Hands OnPreoperative apical periodontitis
Section snippets
Background
For teeth involved with an apical periodontitis lesion preoperatively, the success of endodontic treatment is significantly worse than for teeth with healthy preoperative periapical structures. Years may pass before healing of these lesions occurs, with the European Society of Endodontology recommending follow-up for 4 years after endodontic treatment. When making clinical decisions, it is helpful to be able to predict the prognosis of a tooth as soon as possible after endodontic treatment.
Methods
The radiographic data obtained for 1410 teeth in seven original prospective clinical studies were pooled. Periapical status was documented by a blinded observer using the periapical index (PAI) system, which uses scores from PAI 1 to 5. Follow-up lasted as long as 4 years, with controls followed up for 3 months to 1 year.
Results
For the 683 teeth with no signs of periapical periodontitis when endodontic treatment began, periapical status worsened slightly over the first 2 years depending on progression from PAI 2 to PAI 3. Nine percent of patients developed apical periodontitis more than 1 year after treatment, 3% after 2 years, 2% after 3 years, and 1% after 4 years. Maxillary canines were the site of the highest incidence of apical periodontitis in the first year, but none of the 30 maxillary central incisors
Discussion
Apical periodontitis develops as a consequence of bacterial infection of the dental pulp space. Having an extensive preoperative lesion at the site has a strong negative effect on endodontic outcome. Irrespective of the size of the initial lesion, the lesion tends to decrease to 2 mm or less within 2 years of endodontic treatment, with lesion reduction sometimes continuing for 4 or 5 years, or even 8 to 9 years. As long as continuous shrinkage of the lesion takes place, the case is not
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Huumonen S, Ørstavik D: Radiographic follow-up of periapical status after endodontic treatment of teeth with and without apical periodontitis. Clin Oral Invest 17:2099-2104, 2013
Reprints available from S Huumonen, Inst of Dentistry, Faculty of Medicine, Univ of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland; e-mail: [email protected]