Interference of partial visual analysis of root filling quality and apical status on retreatment decisions

Abstract

Objective The presence of periapical radiolucency has been used as a criterion for endodontic treatment failure. However, in addition to the inherent limitations of radiographic examinations, radiographic interpretations are extremely subjective. Thus, this study investigated the effect of partial analysis of root filling quality and periapical status on retreatment decisions by general dentists. Material and Methods Twelve digitalized periapical radiographs were analyzed by 10 observers. The study was conducted at three time points at 1-week intervals. Radiographs edited with the Adobe Photoshop CS4 software were analyzed at three time points: first, only root filling quality was analyzed; second, only the periapical areas of the teeth under study were visualized; finally, observers analyzed the unedited radiographic image. Spearman's coefficient was used to analyze the correlations between the scores assigned when the periapical area was not visible and when the unedited radiograph was analyzed, as well as between the scores assigned when root fillings where not visible and when the unedited radiograph was analyzed. Sensitivity, specificity, positive and negative predictive values between partial images and unedited radiographs were also used to analyze retreatment decisions. The level of significance was set at 5%. Results The visualization of the root filling on the unedited radiograph affected the interpretation of the periapical status and the technical quality of the fillings has a greater influence on the general dentist's decision to prescribe endodontic retreatment than the periapical condition. Conclusion In order to make endodontic diagnosis, radiographic interpretation process should not only emphasize technical aspects, but also consider biological factors.

Analysis of endodontic success using a Periapical Index in teeth with different types of intraradicular posts

“…Furthermore, fiberglass posts are more practical, conservative, economical and aesthetic, when compared to the cast metal core (Carvalho et al 2020). Morgental et al (2012) investigated the effect of root canal filling quality and periapical status on retreatment decisions based on radiographic interpretations. They concluded that the visualization of the root of the unedited radiograph affected the interpretation of the periapical status, and the quality of fillings influenced the decision to endodontic retreatment.…”

“…General dentists recommend retreatment based on two main criteria: a) planned prosthodontic treatment, and b) presence of periapical radiolucency characterizing endodontic failure. During retreatment decisions, it is important to consider the complexity of the radiographic interpretation process (Morgental et al, 2012). Changes in periapical tissues after endodontic treatment are usually detected on radiographs.…”

Status of Endodontic Treatment and the Correlations to the Quality of Root Canal Filling and Coronal Restoration

“…35 Although radiography provides a static picture of a dynamic process at the time of radiographic evaluation, AP of endodontically treated teeth may appear either during the development or treatment process. 36 Therefore, sectional investigations can provide reliable information on the prevalence of AP in a given population. 37 In the present study, it was observed that AP was present in 52.4% of endodontically treated teeth.…”

Risk Score Algorithm for Treatment of Persistent Apical Periodontitis

“…When asymptomatic AP is associated with a technically inadequate root filling, dentists are more inclined toward further intervention (Morgental et al ., 2012); otherwise, many dentists question the benefit of intervention (Kvist and Reit, 2002) and disagree on the need for, as well as the mode of, further treatment (Reit and Gröndahl, 1984; Rawski et al ., 2003). Although a number of tooth-level clinical parameters, such as periodontal status and quality of root fillings, are commonly considered in decision making (von Arx et al ., 2014), the decision of whether to intervene is largely subjective.…”