Page 36 - MDJ 2022 Jan-Jun, Volume 45 Number 1

Ahmad / Sebastian Rajah

treatment. However, this is not the only factor that therapy, some investigators have questioned their
contributes to inadequate length of root canal filling, as influence. One author concluded that the quality of
obstacles to total negotiation reduces the ability to obturation is the most critical factor in the success of
instrument the entire length of the canal and eliminate endodontically treated teeth, while coronal restoration
canal infection. These obstacles include calcification, quality had a lesser impact on the outcome of the
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complex morphology of the root canal system, suspected endodontic treatment.
ledge, and separated instruments.
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In this study, the coronal restoration was not
Adequate density of root canal filling is an evaluated as it is not possible to score the quality of a
important factor for long-term success of endodontic coronal restoration from a radiograph with certainty, as it
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treatment. In this study, only 43.6 % of canals were of provides only a two-dimensional image. Radiographic
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adequate density. This result is lower compared to a study interpretation is highly subjective and can be influenced
in Thailand which reported 61.7 % of canals possessed by a variety of factors, including changes in beam
adequate density. Their study proved that the likelihood angulation. Microleakage in occlusal margins, cracks, and
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of apical periodontitis was 3.90 times higher when teeth perforations might not be observable in radiographs. Few
had an unsatisfactory density of root filling than when they studies have performed clinical and radiographic
were satisfactory. Significantly, in a review by Ng et al. assessments of coronal restoration quality and found the
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(2008), higher success rates were observed among teeth correlation between these different assessments. 28,39
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rated as having satisfactory root fillings than teeth with Hommez et al. (2002) found a weak correlation existed
unsatisfactory root fillings. between radiographic and clinical coronal parameters
(Spearman’s correlation = 0.485 for quality of restoration).
In our study, only 20.0 % of the root canal fillings Because of this weak correlation, the need to score
were technically adequate. This is lower than the 34.2 % restorations radiographically as well as clinically to assess
reported by a Croatian study, 35 % in Hoen & Pink’s the impact of coronal leakage is obvious. This study could
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(2002) study, 51.5 % in a South Korean study, 51.9 % be improved in the future with the addition of radiographic
in a Thailand study, and 56.9 % in a Brazilian population and clinical evaluation of the coronal restorations which
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study. The inadequacy of root canal fillings could be would also influence the success of the root canal
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considered the primary factor responsible for the high treatment.
frequency of post-treatment apical periodontitis. Our study
confirmed the results of some previous studies that showed Endodontics is a significant treatment modality
a large percentage of root canal fillings were of poor within primary care dentistry. Notably, there is a gap
quality. 19,31,39 The lower percentage of adequate root canal between what is possible to achieve in relation to
fillings in our study was expected as all the subjects endodontic treatment and what is carried out in a general
selected for this study were patients with failed endodontic practice environment. Use of rubber dams in non-surgical
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treatments. root canal treatment is considered mandatory and failure
to use it could be considered to be below the standard of
The majority of the root treated teeth showed care. Despite this, a recent survey on the pattern of
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periradicular lesions (83.0 %). This is similar to Hoen & practice in the delivery of endodontic treatment in
Pink’s (2002) study where there was presence or Malaysia by Wong et al. (2019) found that many GDPs
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enlargement of a radiographic periradicular lesion of about (20.1 %) claimed that they did not use rubber dams. In
84 %. A systematic review and meta-analysis of the addition, 74.6 % of GDPs consistently used normal saline
prevalence of periapical radiolucency and root canal as an irrigant. Normal saline must not be used as the main
treatment done by Pak et al. (2012) showed that a irrigant as it has neither tissue-dissolving nor antimicrobial
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remarkably high proportion (36 %) of the teeth that activity. Moreover, using normal saline as an irrigant
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received root canal treatment had periapical radiolucency. clearly departs from the guidelines for root canal
treatment. This surprising finding indicates a clear
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The result of the present study indicated that the discrepancy between the expected learning outcomes in
quality of the root canal filling was significantly associated higher dental education and attitude of GDPs after
with periapical status. A total of 80.0 % of teeth had graduation.
inadequate root canal fillings, and of these 87.1 % had
periapical lesions (p = 0.05). Many studies have shown a The result of this study indicates the necessity of
strong correlation between the quality of root canal fillings endodontic treatment improvement in dental clinics in
and the presence of apical periodontitis. 28,31,33,39 Pahang. Dental practitioners should have adequate
knowledge in the morphology of teeth, carry out
Another important factor that affects the appropriate measures for the control and prevention of
periapical status is the quality and integrity of coronal infection such as strict aseptic technique, complete chemo-
restoration. 19,28,31,33,34,39 The effects of coronal restoration mechanical preparation using antimicrobial irrigants,
on the outcome of root canal treatment have been intracanal medications, adequate root canal filling, and
investigated extensively in various clinical studies. 30,33,41– proper coronal sealing. This may help to eliminate the
44 Although the results of these studies suggest that coronal chances of root canal failure and subsequent future need
restorations are important for the success of endodontic for retreatment.

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