CONTROVERSIES AND POTENTIAL MEDICAL LIABILITY OF UNINTENTIONAL CANAL OVERFILLING OF ROOT CANAL TREATMENTS AND RETREATMENTS IN TEETH WITH PERIAPICAL RADIOLUCENCY
S. A. Scarlatescu, P. Perlea, C. Preoteasa, I. M. Gheorghiu, I. Parlatescu, G. Nicola, A. M. Pangica, S. Manea
Abstract: Aim. To determine the risk of unintentional root canal overfilling on long term radiographic outcome of root canal treatments and re-treatments in teeth with periapical radiolucency.
Methodology. Fifty-eight patients who presented seventy-nine teeth with periapical radiolucency (24 primary/ 55 retreatments) were treated by 2 endodontists. The teeth were rotary prepared and filled using AH Plus (Dentsply-Sirona, Germany) and warm vertically compacted gutta-percha. All the teeth presented unintentional canal overfilling, recorded on postoperative radiography. The patients were monitored clinically and radiographically for at least 1 year and up to 9 years in some cases. Two independent observers assessed the radiographs and determined the outcome according to PAI score pooled in a 3-category scale (1 or 2 - health, 3 - uncertain, 4 or 5 - diseased). The persistence or resorption of the extruded material and the final coronal restoration were registered. Also, the Kappa coefficient (K) was calculated. Wilcoxon, Friedman, Mann Whitney U and chi-square tests were used for group comparisons. Statistical significance was set at p<0.05.
Results. The level of inter-observer agreement K was 59.1%. The average recall time was 2.96 years. Initial PAI score and tooth location were the factors that significantly affected the outcome. Initial PAI score was statistically significant lower in favorable than in unfavorable/uncertain outcomes (p<0.001). Also a more favorable outcome was observed to the maxillary teeth (93.1%) compared to the mandibular teeth (64%) (p<0.001). At 1 year recall, mean PAI score decreased from 3.32 to 1.45 (p<0.001) and a favorable outcome was observed in 59 (74.68%) teeth. Moreover, mean PAI score decreased from the initial value of 3.5 to 1.58 in the first two years, to 1.17 in the following years (p<0.001), this suggesting healing was more pronounced in this period. Persistence of extruded material was present in 87.2% of cases with recalls at 2 years and in 96.8% of the cases with recalls between 2 and 9 years. However, The type of extruded material, its persistence or resorption did not affect the outcomes.
Conclusions. The outcome of root canal treatment with unintentional canal overfilling registered the best results in the first two years, especially in teeth with lower initial PAI score. Gross overfilling may involve medical liability, while a ”puff ” of sealer is becoming the standard of care, particularly with warm condensation techniques. Keywords: periapical radiolucency, endodontic outcome, unintentional overfilling, sealer resorption.
 were treated by 2 endodontists. The teeth were rotary prepared and filled using AH Plus (Dentsply-Sirona, Germany) and warm vertically compacted gutta-percha. All the teeth presented unintentional canal overfilling, recorded on postoperative radiography. The patients were monitored clinically and radiographically for at least 1 year and up to 9 years in some cases. Two independent observers assessed the radiographs and determined the outcome according to PAI score pooled in a 3-category scale (1 or 2 - health, 3 - uncertain, 4 or 5 - diseased). The persistence or resorption of the extruded material and the final coronal restoration were registered. Also, the Kappa coefficient (K) was calculated. Wilcoxon, Friedman, Mann Whitney U and chi-square tests were used for group comparisons. Statistical significance was set at p<0.05.
<br />Results. The level of inter-observer agreement K was 59.1%. The average recall time was 2.96 years. Initial PAI score and tooth location were the factors that significantly affected the outcome. Initial PAI score was statistically significant lower in favorable than in unfavorable/uncertain outcomes (p<0.001). Also a more favorable outcome was observed to the maxillary teeth (93.1%) compared to the mandibular teeth (64%) (p<0.001). At 1 year recall, mean PAI score decreased from 3.32 to 1.45 (p<0.001) and a favorable outcome was observed in 59 (74.68%) teeth. Moreover, mean PAI score decreased from the initial value of 3.5 to 1.58 in the first two years, to 1.17 in the following years (p<0.001), this suggesting healing was more pronounced in this period. Persistence of extruded material was present in 87.2% of cases with recalls at 2 years and in 96.8% of the cases with recalls between 2 and 9 years. However, The type of extruded material, its persistence or resorption did not affect the outcomes.
<br />Conclusions. The outcome of root canal treatment with unintentional canal overfilling registered the best results in the first two years, especially in teeth with lower initial PAI score. Gross overfilling may involve medical liability, while a ”puff ” of sealer is becoming the standard of care, particularly with warm condensation techniques.&redirect_uri=http://rjlm.ro/index.php/arhiv/997)