Twenty‐year follow‐up of root filled teeth in a Swedish population receiving high‐cost dental care

Abstract

Aim To study the 20-year survival rate and periapical status of root-filled teeth in a Swedish population requiring high cost dental care and to identify factors related to survival and normal periapical status at follow-up.Methodology The study population comprised 104 patients selected from four local health insurance districts with treatment plans including radiographs submitted for approval for reimbursement from the Swedish National Dental Insurance in 1977. In 1998 a clinical and radiographic follow-up examination was conducted, to register the status of 449 teeth identified as root-filled at baseline. Differences in tooth survival and periapical status at follow-up, with reference to periapical status and quality of root-filling at baseline were analyzed by Chi-square tests. Multiple regression analysis was used to describe tooth survival and normal periapical status at followup, with the explanatory baseline variables: tooth type, type of restoration, type of post, quality of root-filling, periapical status, marginal bone loss and caries.Differences were considered significant at a 5% level.Results Two hundred and ninety (65 %) of the root-filled teeth survived at follow-up Baseline variables associated with low odds for tooth survival were mandibular molar, maxillary premolar, prefabricated posts other than screw-posts, severe marginal bone loss, caries and apical periodontitis (AP).Normal periapical status at follow-up was registered in 49 % of the rootfilled teeth. Baseline variables associated with low odds for normal periapical status (high risk for AP) at follow-up were mandibular molar, maxillary premolar, AP, severe marginal bone loss and inadequate root-filling quality. Of the root-filled teeth with AP 3 at baseline 42 % had been left untreated during the observation period and at followup the AP persisted in 57 % of these teeth. ConclusionsAfter 20 years 65 % of the root-filled teeth had survived and one third remained in sound periapical conditions, without any further treatment. Almost half of the APs registered at baseline were left without treatment and more than half of them persisted after 20 years.

A retrospective study on periodontal disease progression in private practice

“…This is in agreement with a recent study reporting a 35% likelihood that root‐filled teeth would be lost within 20 years (Petersson et al. ) and stressed the importance of an overall prognosis system, which takes into account periodontal as well as endodontic and restorative considerations for formulating tooth prognosis.…”

“…The association of previous endodontic treatment and tooth loss was particularly pronounced in this study (nine teeth were extracted for what was judged as recurrent endodontic pathology). This is in agreement with a recent study reporting a 35% likelihood that root-filled teeth would be lost within 20 years (Petersson et al 2016) and stressed the importance of an overall prognosis system, which takes into account periodontal as well as endodontic and restorative considerations for formulating tooth prognosis.…”

A 20‐year historical prospective cohort study of root canal treatments. A Multilevel analysis

“…) and 65% (Petersson et al . ). Another study evaluated the survival of root filled molars in periodontally treated patients after 13.2 years and observed a survival rate of 71.2% and a healing rate of 65.8% (Pretzl et al .…”

“…Previous long-term studies conducted for 20 years have reported survival rates of approximately 71% (Eckerbom et al 2007) and 65% (Petersson et al 2016). Another study evaluated the survival of root filled molars in periodontally treated patients after 13.2 years and observed a survival rate of 71.2% and a healing rate of 65.8% (Pretzl et al 2016).…”

Development of criteria for investigation of periapical tissue from root-filled teeth

“…The sample to which the developed criteria were applied comprised all 199 consecutive biopsies from one surgeon who seems to have adhered to the Strindberg criteria, considering apical surgery on asymptomatic lesions persisting more than 4 years. As it has been shown that many periapical lesions in endodontically treated teeth are left untreated [21], we considered it valuable to test the developed criteria on this specific sample of periapical lesions from endodontically treated teeth as it probably reflects a very strict selection and possibly cases of what we today would presumably consider overtreatment. In a prospective study it would not be advisable to collect samples from only one surgeon: data collected from multiple centres would increase the generalizability of the study results [22].…”