Risk Score Algorithm for Treatment of Persistent Apical Periodontitis

Abstract

Persistent apical periodontitis related to a nonvital tooth that does not resolve following root canal treatment may be compatible with health and may not require further intervention. This research aimed to develop a Deterioration Risk Score (DRS) to differentiate lesions requiring further intervention from lesions likely to be compatible with health. In this cross-sectional study, patient records (2003-2008) were screened for root-filled teeth with periapical radiolucency visible on periapical radiographs taken at treatment and at recruitment at least 4 yr later. The final sample consisted of 228 lesions in 182 patients. Potential demographic and treatment risk factors were screened against 3 categorical outcomes (improved/unchanged/deteriorated), and a multivariate independent multinomial probit regression model was built. A 5-level DRS was constructed by summing values of adjusted regression coefficients in the model, based on predicted probabilities of deterioration. Most lesions (127, 55.7%) had improved over time, while 32 (14.0%) remained unchanged, and 69 (30.3%) had deteriorated. Significant predictors of deterioration were as follows: time since treatment (relative risk [RR]: 1.11, 95% confidence interval [CI]: 1.01-1.22, p = .030, rounded beta value = 1, for every year increase after 4 yr), current pain (RR: 3.79, 95% CI: 1.48-9.70, p = .005, rounded beta value = 13), sinus tract present (RR: 4.13, 95% CI: 1.11-15.29, p = .034, rounded beta value = 14), and lesion size (RR: 7.20, 95% CI: 3.70-14.02, p < .001, rounded beta value = 20). Persistent apical periodontitis with DRS <15 represented very low risk; 15-20, low risk; 21-30, moderate risk; 31-40, high risk; and >40, very high risk. DRS could help the clinician identify persistent apical periodontitis at low risk for deterioration, and it would not require intervention. When validated, this tool could reduce the risk of overtreatment and contribute toward targeted care and better efficiency in the timely management of disease.

Prediction of periapical status and tooth extraction

“…However, other studies include current clinical observations as predictive factors of present disease (Yu et al . ). The obvious difference in approach makes comparisons of results less relevant.…”

Attitude and Current Experience of Dentists About Non-Surgical Retreatment of Endodontically Treated Teeth.

“…Many factors were reported by internship, general practitioners and specialists that should be considered before making their decisions to retreat endodontically treated teeth (19) . Presence of symptomatic periapical lesion may be associated with poor quality of obturation or probability of presence missed canals, so this is represented an indication for root canal retreatment depending on our results and previously studied intention to avoid the progression of the lesion and to lower the possibility of future complications (20,21) . In addition, the specialists were agreed with many researchers who concluded that "the quality of the coronal restoration is significantly more important than the quality of the endodontic treatment for periapical health.".…”

A 60-year-old female with pain on mastication for one month

“…[1][2][3][4] There is severe, continuous pain and the tooth is highly tender to percussion. [5][6][7] Usually there are no radiographic features. In this case there was mild to moderate pain on mastication and radiographic features were present.…”