Periapical health related to the quality of coronal restorations and root fillings

AIMS: To evaluate the impact of the quality of coronal restorations scored on a clinical and radiographic basis and the quality of root fillings on periapical health. METHODOLOGY: Periapical radiographs were taken of 745 root-filled teeth, randomly selected from patients attending the Ghent University Dental School. The teeth had not received restorative treatment in the previous year. The coronal status was scored both clinically according to modified Ryge's criteria, and radiographically by evaluating the presence of signs of marginal leakage or decay. The quality of the root filling was scored according to criteria of length and homogeneity and the periapical status was categorized on the basis of presence or absence of radiographic signs of apical periodontitis. The relationship between coronal status, quality of root filling and periapical health was determined. The data were analyzed using Chi2 test, Odds ratio, Spearman's r(S) and logistic regression. RESULTS: Thirty-three percent of the teeth had apical periodontitis as diagnosed radiographically. Teeth with good and poor coronal restorations scored clinically had apical periodontitis in 31.1 and 36.8%, respectively; this difference was not statistically significant. The quality of the coronal restorations scored radiographically had a statistically significant influence on the periapical condition (P<0.001) with apical periodontitis in 23.8 and 49.1%, respectively, for acceptable and unacceptable restorations. Marginal decay did not influence the periapical status. Teeth restored without a base under the coronal filling had apical periodontitis in 41.3%, whereas teeth with a base had significantly less (P<0.005) apical periodontitis (25.9%). Composite-restored teeth exhibited apical periodontitis in 40.5% of cases whilst amalgam-restored teeth had apical periodontitis in 28.4% of cases; this difference was statistically significant (P<0.01). Root-canal posts had no influence on periapical health. The length and homogeneity of the root-canal fillings had a significant influence (P<0.01 and P<0.001, respectively) on the presence of apical periodontitis, as well as the quality of the coronal restoration scored radiographically (P<0.001). CONCLUSION: The importance of a good coronal restoration, as well as of a good root filling should be emphasized as the technical quality of both influencing the periapical status.