Remote clinical results of the use of endo-sealants in the treatment of teeth with destructive forms of apical periodontitis

Abstract

Abstract. Radiographic examination methods are used to assess the quality of endodontic treatment. The search for new methods for objectively assessing the results of endodontic treatment remains relevant. The development of appropriate accessible standards for assessing the quality of treatment will allow a practicing physician to objectively evaluate the results of their work. Objective: to evaluate the effectiveness of treating teeth with periapical pathology based on the state of apical constriction, substantiating the choice of obturation material, based on clinical and radiographic examination methods. Material and methods. The study involved 156 participants who underwent treatment for 194 teeth (365 roots) with destructive forms of apical periodontitis in the acute stage. For radiographic examination, the following were used: an intraoral X-ray diagnostic dental unit 5D2, a radiovisiograph SOPIX 2 (Acteon Group France), and CBCT in parallel technique. Root canal filling was performed with Foredent, Sealapex, and Trioxident. Foredent was used to fill the root canals of 82 teeth (42.27%), Sealapex – 94 teeth (48.45%), and Trioxident – ​​18 teeth (9.27%). The teeth were divided into three groups based on the degree of apical constriction destruction. The periapical index (PAI) and the "Periapical Index for Assessing the Quality of Endodontic Treatment of Destructive Periodontitis," which we developed, were used to compare and contrast the study data. Results. The PAI value was assessed as the average for each group. Participants were examined from 6 months to 4 years after completion of treatment. In case of destroyed apical constriction, the failure rate of endodontic treatment after using Foredent reaches 80%, which is 5.3 times worse than the indicators of Sealapex and 8.9 times worse than Trioxident. Conclusions. The best treatment results were achieved in the group with preserved apical constriction using Sealapex and gutta-percha pins (11.5% more effective than Foredent (p < 0.005)). In the group with partially destroyed constriction, both Sealapex and Trioxident demonstrated equal success rates. Over a period of up to 4 years, the success rates reached 93% and 89%, respectively. However, for Foredent, the effectiveness was only 35% (p < 0.05), which is due to disrupted canal obturation. In teeth with destroyed apical constriction, the best result was achieved with Trioxident (91% over a period of one year and over 4 years (p < 0.05)). Positive results in this group of teeth were achieved with Sealapex – from 88% to 80%, and with Foredent – ​​from 47.14% to 8%, respectively.