Header

UZH-Logo

Maintenance Infos

Correlation between the clinically diagnosed inflammatory process and periapical index scores in severely painful endodontically involved teeth


Rechenberg, D K; Munir, A; Zehnder, M (2021). Correlation between the clinically diagnosed inflammatory process and periapical index scores in severely painful endodontically involved teeth. International Endodontic Journal, 54(2):172-180.

Abstract

AIM
To assess and correlate three distinct states of severely painful endodontically derived inflammation with their depiction on periapical radiographs using periapical index (PAI) scores.
METHODOLOGY
During a period of 15 months, 368 consecutively enrolled patients with suspected endodontic emergency conditions were examined at the University of Zurich, Center of Dental Medicine. Cases with a severely painful (numeric rating scale, NRS-11 > 6) endodontically involved tooth and a clear pulpal and apical diagnosis (n = 162) were selected (one tooth per patient). Teeth were divided into three groups according to the clinically diagnosed main location of the inflammatory process: level 1: pulp (positive response to cold test), level 2: periodontium (no response to cold without swelling) and level 3: periapical tissues (no response to cold with swelling). Periapical radiographs were obtained using a digital unit and analysed by two calibrated observers. For level 2, which had the highest PAI variance (n = 76), the PAI scores were further scrutinized regarding their dependence on tooth location and the duration of pain. Data were analysed using chi-squared and non-parametric tests, alpha = 0.05.
RESULTS
Overall, the PAI scores correlated well with the clinically diagnosed main location of periapical inflammation (Spearman's rho = 0.5131, P < 0.001), with level 1 having the lowest scores by far (P < 0.001) and level 2 having significantly lower scores compared to level 3 (P < 0.05). However, a PAI score of 5 was found in merely 3 teeth within the entire cohort, and 49% of the teeth in the level 2 group had no radiolucency (PAI < 3). Within level 2, the PAI scores were not dependent on tooth location but were substantially (P < 0.001) higher for teeth which had hurt for more than one week, and for root filled teeth.
CONCLUSIONS
For the analysed, severely painful endodontically involved teeth, the clinically diagnosed main location of inflammation was reflected by the periapical index. PAI scores were not significantly influenced by anatomical noise, yet in some cases under-estimated the clinical situation.

Abstract

AIM
To assess and correlate three distinct states of severely painful endodontically derived inflammation with their depiction on periapical radiographs using periapical index (PAI) scores.
METHODOLOGY
During a period of 15 months, 368 consecutively enrolled patients with suspected endodontic emergency conditions were examined at the University of Zurich, Center of Dental Medicine. Cases with a severely painful (numeric rating scale, NRS-11 > 6) endodontically involved tooth and a clear pulpal and apical diagnosis (n = 162) were selected (one tooth per patient). Teeth were divided into three groups according to the clinically diagnosed main location of the inflammatory process: level 1: pulp (positive response to cold test), level 2: periodontium (no response to cold without swelling) and level 3: periapical tissues (no response to cold with swelling). Periapical radiographs were obtained using a digital unit and analysed by two calibrated observers. For level 2, which had the highest PAI variance (n = 76), the PAI scores were further scrutinized regarding their dependence on tooth location and the duration of pain. Data were analysed using chi-squared and non-parametric tests, alpha = 0.05.
RESULTS
Overall, the PAI scores correlated well with the clinically diagnosed main location of periapical inflammation (Spearman's rho = 0.5131, P < 0.001), with level 1 having the lowest scores by far (P < 0.001) and level 2 having significantly lower scores compared to level 3 (P < 0.05). However, a PAI score of 5 was found in merely 3 teeth within the entire cohort, and 49% of the teeth in the level 2 group had no radiolucency (PAI < 3). Within level 2, the PAI scores were not dependent on tooth location but were substantially (P < 0.001) higher for teeth which had hurt for more than one week, and for root filled teeth.
CONCLUSIONS
For the analysed, severely painful endodontically involved teeth, the clinically diagnosed main location of inflammation was reflected by the periapical index. PAI scores were not significantly influenced by anatomical noise, yet in some cases under-estimated the clinical situation.

Statistics

Citations

Altmetrics

Downloads

6 downloads since deposited on 05 Jan 2021
6 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Center for Dental Medicine > Clinic of Conservative and Preventive Dentistry
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > General Dentistry
Language:English
Date:1 February 2021
Deposited On:05 Jan 2021 17:53
Last Modified:17 Jan 2021 02:10
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0143-2885
Additional Information:This is the peer reviewed version of the following article: Rechenberg, D K; Munir, A; Zehnder, M (2020). Correlation between the clinically diagnosed inflammatory process and periapical index scores in severely painful endodontically involved teeth. International Endodontic Journal:online ahead of print, which has been published in final form at https://doi.org/10.1111/iej.13407 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. (http://www.wileyauthors.com/self-archiving)
OA Status:Hybrid
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1111/iej.13407
PubMed ID:32918280

Download

Hybrid Open Access

Download PDF  'Correlation between the clinically diagnosed inflammatory process and periapical index scores in severely painful endodontically involved teeth'.
Preview
Content: Published Version
Language: English
Filetype: PDF
Size: 553kB
View at publisher
Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)