

    Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants.

  • 3.
    Dawson, Victoria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lunds University.
    EndoReCo, Endodontic Research Collaboration in Scandinavia
    Wigsten, Emma
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg.
    Further interventions after root canal treatment in relation to type of coronal restoration and tooth group: a 10-year follow-up of a Swedish dental register2023In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id R043Conference paper (Other academic)
    Abstract [en]

    Aim: To investigate the frequency of further interventions after root filling during a follow-up of 10 to 11 years, and to compare the outcomes with respect to type of coronal restoration and tooth group.Methods: Data from the Swedish Social Insurance Agency´s register of dental treatments were obtained to identify the teeth registered as root filled in Sweden 2009. Type of coronal restoration within 6 months after root filling, as well as the frequency of further interventions (nonsurgical retreatment, periradicular surgery, extraction, further direct and indirect restoration) were tracked in the data register until December 31, 2019. Descriptive statistics and Chi-square tests were used for statistical analysis.Results: Of the 215 611 teeth root filled in 2009, nonsurgical retreatment, periradicular surgery, and extraction were registered for 3.5%, 1.4% and 20%, respectively. The highest frequency of nonsurgical retreatment was registered for molars (4.2%), and periradicular surgery was most frequent in maxillary canines and incisors (2.3%). The highest frequency of extractions was registered for mandibular molars (25.1%). Directly restored teeth had higher frequency of nonsurgical retreatment (3.9%) and extraction (20.8%), compared to indirectly restored teeth (1.7% and 13.6%, respectively; P < 0.001). Of teeth restored with direct restoration within 6 months after root filling, 41.5% were registered with at least one further direct restoration and 14.7% with an indirect restoration. In the group of indirectly restored teeth, 9.3% and 7.1% underwent further restorative treatment with direct and indirect restoration, respectively. The differences registered between directly and indirectly restored root filled teeth were statistically significant (P < 0.001).Conclusions: The frequencies of nonsurgical retreatment and periradicular surgery were low 10 to 11 years after root filling, despite one in five root filled teeth being registered as extracted. Further interventions were significantly more common for directly restored teeth than for those indirectly restored.

  • 4.
    Dawson, Victoria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Leonard, Kerstin
    Vidigsson, My
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Coronal Restoration of Root-filled Teeth: General Dental Practitioners' Decision-Making Process2019Conference paper (Other academic)
    Abstract [en]

    Objectives: A better outcome has been shown for teeth restored with laboratory-fabricated crowns. This may not necessarily imply that full crowns are better than direct restorations, as it may be a result of selection bias. The aim was to describe the decision process regarding the choice of coronal restoration on a root-filled tooth from the perspective of the dentist. Methods: A strategic selection of 15 general dental practitioners (GDPs) in Sweden was performed. An absolute inclusion criterion was that the dentist had a recent experience of root canal treatments followed by a decision concerning permanent coronal restoration. The included dentists provided a variation concerning gender, age, work experience, location of undergraduate education and dental service provider. Semi-structured in-depth interviews were conducted with focus on the personal experience of the informant when choosing how to permanently restore the root-filled tooth. The informants were invited to, in their own words, narrate on the two latest occasions when this situation occurred for direct and full crown restorations respectively. The interviews were verbatim transcribed and then analyzed according to Qualitative Content Analysis, to be classified into an overall theme covering the latent content together with categories and subcategories illustrating the manifest content. Results: Preliminary results indicate a pattern, not yet definitely classified, but revealing the GDPs' efforts to take their current theoretical knowledge and clinical experience into consideration in the decision-making process together with an assessment of the residual tooth substance and the patients' oral health conditions. This is done parallel to an evaluation of and with certain emphasis to the patients' economic situation and preferences. Conclusions: The general dental practitioners' decision-making process regarding the choice of coronal restoration on a root-filled tooth was based not only on clinical factors: decisive for the decision was contextual factors comprising a patient centered approach.

  • 5.
    Dawson, Victoria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Coronal restoration of the root filled tooth: a qualitative analysis of the dentists' decision-making process2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 4, p. 490-500Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth.

    METHODOLOGY: GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semi-structured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27 - 64 (mean age 46 years), were included and analyzed according to Qualitative Content Analysis.

    RESULTS: A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven sub-categories (manifest content), were identified. The categories were clinical factors, contextual factors and patient´s views. Clinical factors underlying the GDPs´ decision included the current dental status and the estimated longevity of the intended restoration. In certain cases contextual factors were also of importance, either supporting the GDPs´ decision or modifying it. However, the patient´s views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient´s economic status and opinions.

    CONCLUSIONS: With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.

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  • 6.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria (Contributor)
    Malmö högskola, Faculty of Odontology (OD).
    Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations2017In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 43, no 9, p. 1428-1432Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of this study was to evaluate the frequencies of nonsurgical retreatment, root-end surgery, extraction, and further restoration of root-filled teeth in Sweden in 2009 during a follow-up period of 5 years and to compare the outcomes in teeth restored with direct or indirect restorations. METHODS: Data from the Swedish Social Insurance Agency were analyzed, and the frequencies of nonsurgical retreatment, root-end surgery, extractions, and further restoration were calculated for all teeth registered as root filled during 2009. Chi-square tests were applied to detect any significant differences in the frequency of further treatment in teeth registered as restored with either a direct or an indirect restoration within 6 months of root filling. RESULTS: Of the 248,299 teeth reported root filled in Sweden in 2009, nonsurgical retreatment was registered in 2.2%, root-end surgery in 1.0%, and extractions in 9.2% during the follow-up period. Of the teeth restored with a direct restoration within 6 months after the root filling, 30.3% were registered as having undergone at least 1 further direct restoration; the corresponding percentage of teeth with indirect restorations was 6.4%. A statistically significant difference in the frequency of nonsurgical retreatment, extraction, and further restoration was found; teeth restored with an indirect restoration within 6 months of root filling had fewer of these treatments than those restored by direct restoration. CONCLUSIONS: Low frequencies of nonsurgical retreatment and root-end surgery were reported 5 years after root filling, whereas extraction was more common. Fewer additional treatment procedures were registered for teeth with indirect restorations than for those with direct restorations.

  • 7.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Kvist, Thomas
    Frisk, Fredrik
    Bjørndal, Lars
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Survival of Root-filled Teeth in Relation to Restoration and Tooth-group2016Conference paper (Other academic)
    Abstract [en]

    Objectives: To compare the survival of teeth root-filled in Sweden in 2009 in relation to type of restoration and tooth-group.Methods: The database at the Swedish Social Insurance Agency containing information on treatments was used to identify all teeth in Sweden that were root-filled during 2009, by searching for the treatment codes corresponding to root-filling. The completed root-fillings could be linked to a specific tooth in a specific individual. Teeth registered as restored with a direct or indirect restoration within 6 months after completion of the root-filling were tagged and tracked until December 31st 2014. During this period, the treatment codes for extraction were registered for the identified root-filled teeth in order to construct Kaplan-Meier tooth survival analyses.Results: 248,299 teeth were registered as root-filled in Sweden in the year 2009. Of these 142,264 (57.3%) were restored with a direct restoration and 64,092 (25.8%) with an indirect restoration. Survival analysis disclosed that 5-6 years after root canal treatment 93.1% of the teeth with an indirect restoration had survived and 89.6% of the teeth with a direct restoration had survived. In the total material, irrespectively to any coronal restoration, premolars and upper anterior teeth had the highest survival (93.0% respectively 91.4%) and molars the lowest survival (87.6%). The same pattern was observed in sub-group analysis in the group of root-filled teeth with direct restorations. In the group with root-filled teeth with indirect restorations another pattern was observed; upper anterior teeth (92.6%) had a relatively lower survival, equivalent to those of molar teeth (92.6%).Conclusions: 5-6 year survival of root-filled teeth in Sweden were higher in the group with indirect restorations compared to the group with direct restoration. Root-filled upper incisors had an overall high survival, though for root-filled upper anterior teeth with indirect restorations the survival was relatively low.

  • 8.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Åkerman, Sigvard
    Malmö högskola, Faculty of Odontology (OD).
    Periapical status of non-root-filled teeth with resin composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population2014In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 40, no 9, p. 1303-1308Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Experimental studies show that dental pulp cells respond unfavorably to contact with resin composite restorative material. Hypothetically, in a random population, the frequency of apical periodontitis should be higher for teeth restored with resin composite than with amalgam. Therefore, the aim was to compare the periapical status of non-root-filled teeth restored with resin composite, amalgam, or laboratory-fabricated crowns in an adult Swedish population. METHODS: The subjects comprised 440 individuals from a randomly selected sample of 1,000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all non-root-filled teeth by clinical examination and intraoral clinical photographs. Periapical status was evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed using the chi-square test and logistic regression analysis. RESULTS: There was no significant difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite or amalgam (1.3% and 1.1%, respectively). The frequency of AP for teeth restored with laboratory-fabricated crowns was significantly higher (6.3%). Regression analysis showed no association between AP and resin composite restorations but a significant association with laboratory-fabricated crowns. CONCLUSIONS: The results indicate that the risk of damage to the pulp-dentin complex from exposure to resin composite material and dentin bonding agents shown in experimental studies is not reflected in the clinical setting. However, in the study sample, AP was diagnosed in a significantly higher proportion of teeth restored with laboratory-fabricated crowns.

  • 9.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Åkerman, Sigvard
    Malmö högskola, Faculty of Odontology (OD).
    Periapical status of root-filled teeth restored with composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population2016In: 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.

  • 10.
    Dawson, Victoria S
    et al.
    Malmö University, Faculty of Odontology (OD).
    Arnarsdóttir, Elisa
    University of Iceland.
    Malmberg, Leona
    Malmö University, Faculty of Odontology (OD).
    Zandi, Homan
    University of Oslo.
    Markvart, Merete
    University of Copenhagen.
    Varje steg viktigt för optimalt behandlingsresultat2023In: Tandläkartidningen, ISSN 0039-6982, Vol. 115, no 3, p. 62-68Article in journal (Refereed)
    Abstract [en]

    A successful outcome of endodontic treatment is strongly associated with well-performed treatment procedures. A prerequisite for satisfactory treatment is access to the root canals via an adequate access cavity preparation that is correctly positioned, of suitable size, and with straight-line access to the canals. After gaining access to the root canals the root canal working length is determined by an electronic apex locator combined with radiographs, preferably after coronal flaring. The root canals are then cleaned and shaped, and in most cases rotary or reciprocating nickel-titanium instruments can be used. This is performed in conjunction with the use of an irrigation solution, usually a low concentration of sodium hypochlorite. Once the chemo-mechanical instrumentation has been thoroughly performed, filling of the root canals is the next essential step. A good quality root filling should end within 2 mm from the radiographic apex without any voids. This is of significant importance for a successful outcome of the treatment, while the materials and techniques appear less important. Lastly, the tooth should be permanently restored as soon as possible after the root filling, to prevent fracture and reinfection.

    Provided that the treatment procedures have been adequately performed, under aseptic conditions,  high success rates can be expected.

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  • 11.
    Dawson, Victoria S.
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden.
    Wigsten, Emma
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Further Interventions After Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10–11-Year Follow-Up of the Adult Swedish Population2024In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 50, no 6, p. 766-773Article in journal (Refereed)
    Abstract [en]

    Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10 to 11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration, and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction.

    Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and Chi-square tests were used for statistical analysis.

    Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < 0.001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years.

    Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite one in five root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.

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  • 12.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD). Department of Endodontology, University of Gothenburg, Gothenburg, Sweden.
    Bjørndal, L
    Section of Clinical Oral Microbiology, Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark.
    Frisk, F
    Department of Endodontology, University of Gothenburg, Gothenburg, Sweden; Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Landt, Kristoffer
    Malmö University, Faculty of Odontology (OD).
    Isberg, P-E
    Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden.
    Kvist, T
    Department of Endodontology, University of Gothenburg, Gothenburg, Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Factors Associated with Extraction following Root Canal Filling in Adults2021In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 100, no 6, p. 608-614, article id 22034520982962Article in journal (Refereed)
    Abstract [en]

    Essentially, root fillings are performed to preserve natural teeth. Over time, however, some root-filled teeth will inevitably be extracted. The aim of this historical prospective cohort study in the adult Swedish population was to identify factors associated with extractions within 5 y of registration of a root filling. The cohort consisted of all those whose root fillings had been reported to the tax-funded Swedish Social Insurance Agency (SSIA) in 2009. Demographic data on the individuals registered with a root filling (sex, age, country of birth, disposable income, educational level, and marital status) were received from Statistics Sweden or the SSIA. Dental care setting, tooth type, and any registration of subsequent restorations within 6 mo were received from the SSIA. Multivariable regression analysis was used, and P < 0.05 was considered statistically significant. In total, 216,764 individuals had been registered with at least 1 root filling. Individuals (n = 824) without complete data were excluded from the analyses. After 5 y, 9.3% of the root-filled teeth had been registered as extracted. Logistic regression analysis found significant associations for all variables except country of birth, disposable income, and educational level. The highest odds ratios for extractions were associated with the type of restoration: teeth with no registration of any restoration and teeth with a direct restoration combined with a post were 3 times more likely to undergo extraction than teeth restored with an indirect restoration combined with a post and core. Overall, high odds ratios for extractions were associated with any type of composite restoration, including composite fillings and crowns combined with or without any post. In summary, after root filling in the Swedish adult population, several individual- and tooth-specific variables were associated with extraction. The reasons for the extractions remain to be studied further.

  • 13.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Bjørndal, Lars
    Odont inst, Köpenhamns universitet.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Frisk, Fredrik
    Odont inst, Folktandvården, Region Jönköpings län.
    Kvist, Thomas
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    Markvart, Merete
    Odont inst, Köpen-hamns universitet.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Wigsten, Emma
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    EndoReCo banar väg för ökad kunskap och akademisk meritering2022In: Tandläkartidningen, ISSN 0039-6982, Vol. 114, no 12, p. 46-52Article in journal (Other academic)
    Abstract [en]

    Collaboration is essential to focus on the urgent research questions and to fill knowledge gaps in Odontology. Larger research consortiums have a better potential to utilize different competencies and other resources, and consequently increase research output. Bigger, more complex projects can be undertaken, which in turn improves the potential to attract external funding. Collaboration with other institutions also facilitates academic meriting, which is highly desirable from a Swedish perspective, especially since the number of senior researchers with formal competence to supervise doctoral research projects is lower than ever before. Here, we present EndoReCo, a Scandinavian research network in Endodontics initiated a decade ago with these very opportunities in mind. The article describes the results of this collaboration to date, highlights the success factors and difficulties, and aims to inspire others to similar collaborations in other disciplines.

  • 14.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Tooth survival after endodontic treatment2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no S2, p. 140-153Article, review/survey (Refereed)
    Abstract [en]

    There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. However, we do not know if or how this affects the health of the individual. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome ´healthy periapical tissues´ or ´tooth survival´ they are equally important to know. Factors affecting the outcome ´healthy periapical tissues´ probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst ´tooth survival´ is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Of the pre-, peri- and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor.

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  • 15.
    Fransson, Helena
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Dawson, Victoria
    Malmö högskola, Faculty of Odontology (OD).
    Frisk, Fredrik
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bjørndal, Lars
    Department of Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD). EndoReCo.
    Survival of Root-filled Teeth in the Swedish Adult Population2016In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 42, no 2, p. 216-220Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim was to assess survival in the Swedish population of teeth treated by nonsurgical root canal treatment during 2009. METHODS: Data from the Swedish Social Insurance Agency were analyzed by Kaplan-Meier analysis to assess cumulative tooth survival during a period of 5-6 years of all teeth that were root-filled during 2009. RESULTS: In 2009, 248,299 teeth were reported as root-filled. The average age of the patients at the time of the root filling was 55 years (range, 20-102 years). The teeth most frequently root-filled were the maxillary and mandibular first molars. During the 5- to 6-year period 25,228 of the root-filled teeth (10.2%) were reported to have been extracted; thus 223,071 teeth (89.8%) survived. Tooth survival was highest in the youngest age group (93.2%). The highest survival (93.0%) was for the mandibular premolars, and the lowest (87.5%) was for the mandibular molars. Teeth restored with indirect restorations within 6 months of the root filling had higher survival rates (93.1%) than those restored with a direct filling (89.6%). CONCLUSIONS: In the adult population of Sweden, teeth that are root-filled by general practitioners under the tax-funded Swedish Social Insurance Agency have a 5- to 6-year survival rate of approximately 90%.

  • 16.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Landt, Kristoffer
    Malmö University, Faculty of Odontology (OD).
    Kvist, Thomas
    Bjørndal, Lars
    Frisk, Fredrik
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Factors Associated with Extractions Following Root-filling in Swedish Adults2019Conference paper (Other academic)
    Abstract [en]

    Objectives: Root-fillings are essentially performed to preserve natural teeth. However over time some root-filled teeth will be extracted. The aim of this study was to identify factors associated with extractions within a period of 5 years after completion of a root-filling in the adult Swedish population. Methods: In this registry study, the cohort consisted of all root-fillings reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. Tooth type, any registration of subsequent coronal restorations within 6 months and type of caregiver were recorded. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi-square test, t-test and logistic regression analysis. P<0.05 was considered statistically significant. Results: The total number of individuals registered with at least one root-filling was 216,764. Not all had a registration of a tooth number or had no registrations at Statistics Sweden (n=824) and were excluded from the analyses. After 5 years, 9.4% of the teeth had been registered as extracted. Preliminary data showed risk factors associated with higher odds for extractions to be molar teeth, teeth with no registration of any permanent coronal restoration within 6 months following the registration of the root-filling, root-fillings performed in the private sector, women, older age-group and widow(er)s or divorcees. Conclusions: Several individual and tooth specific factors were associated with extraction following root-filling in the Swedish adult population. The direct reasons for the extractions remain to be studied further.

  • 17.
    Jonsson Sjögren, Jakob
    et al.
    Malmö University, Faculty of Odontology (OD). Dental Research Department, Public Dental Health Service, Örebro County, Örebro, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eliasson, Alf
    Dental Research Department, Public Dental Health Service, Örebro County, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    The frequency and characteristics of pain and discomfort associated with root filled teeth: A practice based study.2019In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, no 9, p. 1264-1273Article in journal (Refereed)
    Abstract [en]

    AIM: To (1) investigate the frequency and characteristics of pain and discomfort associated with root filled teeth in adult patients regularly attending the Public Dental Service in Örebro County, Sweden; (2) assess the association between symptoms and clinical and radiographic findings, and (3) explore the impact of pain and discomfort from root filled teeth on daily life. METHODOLOGY: Patient records of adult patients (> 20 years) scheduled for routine check-ups in April 2015 were screened to identify individuals with root filled teeth; all patients with >1 root filled tooth were asked to participate. The examination comprised clinical and radiographic examinations and questionnaires on general health, on pain symptoms from root filled teeth, and on the impact of pain on daily activities. In a general estimation equation (GEE), examination findings and patient-related factors were independently analysed in relation to the outcome "presence of pain". RESULTS: In total 550 patients with 1 256 root filled teeth participated. Fifty-three patients (9.6%) experienced pain or discomfort from 62 (4.9%) root filled teeth. Lower age, percussion tenderness and apical tenderness were significantly associated with pain (P > 0.001-P=0.044). The average pain intensity was 2.1 on (0-10) Numeric Rating Scale, and average duration was 28.4 months. The impact on daily life was low. CONCLUSIONS: On average, pain associated with root filled teeth was of mild intensity, >2 years of duration and had low impact on daily life. Although the significantly associated clinical findings may indicate apical periodontitis as the most probable explanation in some teeth, the origin of pain from root filled teeth remains partly unexplained.

  • 18.
    Landt, Kristoffer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Hagstam-Harrison, Linda
    Malmö University, Faculty of Odontology (OD).
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Frisk, Fredrik
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Bjørndal, Lars
    Department of Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Demographic factors in Swedish adults undergoing root filling and subsequent extraction of a maxillary first molar: a comparative study2018In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 51, no 9, p. 975-980Article in journal (Refereed)
    Abstract [en]

    AIM: To study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5-6 years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome. METHODOLOGY: The root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses. RESULTS: In the year 2009, 36 139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5-6 year period. Only minor intergroup differences were noted: 86.5% of the study group were Swedish-born, compared with 84.4% of the comparison group (P = 0.007). Women comprised 53.2% of the study group and 50.5% (P = 0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80-0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01-1.01. No other significant differences were detected. CONCLUSIONS: There was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5-6 years, and the comparison group, with uneventful outcomes after a corresponding root filling.

  • 19.
    Lindström, Maria Granevik
    et al.
    Malmö University, Faculty of Odontology (OD). Specialist Clinic Kaniken, Public Dental Health Service, Uppsala, Sweden.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden.
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Why do dentists refrain from intervention in cases of persistent asymptomatic apical periodontitis in root canal filled teeth? An interview study among general dental practitioners2024In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the context in which general dental practitioners (GDPs) decide to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with persistent asymptomatic apical periodontitis (PAAP).

    Methodology: Fifteen GDPs were strategically selected for in-depth interviews. The informants were encouraged to describe in their own words and in as much detail as possible, the three most recent patient cases of PAAP of a root canal filled tooth, in which they decided to refrain from further treatment. The interviews were recorded digitally and transcribed verbatim. The collected material was analysed according to Qualitative Content Analysis with an inductive approach.

    Results: A pattern of varying degrees of uncertainty associated with the decision process was identified. The motives to refrain intervention had great diversity. The result from analysis of the qualitative data was formulated in an overall theme 'Between doubt and certainty in a complex clinical context' covering the latent content. The first main category covering the manifest content was 'The continuum of confidence' with three subcategories 'Experienced uncertainty', 'Reluctant approval' and 'At ease with refraining' illustrating the feelings and attitudes experienced by the informants. The second category was 'In support of acceptance' with three subcategories 'Patient's autonomy, risks and cost-benefits', 'Emotional aspects' and 'Relieving measures' representing the reasons for refraining from intervention.

    Conclusions: The decision to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with PAAP was made with some measure of confidence, combined with compensatory strategies to support the decision, taking into account not only values beneficial to the patient and awareness of limited external resources, but also factors related to the informants' personal preferences, convenience, concerns, ambition and emotions.

  • 20.
    Markvart, M
    et al.
    University of Copenhagen, Denmark.
    Tibbelin, N
    Specialist Clinic for Endodontics, Public Dental Service, Lund.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). University of Gothenburg.
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Frequency of additional treatments in relation to the number of root filled canals in molar teeth in the Swedish adult population2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 6, p. 826-833Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the 5-year frequency of additional treatments in relation to the number of reported root filled canals in molar teeth in Sweden.

    METHODOLOGY: The cohort included first and second molars in adult individuals who were registered with a root filling performed in 2009. Treatment codes corresponding to root fillings of teeth with from one up to four root filled canals were identified in the Swedish Social Insurance Agency database. The studied additional treatments were extraction, non-surgical root canal retreatment and endodontic surgery during the subsequent 5 years, identified by corresponding codes for these treatments registered on these specific teeth. Differences in the frequency of additional treatments based on the number of root filled canals were analysed using Chi-square test, and considered statistically significant at p<0.05.

    RESULTS: In 2009, root fillings on a first or second molar tooth were registered in 100 720 individuals. The study included 32 901 maxillary first molars (6.4% with four root filled canals), 12 763 maxillary second molars (3.3% with four root filled canals), 37 703 mandibular first molars (19.2% with four root filled canals) and 17 353 mandibular second molars (3.7% with four root filled canals). The total frequency additional treatments was 14.3% (n=14 425) during the 5-year observational period. Additional treatments were more frequent in teeth with 1-3 root filled canals compared to teeth with four root filled canals for maxillary first molars (15.2% vs. 12.7%, p=0.002), maxillary second molars (13.8% vs. 9.1%, p=0.007) and mandibular first molars (14.0% vs. 10.7%, p<0.001) but not mandibular second molars (15.6% vs. 13.7%, p=0.200).

    CONCLUSIONS: Over 5 years, 85.7% of the included teeth were not registered with any additional treatments. Maxillary first and second molars and mandibular first molar teeth had a greater frequency of additional treatments when ≤3 root canals were root filled compared to 4 canals.

  • 21.
    Markvart, Merete
    et al.
    Section of Cariology and Endodontics, Department of Odontology, University of Copenhagen, Copenhagen, Denmark.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Bjørndal, Lars
    Section of Cariology and Endodontics, Department of Odontology, University of Copenhagen, Copenhagen, Denmark.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Ten-year follow-up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 7, p. 515-519Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to re-assess the adoption of certain endodontic technology and central treatment principles of root canal treatments as advocated by guidelines presented by the European Society of Endodontology. Material and methods: The questionnaire included the same questions in 2003 and 2013. The general dental practitioners (GDPs) anonymously reported how frequent ('often', 'occasionally', and 'never') they used certain endodontic technology and adhered to central treatment principles. The statistical analyses were performed using Chi-squared test and Goodman-Kruskal's gamma-coefficient as an association measure. Results: The overall response rate of the 2013 group was 46.5% (n = 531). The frequencies of GDPs reporting often use of rubber dam, apex locator and rotary NiTi instruments were significantly higher (p < .0001) than in 2003, as well as reporting the use of composite resin for coronal sealing (p < .019). Adoption was significantly influenced by the factors gender (p = .601) and time since graduation (p = .361), and the cluster analyses revealed the neglected use of rubber dam to be associated with no established postoperative recall system. Conclusions: After 10 years, there was a higher frequency of GDPs who had adopted certain endodontic technologies. However, progress towards high-quality root canal treatment might be obstructed as the majority of GDPs avoids consistent use of rubber dam, and routinely neglects recalls for postoperative controls of their endodontic treatments.

  • 22.
    Mota de Almeida, Fernando José
    et al.
    Tandvårdens Kompetenscentrum, Norrbotten Public Dental Service Luleå Sweden; Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg, Sweden.
    Frisk, Fredrik
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden; Department of Endodontology Institute for Postgraduate Dental Education Jönköping Sweden; School of Health and Welfare Jönköping University Jönköping Sweden.
    Bjørndal, Lars
    Department of Cariology and Endodontics, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.
    Isberg, Per‐Erik
    Department of Statistics, Lund University School of Economics and Management Lund University Lund Sweden.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). EndoReCo.
    Periradicular surgery: A longitudinal registry study of 10‐year outcomes and factors predictive of post‐surgical extraction2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no 10, p. 1212-1221Article in journal (Refereed)
    Abstract [en]

    Aim: This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long-term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery.

    Methodology: The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) during 2009. The cohort was followed until December 31, 2020. Subsequent registrations of extractions were collected for Kaplan-Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and P < 0.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed.

    Results: After data cleaning, and exclusion of 157 teeth, 5 622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20-97, standard deviation 13.31); 55% were women. At the end of the follow-up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow-up data at 10 years after registration of the periradicular surgery, included 5 548 teeth, of which 1 461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both P < 0.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975-2.987, P < 0.001).

    Conclusions: After periradicular surgery in predominantly elderly people in Sweden, approximately three quarters of the teeth are retained over a 10-year period. The type of tooth is associated with extraction: mandibular molars are at greater risk of extraction than maxillary incisors and canines.

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  • 23.
    Olsson, Sara R
    et al.
    Malmö University, Faculty of Odontology (OD). Dental Research Department, Public Dental Health Service, Örebro, Sweden.
    Jonsson Sjögren, Jakob
    Malmö University, Faculty of Odontology (OD). Dental Research Department, Public Dental Health Service Örebro Sweden.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Eliasson, Alf
    Dental Research Department, Public Dental Health Service Örebro Sweden; Department of Dentistry, Faculty of Medicine and Health Örebro University Örebro Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study2024In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 57, no 9, p. 1212-1227Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate what happens to cross-sectionally identified root-filled teeth over a 6-year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root-filled teeth over the same time were associated with variables obtained from a baseline examination.

    Methodology: Adult patients with ≥1 previously root-filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root-filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision-making and treatments. After six years, information on events of the root-filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5-point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient- and tooth-related factors and events.

    Results: A total of 445 patients with 1007 root-filled teeth were followed the entire observation time. Twenty (2.0%) of the root-filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p < .0001), tenderness to percussion (p < .0001), and poor coronal restoration (p < .0001).

    Conclusions: This study corroborates the notion that in general dentistry, root-filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root-filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six-year period.

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  • 24.
    Olsson, Sara R
    et al.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population2019In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 46, no 1, p. 58-64Article in journal (Refereed)
    Abstract [en]

    Background: After root canal treatment, a choice is made between different coronal restorations which in the long run could affect the survival of the tooth.

    Objective: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals choosing other restorations after completion of a root filling.

    Methods: The cohort consisted of all root-filled upper first molars that were reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. After registration of the root filling, any subsequent coronal restorations within 2 years were identified. The crown group consisted of individuals registered with an indirect coronal restoration and the restoration group was the remaining individuals with a direct coronal restoration or lacking registration. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi-square test, t test and logistic regression analysis. P < 0.05 was considered statistically significant.

    Results: An indirect coronal restoration was received by 7806 individuals (21.9%), and 27 886 individuals (78.1%) received a direct restoration. All demographic variables except gender differed significantly between groups. Logistic regression analysis found significant associations for all demographic variables and the registration of an indirect restoration except for country of birth and gender.

    Conclusions: The identified demographic differences between individuals choosing to restore their newly root-filled teeth with an indirect restoration compared to those receiving other restorations may indicate that the tax-funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens.

  • 25.
    Pigg, Maria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Brodén, Joséphine
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Vareman, Niklas
    Department of Medical Ethics, Lund University, Sweden.
    the Foresight Research Consortium,
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    How do we and how should we deal with uncertainty in Endodontics?2022In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 55, no 4, p. 282-289Article in journal (Refereed)
    Abstract [en]

    In many clinical cases a dentist may feel certain when for example diagnosing, deciding on treatment, or assessing the prognosis - in other cases many dentists may feel a degree of doubt or uncertainty. This paper aims to explore the philosophical concept of uncertainty and its different dimensions, using the condition "persistent apical periodontitis associated with a previously root filled tooth" as an example. Acknowledging that uncertainty exists in any clinical situation can be perceived as uncomfortable, as some might regard it as a weakness. While some types of uncertainty met in dental practice can be addressed and reduced, there are other types which are inevitable and must be accepted. To make sound decisions, it is pertinent that the dentist reflects on and values the consequences of uncertainty. In this paper, a conceptual model is presented by which the dentist can identify the type of uncertainty in a clinical case, making it possible to decide on a strategy on how to manage the uncertainty and its possible consequences, with the aim to support the dentist's care for their patients. The understanding that uncertainty exists and the ability to acknowledge and be comfortable with it when making decisions should be addressed throughout our professional career, and thus ought to be developed during undergraduate education. Some suggestions on how teachers could target this are given in the paper.

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  • 26.
    Sebring, Dan
    et al.
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Buhlin, Kåre
    Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
    Lund, Henrik
    Department of Oral Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Norhammar, Anna
    Unit of Cardiology, Department of Medicine, MedS Solna, Karolinska Institutet, Stockholm, Sweden; Capio St Görans Hospital, Stockholm, Sweden.
    Rydén, Lars
    Unit of Cardiology, Department of Medicine, MedS Solna, Karolinska Institutet, Stockholm, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Endodontic Inflammatory Disease and Future Cardiovascular Events and Mortality: A Report from the PAROKRANK Study2024In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 50, no 8, p. 1073-1081.e3, article id S0099-2399(24)00283-8Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Prospective studies assessing the relation between endodontic inflammatory disease and subsequent cardiovascular events are few. The present aim was to explore associations between endodontic variables and future cardiovascular events in patients with myocardial infarction and matched controls participating in the PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study.

    METHODS: Eight-hundred five patients hospitalized for a first myocardial infarction and 805 controls were recruited between 2010 and 2014. Signs of endodontic inflammatory disease were assessed in panoramic radiographs taken at baseline. Mortality and morbidity data during the approximately 8 years of follow up were obtained from national registries. The risk for future cardiovascular events (first of mortality and nonfatal myocardial infarction, stroke, or hospitalization for heart failure) was analyzed with the log-rank test and Cox proportional hazards regression adjusted for the following confounders: sex, age, smoking, myocardial infarction, diabetes, education, marital status, family history of cardiovascular disease, and marginal periodontitis.

    RESULTS: In total, 285 future events were observed during the follow-up period. Unadjusted analyses revealed that ≥1 root-filled tooth increased the risk of a future event. After adjustment, the number of remaining teeth and non-root-filled teeth decreased the risk of future events, whereas a higher Decayed, Missing and Filled Teeth score increased the risk and ≥1 primary apical periodontitis decreased the risk of suffering cardiovascular events. A higher Decayed, Missing and Filled Teeth score and decayed teeth increased the risk of all-cause mortality.

    CONCLUSIONS: Tooth loss is a strong indicator of an increased risk for future cardiovascular events. Root-filled teeth seem of limited value as a risk indicator when accounting for other risk factors. The potential effect of dental interventions on future events should be assessed in future research.

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  • 27.
    Sebring, Dan
    et al.
    Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Buhlin, Kåre
    Division of Periodontology Department of Dental Medicine Karolinska Institutet Huddinge Sweden.
    Norhammar, Anna
    Department of Medicine Karolinska Institutet Stockholm Sweden; Capio St Görans Hospital Stockholm Sweden.
    Rydén, Lars
    Department of Medicine Karolinska Institutet Stockholm Sweden.
    Jonasson, Peter
    Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Lund, Henrik
    Department of Oral Maxillofacial Radiology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Kvist, Thomas
    Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Endodontic inflammatory disease: A risk indicator for a first myocardial infarction2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 55, no 1, p. 6-17Article in journal (Refereed)
    Abstract [en]

    Aim: To study the association between endodontic inflammatory disease and a first myocardial infarction (MI).

    Methodology: The study comprised 805 patients with recent experience of a first MI, each gender, age and geographically matched with a control. Panoramic radiographs were available for 797 patients and 796 controls. Endodontic inflammatory disease was assessed radiographically. The sum of decayed, missing and filled teeth (DMFT) was calculated, and the number of root filled teeth and teeth with periapical lesions were recorded. The associated risk of a first MI was expressed as odds ratios (OR) with 95% confidence intervals (CI), unadjusted and adjusted for confounders (family history of cardiovascular disease, smoking habits, marital status, education and diabetes).

    Results: Patients who had suffered a first MI had higher DMFT (mean 22.5 vs. 21.9, p = .013) and more missing teeth (mean 7.5 vs. 6.3; p < .0001) than the healthy controls. The number of missing teeth was associated with an increased risk of a first MI (adjusted OR 1.04; CI 1.02-1.06). Conversely, decay-free, filled teeth were associated with decreased risk (adjusted OR 0.98; CI 0.96-1.00). Analysis based on age disclosed the following variables to be associated with an increased risk of a first MI: number of decayed teeth (adjusted OR 1.18; CI 1.02-1.37, in patients <60 years), any primary periapical lesion (adjusted OR 1.57; CI 1.08-2.29, in patients <65 years) and the proportion of root filled teeth (adjusted OR 1.18; CI 1.03-1.36, in patients ≥65 years).

    Conclusions: More missing teeth was independently associated with an increased risk of a first MI. In addition, endodontic inflammatory disease may contribute as an independent risk factor to cardiovascular disease since untreated caries, periapical lesions and root fillings, depending on age, were significantly associated with a first MI.

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  • 28.
    Sebring, Dan
    et al.
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Lund, Henrik
    Department of Oral Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Jonasson, Peter
    Endodontikliniken Gothenburg Sweden.
    Lira‐Junior, Ronaldo
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine Karolinska Institutet Huddinge Sweden.
    Norhammar, Anna
    Unit of Cardiology, Department of Medicine, MedS Solna Karolinska Institutet Stockholm Sweden; Capio S:t Görans Hospital Stockholm Sweden.
    Rydén, Lars
    Unit of Cardiology, Department of Medicine, MedS Solna Karolinska Institutet Stockholm Sweden.
    Buhlin, Kåre
    Unit of Periodontology, Department of Dental Medicine Karolinska Institutet Huddinge Sweden; Department of Oral and Maxillofacial Diseases University of Helsinki Helsinki Finland.
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Primary apical periodontitis correlates to elevated levels of interleukin‐8 in a Swedish population: A report from the PAROKRANK study2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 57, no 1, p. 12-22Article in journal (Refereed)
    Abstract [en]

    Aim: To explore associations between root filled teeth, primary and secondary apical periodontitis, and levels of inflammatory markers in blood from patients with a first myocardial infarction and matched controls.

    Methodology: Between May 2010 and February 2014, 805 patients with a first myocardial infarction and 805 controls, matched for sex, age, and postal code area, were recruited to the multicentre case-control study PAROKRANK (periodontitis and its relation to coronary artery disease). All participants underwent a physical and oral examination, as well as blood sampling. Using panoramic radiography, root filled teeth, primary apical periodontitis, and secondary apical periodontitis were assessed by three independent observers. Blood samples were analysed with enzyme-linked immunosorbent assay method for the following inflammatory markers: interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-12p70, tumour necrosis factor-α, and high-sensitivity C-reactive protein (hsCRP). Additionally, white blood cell count and plasma-fibrinogen were analysed. Associations between endodontic variables and the levels of inflammatory markers were statistically analysed with Mann-Whitney U-test and Spearman correlation, adjusted for confounding effects of baseline factors (sex, age, myocardial infarction, current smoking, diabetes, family history of cardiovascular disease, education, marital status, and periodontal disease).

    Results: Mean age of the cohort was 62 years, and 81% were males. Root fillings were present in 8.4% of the 39 978 examined teeth and were associated with higher levels of hsCRP, fibrinogen, and leukocyte count, but lower levels of IL-2 and IL-12p70. After adjusting for confounders, root filled teeth remained associated with higher levels of fibrinogen, but lower levels of IL-1β, IL-2, IL-6, and IL-12p70. Primary apical periodontitis was found in 1.2% of non-root filled teeth and associated with higher levels of IL-8 (correlation 0.06, p = .025). Secondary apical periodontitis was found in 29.6% of root filled teeth but did not relate to the levels of any of the inflammatory markers.

    Conclusions: This study supports the notion that inflammation at the periapex is more than a local process and that systemic influences cannot be disregarded. Whether the observed alterations in plasma levels of inflammatory markers have any dismal effects on systemic health is presently unknown but, considering the present results, in demand of further investigation.

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  • 29.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Al Hajj, Amenah
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jonasson, Peter
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Patient satisfaction with root canal treatment and outcomes in the Swedish public dental health service: A prospective cohort study2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 9, p. 1462-1472Article in journal (Refereed)
    Abstract [en]

    AIM: To document satisfaction with root canal treatment procedures and outcomes among patients treated at Swedish public dental clinics.

    METHOD: The original material comprised 243 patients who began root canal treatment (RCT) at 20 public dental clinics in the county of Västra Götaland, Sweden. One to three years later, 236 (97.1%) were posted a questionnaire of eight items, rating patient perceptions of RCT-completion, present pain intensity and satisfaction with the RCT. To evaluate the reliability of the original responses, the first 50 respondents were mailed a follow-up questionnaire. Both descriptive and analytical statistics were used to compare respondents and non-respondents and tooth groups.

    RESULTS: One hundred and fifty-nine patients (67.4%) responded: 86 (54.1%) women and 73 (45.9%) men. The mean age 52.5 years, was higher than for non-respondents (P<0.001). A completed root filling was registered for the majority of the teeth (n = 112, 70.9%), but significantly fewer molars had been completed (n = 46, 59.7%, P = 0.02). Fifty percent (n = 59) of the patients reported current pain, mostly mild in intensity (n = 45, 38.1%). One hundred and twenty-three patients (80.9%) recalled experiencing pain during RCT. The highest satisfaction was registered for the item 'chewing ability' (mean = 1.6, SD = 1.9). The majority of patients (n = 114, 75.0%) stated that in retrospect they would still have chosen RCT. However, these patients belonged to the group which either registered the tooth as still present, or had not experienced much discomfort during or after RCT. Forty-four patients (88.0%) responded to the second questionnaire. The reliability of the responses was good. In summary, one to 3 years after beginning RCT at a public dental clinic, patient satisfaction was high, even though every fourth molar had been extracted or treatment had not been completed and half the patients reported persistent pain. The reliability of the patients' responses was considered to be good.

    CONCLUSIONS: The results indicate a need for further clinical observational studies of RCTs undertaken in general dental practice, with special reference to patient-centred outcomes.

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  • 30.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per‐Erik
    Department of Statistics, Lund University School of Economics and Management Lund University Lund Sweden.
    Dawson, Victoria S.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    General dental practitioners' fees for root canal treatment, coronal restoration and follow‐on treatment in the adult population in Sweden: A 10‐year follow‐up of data from the Swedish Dental Register2024In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 10, no 1, article id e826Article in journal (Refereed)
    Abstract [en]

    Objectives: To analyze the accumulated fees connected with root filling, permanent coronal restoration and follow-on treatment charged by Swedish dentists over a 10-11-year follow-up period. Furthermore, analyzing these fees with reference to the type of restoration, tooth group, and the root-filled teeth which survived compared to those requiring extraction.

    Material and methods: In 2009, the data register of the Swedish Social Insurance Agency recorded a total of 215,611 teeth as root-filled. The accumulated fees for each tooth encompassed the following interventions: initial root filling, coronal restorations, and follow-up treatments during the designated period. The outcomes were analyzed using descriptive and analytic statistics, including t tests and one-way analysis of variance. The fees are presented in Euros (€1 = SEK 8.94).

    Results: The total accumulated fees for root fillings amounted to 72 million Euros: the mean fee per root filled tooth was €333.6. The total mean fee over a 10-11-year period, comprising root canal treatment, coronal restorations, and any follow-up treatments, was €923.4. Root-filled teeth with indirect restorations presented a higher mean fee (€1 279.3) compared to those with direct restorations (€829.4) or those without specified restorations (€832.7; p < .001). Moreover, molars presented a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; p < .001). Lastly, the mean fee for extracted teeth was €1225.3, which was higher compared to those who survived the follow-up period (€848.0; p < .001).

    Conclusions: Fees charged by general dental practitioners for root-filled teeth accumulate over time, probably due to the need for further treatment of the tooth. The total mean fee was significantly higher for molars and root-filled teeth with indirect restorations. However, an analysis of the total costs would require prospective clinical cost-effectiveness studies.

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  • 31.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lunds University.
    EndoReCo, Endodontic Research Collaboration in Scandinavia
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Fees for root canal treatment and further dental care in the adult population in sweden: a 10-year follow-up of data from the Swedish dental register2023In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id R107Conference paper (Other academic)
    Abstract [en]

    Aim: To investigate the fees for root filling and further dental care charged by Swedish dentists during a follow-up period of 10 to 11 years. Comparisons are made between type of restoration registered within 6 months of the root filling, the tooth group, and the root filled teeth that survived versus those that were extracted.Methods: A total of 215 611 teeth were registered as root filled in the Swedish Social Insurance Agency’s data register in 2009. For each identified tooth, the fees for the following interventions were tracked: initial root filling, coronal restorations, and further dental interventions registered during the follow-up period. The outcomes were analysed with descriptive and analytic statistics, using one-way ANOVA and t-tests. The fees are presented in Euro (€1 = SEK 8.94; 01/01/2012).Results: The total fee for the root fillings was 72 million euros, and the mean fee was €333.6 per root filling. The total mean fee for the preservation of a root filled tooth over 10 to 11 years was €923.4, which included root canal treatment, coronal restorations, and further interventions. The mean fee for indirectly restored root filled teeth was higher (€1 279.3) than for those directly restored (€829.4) and for teeth without specified restorations (€832.7; P < 0.001). Molars had a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; P < 0.001). The mean fee for teeth that were extracted was higher (€1 225.3) than for those that survived the follow-up (€848.0; P < 0.001). Conclusions: Fees for root filled teeth have accumulated over time probably due to further dental care needed. The total mean fee was significantly higher for indirectly restored root filled teeth than for directly restored. However, prospective clinical cost-effectiveness studies are needed to analyse the total costs.

  • 32.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jonasson, Peter
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Indications for root canal treatment in a Swedish county dental service: patient- and tooth-specific characteristics2019In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, no 2, p. 158-168Article in journal (Refereed)
    Abstract [en]

    AIM: To study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden.

    METHODOLOGY: During a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics.

    RESULTS: The material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%).

    CONCLUSIONS: In the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

  • 33.
    Wigsten, Emma
    et al.
    Department of Endodontology Institute of Odontology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Kvist, Thomas
    Department of Endodontology Institute of Odontology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Patient record assessment of results and related resources spent during 1 year after initiation of root canal treatment in a Swedish public dental organization2022In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 55, no 5, p. 453-466Article in journal (Refereed)
    Abstract [en]

    Aim: To document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start.

    Methodology: The subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment-specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis.

    Results: Complete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated (n = 113, 47.1%). Most cases were completed with a root filling (n = 169, 70.4%). The remainder were extracted (n = 32, 13.3%) or were still uncompleted (n = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT-related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period.

    Conclusions: Patient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases.

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  • 34.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dawson, Victoria S
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, School of Economics and Management, Lund University, Lund, Sweden.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Comparative analysis of general dental practitioners' fees and scheduled fees for root canal treatment and coronal restorations in the adult population of Sweden: a five-year follow-up of data from the Swedish Dental Register2018In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 51, no 2, p. 141-147Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the fees charged by Swedish dentists for root fillings, coronal restorations and further dental interventions during a follow-up period of 5-6 years. METHODOLOGY: A total of 248,299 root fillings were linked with the tooth, the patient and the provider and entered into the Swedish Social Insurance Agency register in 2009. The data register also recorded the subsidy-based (scheduled) fee and the fee actually charged for the root fillings. Fees charged for direct or indirect coronal restorations and additional interventions during the follow-up period were also recorded. One-way ANOVA and T-test were used for statistical analysis. RESULTS: The mean overall fee charged for a root filling was approximately 332 Euro and differed only marginally (13 Euro) from the scheduled fee. The total mean fee for preservation of a root filled tooth was 717 Euro, which included the root canal treatment, the coronal restoration and any additional interventions during the follow-up period. The fees for indirectly restored root filled teeth were significantly higher (1,105 Euro) than for directly restored teeth (610 Euro), despite further additional treatment (P< 0.001). The mean fee for teeth which were subsequently extracted was higher (769 Euro) than for the retained teeth (711 Euro) (P< 0.001). CONCLUSIONS: Fees charged by Swedish dentists for root canal treatment were in accordance with the scheduled fees. The overall mean fee was significantly higher for root filled teeth with indirect restorations than for teeth with direct coronal restorations. However, prospective clinical cost-effectiveness studies are needed to analyse the total costs. This article is protected by copyright. All rights reserved.

  • 35.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden; Public Dental Service Region Västra Götaland Gothenburg Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden; Public Dental Service Region Västra Götaland Gothenburg Sweden.
    Husberg, Magnus
    Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden.
    Davidson, Thomas
    Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Cost‐effectiveness of root canal treatment compared with tooth extraction in a Swedish Public Dental Service: A prospective controlled cohort study2023In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 9, no 4, p. 661-669Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the cost-effectiveness of root canal treatment (RCT) compared with a tooth extraction in a general dental practice setting, with reference to cost per quality-adjusted life-year (QALY) gained over 1 year.

    Material and methods: This is a prospective controlled cohort study based on patients either starting RCT or undergoing extraction at one of six Public Dental Service clinics in the county of Västra Götaland, Sweden. From a total of 65 patients, 2 comparable groups were formed: 37 started RCT and 28 underwent extraction. A societal perspective was used for the cost calculations. QALYs were estimated, based on the EQ-5D-5L given to the patients at their first treatment appointment and then after 1, 6, and 12 months.

    Results: The total mean cost of RCT ($689.1) was higher than for extraction ($280.1). For those patients whose extracted tooth was replaced, the costs were even higher ($1245.5). There were no significant intergroup differences in QALYs, but a significant improvement in health state values in the tooth-preserving group.

    Conclusions: In the short term, extraction was cost-effective compared with preserving a tooth with RCT. However, the potential need for future replacement of the extracted tooth, by an implant, fixed prosthesis, or removable partial dentures, may change the calculation in favor of RCT.

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  • 36.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jonasson, Peter
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Davidson, Thomas
    Centre for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Pigg, Maria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria (Contributor)
    Malmö University, Faculty of Odontology (OD).
    Comparing Quality of Life of Patients Undergoing Root Canal Treatment or Tooth Extraction2020In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 46, no 1, p. 19-28.e1, article id S0099-2399(19)30751-4Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The knowledge of patient-centered outcomes concerning the consequences of root canal treatment in daily life is limited. The treatment option is often tooth extraction with possible prosthetic replacement. This study aimed to achieve a greater understanding of the patient perspective by evaluating the effect of root canal treatment in terms of quality of life and quality-adjusted life year (QALY) weights in comparison with patients who underwent tooth extraction.

    METHODS: Patients with either root canal treatment or extraction were recruited from 6 clinics in the general public dental service during a predetermined period of 8 weeks. Three different instruments were used: the Oral Health Impact Profile evaluating the oral health-related quality of life (OHRQOL), the EQ-5D-5L evaluating health-related quality of life (HRQOL) and QALY weights, and a disease-specific questionnaire evaluating satisfaction regarding the root canal treatment. The evaluation was assessed at the initiation of treatment and after 1 month. Patient-based and tooth-specific characteristics were obtained from the dental records.

    RESULTS: Eighty-five patients were included. The distribution between sexes was even, with 43 women and 42 men. The mean age was 51.1 years. Forty-eight patients (56.5%) had a tooth extraction, and 37 patients (43.5%) initiated root canal treatment. The response rate for the questionnaire at baseline was 95.3%, and at the 1-month follow-up, it was 74.1%. Two relevant and comparable groups were obtained after exclusion of the extracted third molars (n = 20), resulting in 65 patients for further analyses. At follow-up, the patients who initiated root canal treatment registered a significant improvement in perceived HRQOL according to the QALY weights (P = .02 and P < .01, respectively). Patients initiating root canal treatment reported generally high satisfaction.

    CONCLUSIONS: A cohort of patients either initiating root canal treatment or tooth extraction as a control group was established. Initiating root canal treatment had a positive impact on perceived HRQOL. The included patients in general dental practice registered overall high satisfaction regarding root canal treatment.

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