• Evaluation of Factors Related to Long-term Healing in Endodontic Treatment

      Orgel, Adam William; Fouad, Ashraf F. (2012)
      Introduction: This study sought to determine the effects of residual root canal bacteria and treatment factors on endodontic treatment outcomes up to 6 years post-operatively using traditional radiography (PA radiographs) and limited cone beam computed tomography (CBCT). Methods: Root canal samples were obtained from 50 patients with pulp necrosis and a periapical lesion, following two-visit treatment using contemporary chemomechanical preparation techniques. PCR, with broad range 16S rDNA bacterial primers, was performed followed by cloning and sequencing on pre-obturation specimens. Periapical and CBCT radiographs were taken at 10 months to 6 years post-treatment. Images were scored by two blinded, calibrated endodontists using the conventional periapical index (PAI) and a CBCT index. Statistical analysis was performed using bivariate and multivariate regression analysis for treatment factors. Kaplan-Meier survival analysis and Pearson's regression analysis was used for year-over-year changes. Results: 41 patients were included in the final data analysis. Recall decreased from 98% at 10-17 months to 51% at 33+ months. The percentage of patients healed at 10-17 months, 18-32 months and 33+ months and overall was 65%, 63%, and 66% respectively. Factors influencing outcomes were presence of bacteria at time of obturation (56% when present, 81% absent), primary versus persistent disease (71% vs. 39%), tooth type (85% anterior,23% molar), obturation to the radiographic apex (100% to the apex, 56% not to the apex), and larger master apical file sizes (73%MAF>45 vs. 36% MAF<45).. Short-term outcomes had a strong positive relationship with final outcome (Pearson's, r2=0.56, p=<0.01). Conclusions: Bacterial DNA presence at the time of obturation adversely affects short-term and intermediate-term endodontic treatment outcomes, but this effect is not found in the long-term. Various patient factors such as tooth type and treatment factors such as master apical file size influence outcomes. Short-term treatment outcomes are good predictors of long-term outcomes.
    • The Relationship Between Short Term Healing of Periapical Lesions and Glycemic Control: A Pilot Study

      Zhou, Zuwu; Chand, Priya; Tordik, Patricia (2019)
      The aim of this study was to evaluate the relationship between HbA1c level and short-term healing of periapical lesions after non-surgical root canal treatment (NSRCT). After NSRCT, digital periapical radiographs were taken and blood samples were drawn for HbA1c analysis. To assess short-term healing (PAI difference), subjects returned after six months for a radiograph and blood draw. A calibration exercise established the reliability of the PAI scoring process. Thirty-eight subjects returned for the recall. The relationship between HbA1c level and also the co-variables, with healing was explained using Spearman’s rho and logistic regression. There was a significant correlation between healing and HbA1c level (rs = -.52, p ≤.0001), age (rs = -.44, p ≤.003), recall days (rs =.29, p ≤.036), and cardiovascular status (rs = -.34, p ≤.018). A final logistic regression showed a significant relationship between HbA1c level and short-term healing of periapical lesions (R = .62, p≤ .05).