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

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.

journal_name

Int Endod J

journal_title

International endodontic journal

authors

Rechenberg DK,Munir A,Zehnder M

doi

10.1111/iej.13407

subject

Has Abstract

pub_date

2021-02-01 00:00:00

pages

172-180

issue

eissn

0143-2885

issn

1365-2591

journal_volume

pub_type

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