Key words: Endodontic treatment - periodontal disease - probing depth
Introduction
Endodontics is one of the dental specialties that has presented most changes in the way its treatment is performed by the technical and scientific advances that have occurred over the past few decades.[1 ]
[2 ]
[3 ]
[4 ] Nevertheless, maintaining endodontically treated in the oral cavity for a long period continues to represent a great challenge.[5 ]
[6 ]
[7 ]
[8 ]
Among the main reasons associated with the loss of endodontically treated teeth, periodontal diseases frequently appear as one of the most relevant types.[9 ]
[10 ]
[11 ] However, strangely enough, there is limited scientific evidence about the importance of periodontal status in relation to successful endodontic treatment and maintenance of endodontically treated teeth in the long term.[11 ],[12 ]
Therefore, the aim of this study was to evaluate the incidence of periodontal compromise in teeth indicated for undergoing endodontic treatment.
Materials and Methods
Sample size calculation
To obtain the minimum number of teeth to be evaluated in this study, the following formula was used:[13 ],[14 ]
Where:
N : Size of the target population. According to data from the Brazilian Institute of Geography and Statistics,[15 ] at the time of conducting the research, the population of the State of Santa Catarina, Brazil (where data were collected), was 6.8 million persons.
n : size of desired sample.
t : Abscissa of the normal curve determined by an area of size α (alpha), which is the calculated risk, so that the maximum margin of error adopted would be as low as possible; in this case, t = 1.96.
d : Maximum margin of error adopted, or also called the precision adopted; values between 1% and 20% could be adopted; the value 5% (margin of error), whose precision was thus equivalent to 95% was one of the most usual values.
P : Proportion of occurrence of the fact observed. When the population value is previously unknown, the population value, P = 50% (0.5000) is adopted), which allows maximization of the value of ‘n ’; in this case, the value of 9.6% was adopted, which was the information coming from the National Oral Health Survey of 2010.[16 ]
Therefore, by substituting the values adopted, a minimum number of 134 teeth was obtained [Table 1 ].
Clinical procedures
This research was conducted in accordance with the principles of the Helsinki Declaration, and all the participants or their legal guardians signed the long term of free and informed consent, authorizing the treatment to be performed and disclosure of its results. Thus, 209 teeth of 209 patients with ages ranging from 31 to 40 years with endodontic treatment needs were evaluated by means of probing depth tests at three vestibular and three palatine/lingual sites, performed by a single operator during clinical activities of the specialization course in Endodontics of the Hermann Blumenau Institute between October 2014 and August 2015. Teeth that presented up to 3 mm probing depth were considered healthy. Those that presented at least one site with probing depth >3 mm were considered compromised. Teeth associated with suspected cracks or root fractures were excluded from the analysis.
Statistical analysis
The data obtained were statistically analyzed using applying the Chi square test, with a level of significance of 5%. All data were analyzed using the SPSS statistical program (SPSS Inc., Chicago, IL, USA).
Table 1:
Summary of sample size calculation
t
t
2
P
1-P
d
d
2
n
1.96
3.8416
0.0960
0.9040
0.05
0.0025
134
Table 2:
Number of teeth evaluated in the study, by gender
Tooth treated
Patients of male gender (n )
Patients of female gender (n )
Total
Maxillary central incisor
5
7
12
Maxillary lateral incisor
8
8
16
Maxillary canine
4
11
15
Maxillary first premolar
6
16
22
Maxillary second premolar
7
11
18
Maxillary first molar
6
17
23
Maxillary second molar
4
6
10
Maxillary third molar
0
1
1
Mandibular central incisor
2
1
3
Mandibular lateral incisor
1
2
3
Mandibular canine
0
1
1
Mandibular first premolar
4
7
11
Mandibular second premolar
7
8
15
Mandibular first molar
14
25
39
Mandibular second molar
5
14
19
Mandibular third molar
0
1
1
Total
73
136
209
RESULTS
The general list of teeth treated and their distribution, considering gender may be viewed in [Table 2 ].
Of the total of 209 teeth evaluated, 40 (19.10%) presented periodontal compromise (probing depth >3 mm in at least one site analyzed). Statistically significant difference was found relative to a number of compromised teeth of patients of the female (22.80%) and male (12.30%) gender (P = 0.04) [Table 3 ].
When the position of the teeth in the arch was compared, the number of compromised anterior teeth was similar to the number found for posterior teeth (18% and 19.5%, respectively) (P = 0.81) [Table 4 ].
In patients of the female gender, the proportion of compromised anterior teeth was higher (27.7%) than that in patients of the male gender (5.0%) (P = 0.03) [Table 5 ].
When the same analysis was made for the posterior teeth, the number of compromised teeth in patients of the female gender was also higher (21.7%) compared with that found in patients of the male gender (15.1%). However, there was no statistically significant difference (P = 0.31) [Table 6 ].
Discussion
There is little scientific evidence that associates successful endodontic treatment with the maintenance of these teeth in the oral cavity in the long term.[11 ],[12 ] Considering that periodontal diseases frequently appear as one of the main factors associated with the loss of endodontically treated teeth,[9 ]
[10 ]
[11 ] the aim of this study was to evaluate the incidence of periodontal compromise in teeth indicated for undergoing endodontic treatment.
The general results obtained revealed that only a small number of teeth (19.10%) presented a probing depth >3 mm in at least one of the sites evaluated; However, a significantly higher number of compromised teeth were observed in patients of the female gender (22.80%) compared with the teeth in patients of the male gender (12.30%). These results were contrary to those observed in the majority of studies previously conducted, in which higher rates of periodontal compromise were observed in patients of the male gender.[5 ]
[6 ]
[7 ] This may be associated with the substantial difference in the number of patients per gender evaluated in this study (136 teeth of female patients and 73 teeth of male patients). Moreover, there are scientific evidence showing different rates of periodontal diseases in patients of different age ranges and with systemic compromise, such as diabetes, obesity, and cardiovascular diseases.[17 ] In the present study, these extrinsic factors were not compared, taking into consideration the gender of patients, representing a limitation about interpreting the results.
Table 3:
General analysis of periodontally compromised teeth considering patients’ gender
Periodontal status
Patients of male gender, n (%)
Patients of female gender, n (%)
Total, n (%)
P =0.04
Healthy teeth
64 (87.70)
105 (77.20)
169 (80.90)
Compromised teeth
9 (12.30)
31 (22.80)
40 (19.10)
Total
73 (100)
136 (100)
209 (100)
Table 4:
General analysis of compromised teeth considering position in the arch
Periodontal status
Anterior teeth, n (%)
Posterior teeth, n (%)
Total, n (%)
P =0.81
Healthy patients
41 (82)
128 (80.5)
169 (80.9)
Compromised patients
9 (18)
31 (19.5)
40 (19.1)
Total
50 (100)
159 (100)
209 (100)
Table 5:
Specific analysis of anterior teeth considering patients’ gender
Periodontal status
Patients of male gender, n (%)
Patients of female gender, n (%)
Total, n (%)
P =0.03
Healthy teeth
19 (95)
22 (73.3)
41 (82)
Compromised teeth
1 (5)
8 (27.7)
9 (18)
Total
20 (100)
30 (100)
50 (100)
Table 6:
Specific analysis of posterior teeth considering patients’ gender
Periodontal status
Patients of male gender, n (%)
Patients of female gender, n (%)
Total, n (%)
P =0.31
Healthy teeth
45 (84.9)
83 (78.3)
128 (80.5)
Compromised teeth
8 (15.1)
23 (21.7)
31 (19.5)
Total
53 (100)
106 (100)
159 (100)
Irrespective of gender, when the position of the teeth in the arch was compared, the number of compromised anterior teeth was similar to the number found for posterior teeth (18% and 19.5%, respectively). These results were associated with the fact that periodontal compromise frequently occurred in a generalized manner in the dental arch. As previously observed, the patients who presented a probing depth >3 mm in at least one site of the tooth referred for undergoing endodontic treatment, probably also presented more compromised teeth.[17 ],[18 ]
In this research, only observational data were obtained about the presence of periodontal pockets in teeth referred for undergoing endodontic treatment. In a study with a broader scope, Skupien et al .[11 ] investigated the success rate and maintenance of endodontically treated and restored teeth, and correlated these variables with periodontal data. Of the 360 teeth evaluated for the mean period of 4.34 years, 19 teeth were extracted and 27 restorations required repair or replacement. Moreover, the authors observed that the increase in probing depth resulted in a significant increase in the risk of loss of the treated tooth. These results ratified the importance of correct periodontal examination to be performed by the endodontist. For this reason, further multicentric studies are necessary, with methodological designs similar to that of the present study; however, with a larger number of samples and more extensive periodontal analyses, to identifying other risk factors that could contribute to the loss of endodontically treated teeth.
Conclusions
According to the data observed in this study, fewer than 20% of teeth referred for undergoing endodontic treatment presented a periodontal compromise. Patients of the female gender presented a higher number of periodontally compromised teeth in comparison with patients of the male gender.
Financial support and sponsorship
Nil.
