OBJECTIVE: The aim was to compare the cost-effectiveness of root canal treatment and an indirect restoration (RCT + PC) versus an implant-supported single crown (ISSC) in the case of a decayed first mandibular molar with a necrotic pulp. The study was based on Swedish population and the reference prices for dental treatments in Sweden. MATERIALS AND METHODS: The cost-effectiveness for RCT + PC and ISSC were calculated with the help of two decision trees. The initial costs were from the Swedish dental reference prices in 2024, and the probability values were from published articles based on Swedish data. RESULTS: In Decision tree I, the expected costs for RCT + PC and for ISSC were 17,400 and 18,800 SEK, respectively. In the Decision tree II, the respected expected costs were 19,500 SEK and 18,800 SEK. The threshold probability values were 83 and 93% for RCT survival. CONCLUSIONS: Given the assumptions and limitations of this decision analysis, the probability of survival for RCT + PC needs to be in the range of 83-93% in order for it to be more cost-effective than ISSC, when deciding about treatment on a compromised first mandibular molar.

BACKGROUND: In conjunction with post placement in root-filled teeth with periapical healthy conditions, root canal retreatment may be performed to improve the seal of the root canal. Whether root canal retreatment for technical reasons (retreatments in teeth without apical periodontitis (AP)) results in lower frequency of AP is unknown.

OBJECTIVE: To examine whether there is a difference in frequency of AP between roots with root canals retreated for technical reasons, and roots with root canals not retreated before post placement, with a minimum follow-up of 5 years. Also, to examine changes in root filling quality following root canal retreatment for technical reasons.

METHODS: This retrospective study included radiographs of 441 root-filled roots without periapical radiolucencies at baseline, scheduled for post and core treatment. Follow-up data for a minimum of 5 years were available for 305 roots (loss to follow-up 30.8%), 46 of which were retreated for technical reasons. Two calibrated observers assessed root filling sealing quality and length, respectively, and periapical status according to the Periapical Index. The main outcome of the study, AP, was used as the dependent variable and all analyses were performed at root level.

RESULTS: The overall frequency of AP at follow-up was 13.8%. The difference in frequency of AP between retreated (4.3%) and nonretreated (15.4%) root canals was not statistically significant, p = .061. Analyses including only roots with preoperatively inadequate root filling quality showed a statistically significant difference (p = .017) between the two treatment groups (2.4% vs. 22.9%).

CONCLUSIONS: Root canal retreatment for technical reasons before post and core placement significantly reduces the frequency of AP in roots with inadequate root filling quality.

ObjectivesPoor oral health and dental infections can jeopardize medical treatment and be life-threatening. Due to this, patients with head and neck malignancies, generalized tumor spread, organ transplant, or severe infection are referred for a clinical oral and radiographic examination. The aim of this study was to compare the diagnostic agreement of three radiographic modalities: intraoral radiographs (IO), panoramic radiographs (PX), and cone beam computed tomography (CBCT) for diagnosis of dental diseases.Materials and methodsThree hundred patients were examined with IO, PX, and CBCT. Periapical lesions, marginal bone level, and caries lesions were diagnosed separately by four oral radiologists. All observers also assessed six teeth in 30 randomly selected patients at two different occasions. Kappa values and percent agreement were calculated.ResultsThe highest Kappa value and percent agreement were for diagnosing periapical lesions (0.76, 97.7%), and for the assessment of marginal bone level, it varied between 0.58 and 0.60 (87.8-89.3%). In CBCT, only 44.4% of all teeth were assessable for caries (Kappa 0.68, 93.4%). The intra-observer agreement, for all modalities and diagnoses, showed Kappa values between 0.5 and 0.93 and inter-observer agreement varied from 0.51 to 0.87.ConclusionsCBCT was an alternative to IO in diagnosing periapical lesions. Both modalities found the same healthy teeth in 93.8%. All modalities were performed equally regarding marginal bone level. In caries diagnosis, artifacts were the major cause of fallout for CBCT.Clinical relevanceIntraoral radiography is the first-hand choice for diagnosing dental disease. For some rare cases where intraoral imaging is not possible, a dedicated panoramic image and/or CBCT examination is an alternative.

Objective

To investigate the quality of root canal fillings and frequency of apical periodontitis (AP) in root canal filled teeth in a Swedish population.

Material and methods

This study used data from a cross-sectional survey conducted in 2013. The root canal filling quality and periapical status were assessed in 491 root canal filled teeth in 196 individuals aged 20-70 years, randomly selected from the population of Jonkoping, Sweden. All root canal filled teeth were examined with periapical radiographs. Three calibrated observers recorded length and density in root canal fillings as well as periapical status according to the Periapical Index. A root filling ending within 0.5-2 mm from the radiographic apex without lateral or apical voids was considered adequate. Data were analyzed in a generalized estimating equation (GEE) model with AP as dependent variable and gender, age, number of teeth, number of root filled teeth, tooth type, and root filling quality as independent variables.

Results

Teeth with technically inadequate root fillings were associated with AP in a simple GEE-analysis. In the multiple GEE-model, the association between technical quality and apical peridontitis was nonsignificant when controlling for tooth type and gender.

Conclusions

The quality of root canal fillings is poor and the prevalence of AP in root canal filled teeth is high, particularly in molar teeth, in a Swedish population.

Aim: This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long-term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery.

Methodology: The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) in 2009. The cohort was followed until 31 December 2020. Subsequent registrations of extractions were collected for Kaplan–Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and p <.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed.

Results: After data cleaning, and exclusion of 157 teeth, 5622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20–97, standard deviation 13.31); 55% were women. At the end of the follow-up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow-up data at 10 years after registration of the periradicular surgery, included 5548 teeth, of which 1461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both p <.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975–2.987, p <.001).

Conclusions: After periradicular surgery in predominantly elderly people in Sweden, approximately three-quarters of the teeth are retained over a 10-year period. The type of tooth is associated with extraction: mandibular molars are at greater risk of extraction than maxillary incisors and canines.

Aim: To study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5–6 years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome.

Methodology: The root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses.

Results: In the year 2009, 36 139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5–6 year period. Only minor intergroup differences were noted: 86.5% of the study group were Swedish-born, compared with 84.4% of the comparison group (P = 0.007). Women comprised 53.2% of the study group and 50.5% (P = 0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80–0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01–1.01. No other significant differences were detected.

Conclusions: There was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5–6 years, and the comparison group, with uneventful outcomes after a corresponding root filling. 

The aim of the this study was to present data on oral care habits and knowledge of oral health in 2013, and to compare these data with results from a series of four previous cross-sectional epidemiological studies. All these studies were carried out in the city of Jönköping, Sweden, in 1973, 1983, 1993, 2003, and 2013. The 1973 study constituted a random sample of 1,000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993, 2003, and 2013 studies, which comprised 1,104; 1,078; 987; and 1,010 individuals, respectively.

A questionnaire about dental care habits and knowledge of oral health was used. The questionnaire contained the same questions in all the five studies, although some had to be slightly modernised during the 40-year period.

During the period 1973–2013, a continous increase of individuals in the age group 20–60 years were treated by the Public Dental Service amounting to about 50%. Almost 70% of the 70- and 80-year-olds were treated by private practitioners. In 2013, 10–20% of the individuals in the age groups 30–40 years did not regularly visit neither Public Dental Service nor a private practitioner. The corresponding figures for the individuals 50–80 years old were 4–7%. Similar number of avoidance was reported in the previous studies.

In the survey 2013, about 20–30% of the individuals in the age groups 20–50 felt frightened, sick, or ill at ease at the prospect of an appointment with the dentist. These findings were in agreement with the results from the surveys 1973–2003. Among the younger age groups, 10–15 years, a reduction in self-reported "ill at ease" was found in the surveys 2003 and 2013 compared to the previous surveys in this series.

In 2013, the knowledge of the etiology of caries was known by about 60% of the individuals which was similar to that reported 1973–2003. Twenty per cent of the individuals stated that they did not know which etiological factors that causes caries. This percentage was equivalent during the period 1973–2013. About 85% of the individuals in all age groups brushed their teeth with fluoride tooth paste at least two times a day. These frequencies have gradually increased during the 40-year period.

Around 40% in the age groups 50–80 years used toothpicks regularly in 2013. This is a about 1/3–1/2 less compared to 2003. In the age groups 20–40 years 3–14% used toothpicks for proximal cleaning in 2013.

In 2013, about 35% of the individuals never consumed soft drinks, in comparison with 20% in 2003. In the age groups 3–20 years about 20% were consuming soft drinks every day or several times a week, which is a reduction by half compared to 2013

Syftet med denna studie var att jämföra munvårdsvanor och kunskap om munhälsa i en serie av fem epidemiologiska tvärsnittsundersökningar. Dessa utfördes i Jönköpings stad 1973, 1983, 1993, 2003 och 2013. Undersökningen 1973 bestod av ett slumpvis urval av 1000 individer jämnt fördelade i åldersgrupperna 3, 5, 10, 15, 20, 30, 40, 50, 60 och 70 år. Samma åldersgrupper med tillägg av åldersgruppen 80 år inkluderades i undersökningarna 1983, 1993, 2003 och 2013 som totalt bestod av 1104, 1078, 987 respektive 1010 individer.

Ett frågeformulär om munvårdsvanor och kunskap om munhälsa användes. Formuläret innehöll samma frågor i alla fem delstudierna, men en del av frågorna hade moderniserats något under 40-årsperioden.

Under 1973 – 2013 sågs en fortgående ökning av individer i åldersgrupperna 20 – 60 år som behandlades inom den offentliga tandvården. Nästan 70 % av 70- och 80-åringarna behandlades inom privattandvården. Tio till tjugo procent av 30- och 40-åringarna gick inte regelbundet till tandvården 2013. Motsvarande siffror för 50 - 80-åringar var 4 – 7 %. Liknande tandvårdsundvikande beteende sågs även i de tidigare studierna.

I undersökningen 2013 upplevde 20 – 30 % av 20 – 50-åringarna rädsla, illamående eller obehag inför tandläkarbesök. Dessa fynd överensstämmer med resultaten 1973 – 2003. I de yngre åldersgrupperna 10 – 15-åringar sågs en minskning av självrapporterad känsla av obehag inför tandläkarbesök i undersökningarna 2003 och 2013 jämfört med tidigare.

Kunskap om kariesetiologi var god hos ungefär 60 % av individerna 2013, liknande resultaten från undersökningarna 1973 – 2003. Tjugo procent uppgav att de inte visste vilka faktorer som orsakar karies och detta var oförändrat 1973 – 2013. Ungefär 85 % i alla åldersgrupper borstade sina tänder med fluortandkräm två gånger dagligen. Denna frekvens har ökat gradvis över 40 år.

Omkring 40 % i åldersgrupperna 50 – 80 år använde tandsticka regelbundet 2013. Detta är en minskning med 1/3–1/2 jämfört med 2003. 2013 använde 3 – 14 % av 20 – 40-åringarna tandsticka regelbundet för approximal rengöring.

Ungefär 20 % av individerna drack aldrig läsk 2003 och 2013 var motsvarande siffra 35 %. Denna förändring var mest uttalad i de yngsta och de äldsta åldersgrupperna. 2013 drack ungefär 20 % av individerna läsk dagligen eller flera gånger i veckan vilket var en halvering jämfört med 2003.

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973–2003. In 1973, 1983, 1993, 2003, and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80 years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jönköping, Sweden.

The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment.

The frequency of edentulous individuals aged 40–70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respectively. No complete denture wearer younger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30–80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003.

The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10–20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5–60 years, DFS was lower in 2013 compared to the earlier examinations. There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40- year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age goups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups.

In age groups 10–30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between 1973–2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003–2013. The percentage of tooth sites with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the other years, 1973–1993.

The percentage of individuals with probing pocket depths >4mm increased with age. Between 2003–2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth >4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen.

The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.

Syftet med denna epidemiologiska studie utförd 2013 var att analysera kliniska och röntgenologiska data om oral hälsa och jämföra resultaten med fyra tvärsnittsstudier utförda 1973 till 2003. Ettusen, 1104, 1078, 987 och 1010 slumpvis utvalda individer undersöktes under respektive år1973, 1983, 1993, 2003 och 2013. Individerna var jämnt fördelade i åldersgrupperna 3, 5, 10, 15, 20, 30, 40, 50, 70 och 80 år. 1973 var inga 80-åringar med. Alla studiedeltagare bodde i Jönköpings stad.

Vid den kliniska och röntgenologiska undersökningen registrerades tandlöshet, avtagbar protetik, dentala implantat, antal tänder, karies, fyllningar, munhygien, tandsten, parodontalt status, utförd endodontisk behandling och apikalstatus.

Frekvensen av tandlösa individer 40-70 år var 16 %, 12 %, 8 %, 1 % och 0,3 % under respektive år 1973, 1983, 1993, 2003 och 2013. Det fanns inga helt tandlösa protesbärare yngre än 80 år 2013.

Under hela 40-årsperioden från 1973 ökade antalet tänder i åldersgrupperna 30-80 år. 2013 hade 60-åringar nästan kompletta dentitioner. Implantat fanns i alla åldersgrupper från 30 år och uppåt. Trettiosex individer hade implantat 2013. Detta var signifikant fler än vid de tidigare undersökningarna med fyra 1993 och arton 2003.

Antalet karies- och fyllningsfria barn och vuxna ökade under hela 40-årsperioden. Kariesfria 3- och 5-åringar ökade till 79 % respektive 69 % 2013. I åldersgruppen 10-20 år ökade antalet kariesfria individer mellan 2003 och 2013. Antalet karies- och fyllningsfria 15-åringar 2013 var 43 % jämfört med 20% 2003. I alla åldersgrupper 5-60 år var DFS lägre 2013 jämfört med tidigare undersökningar, medan DFS i åldersgrupperna 70 och 80 år var oförändrad. Den mest uttalade förändringen var minskningen i antalet fyllda ytor, FS. Bland 15-åringarna registrerades 17,8 FS 1973 jämfört med 0,9 2013. Bland 40-åringarna var motsvarande siffror för FS 50,8 respektive 13,1.

Avseende andelen kronförsedda tänder var den mest uppenbara förändringen den procentuella minskningen i åldersgruppen 50 år från 24 % till 4 %. Andelen rotfyllda tänder minskade mellan 1973 och 2013 i alla åldersgrupper.

I åldersgrupperna 10-30 år sågs en stor reduktion av medelvärdet av plack 1973 – 2003. Endast en mindre förändring sågs den senaste 10-årsperioden. För åldersgrupperna 40 år och äldre observerades en minskning av tandytor med plack mellan 2003 och 2013.

Frekvensen av gingivit var generellt lägre 2013 jämfört med undersökningsåren 1973-1993. Ingen förändring i gingivitmedelvärde noterades mellan 2003-2013 förutom en mindre ökning bland 20-åringarna.

Procenten individer med tandköttsfickor > 4 mm ökade med ålder. Mellan 2003 och 2013 sågs en tydlig minskning i alla åldersgrupper med fickdjup 4 mm eller mer. Bland 50-åringar var andelen individer med tandköttsfickor > 4 mm 76 % 2003 och 38 % 2013. Över hela 40-årsperioden minskade antal individer med måttlig marginal benförlust och antalet individer utan marginal benförlust ökade.

En jämförelse av de fem studierna visar på en stor generell förbättring i oral hälsa över 40 år. Detta kommer innebära betydande förändringar för tandvården.

Objective. The aim of the study was to test the hypothesis that root-filled teeth are at a higher caries risk than non-root-filled teeth. Materials and methods. Two sub-samples from epidemiologically obtained data collected in 1983, 1993 and 2003 in the city of Jönköping, Sweden, were analysed. All the participants were examined clinically and radiographically and the type of filling and the presence or absence of caries were recorded. Sub-sample 1 comprised 832 individuals (9202 teeth) aged 20–70 years with at least eight premolars/molars. In sub-sample 2, 163 subjects (577 teeth) with only one or two decayed tooth surfaces and at least one tooth with full crown coverage were analysed. Results . Logistic regression analysis found that root-filled teeth were predictive of recurrent caries when controlling for the type of restoration in sub-sample 1 (OR = 1.68; 1.41–2.0; CI 95%) and sub-sample 2 (OR = 2.20; 1.07–4.52; CI 95%). Conclusion . In support of the suggested hypothesis, the data revealed a significant association between root-filled teeth and recurrent caries.Read More: http://informahealthcare.com/doi/abs/10.3109/00016357.2011.572291

Aim

To study changes in technical quality of root fillings and periapical status in root filled teeth in random samples of 20 to 70 year-olds between 1973 and 2003.

Methodology

Data from dentate subjects aged 20–70 years from examinations conducted in 1973 (n = 498), 1983 (n = 530), 1993 (n = 547) and 2003 (n = 491) were used for the analysis. Length of root fillings were measured on radiographs to the nearest 0.1 mm. Adequate seal was defined as a root filling without lateral and/or apical voids. Periapical status was assessed according to the periapical index. All observations were made by one calibrated observer registered from full mouth radiographic examinations. Teeth with root fillings ending within the canal without lateral or apical voids were considered adequate. The association between root filling quality and periapical status was analysed by means of the Chi-squared test and a multilevel logistic regression analysis.

Results

Adequately root filled teeth had a significantly lower frequency of apical periodontitis than inadequately root filled teeth (11.8% vs. 22.8%). The frequency of technically adequate root fillings increased statistically significant from 1973 (23.7%) to 2003 (36.4%) without a concomitant improvement of the periapical status in root filled teeth over time (24.5% vs. 24.6%).

Conclusions

This study reports on an improving technical quality of root fillings over time, without a concomitant improvement of the periapical status in root filled teeth. A larger proportion of treated molars over time may be of importance for the result.