Page 31 - MDJ 2022 Jan-Jun, Volume 45 Number 1

Malaysian Dental Journal Volume 45 Issue 1/2022
 2022 The Malaysian Dental Association
MALAYSIAN DENTAL JOURNAL

Radiographic Assessment of the Technical Quality of Failed Endodontic
Treatment Referred from General Dental Practitioners in Pahang, Malaysia: A

retrospective study

*
Ahmad F Restorative Dental Specialist Unit, Beserah Dental Clinic, Kuantan, Pahang, Ministry of Health, Malaysia.

Sebastian Rajah JR Restorative Dental Specialist Unit, Beserah Dental Clinic, Kuantan, Pahang, Ministry of Health,
Malaysia.

Correspondence: Dr Fauziah binti Ahmad, [email protected]
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ABSTRACT

Aim: To perform a radiographic assessment of the technical quality of root canal fillings in failed endodontic cases referred from general
dental practitioners in Pahang, Malaysia.

Materials and Methods: This study was conducted using a retrospective approach. Out of a total of 237 dental patients with failed
endodontic cases referred from the year 2009 to 2017, 165 root treated teeth were selected after taking into consideration the inclusion
and exclusion criteria. Assessment of the technical quality of root canal fillings was done using periapical radiographs (PA). The
radiographic technical quality of root canal fillings was evaluated by the length, density, and taper. Descriptive statistics and chi-square
tests were both used for statistical analysis.

Results: In this study, only 20.0 % of the total number of teeth had adequate root canal fillings; 80.0 % were inadequate. Maxillary
incisors had the highest frequency of inadequate root fillings at 49.2 %, followed by mandibular molars (21.2 %) and maxillary premolars
(12.9 %). 87.1 % of the inadequately filled root-treated teeth showed the presence of periapical lesions. There was a statistically
significant difference between the adequate and inadequate root canal filling groups in relation to periapical lesion (p ≤ 0.05).

Conclusion: From radiographic assessment, 80 % of the root canal fillings from failed cases referred by general dental practitioners in
Pahang were found to be inadequate. This finding indicates that there is still a substantial need for reinforcement of correct endodontic
procedures and continuing dental education for dental practitioners after graduation.
Key words: root canal filling, failure of endodontic treatment, radiographic assessment, quality of root canal filling.

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INTRODUCTION A root canal treatment performed with the highest
standards of care will often result in healing of the
Root canal treatment is often carried out to periapical lesion. However, root canal treatment may not
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preserve natural dentition. This treatment is a well-tested always lead to a favourable outcome. This treatment
procedure that provides pain relief and restores function usually fails when the procedure falls short of acceptable
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and aesthetics for patients. It is performed to reduce the standards. Major factors associated with endodontic
bacterial load, entomb the remaining bacteria, and prevent failure are the persistence of microbial infection in the root
reinfection. When one undergoes a root canal treatment, canal system and/or the periradicular area. Endodontic
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the inflamed or infected pulp is removed and the root canal procedural errors such as underfilling, overfilling,
system is carefully cleaned and disinfected, then filled and separated instruments, perforations, and ledge formation
sealed. The key to success for this treatment is to are not direct causes of treatment failure. Rather, they
thoroughly debride the root canal system of infected or increase the risk of failure because of the clinician’s
necrotic pulp tissue and microorganisms. Subsequently, inability to eliminate intraradicular microorganisms from
the root canal space has to be sealed completely to prevent the infected root canal. It has additionally been stated that
persistence of infection and reduce the risk of reinfection.
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