{"paper_id":"2b9a3477-1034-4b4a-a153-9c2f82c6f2a1","body_text":"Endodontic versus coronal treatment quality on the periapical status | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endodontic versus coronal treatment quality on the periapical status Gasqui MA, M Pérard, F Decup, C Villat, C Chevalier, P Nony, F Gueyffier, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2008630/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION: Coronal sealing, quality of root canal treatment, and periapical status have been widely investigated. However, which of two practitioner-dependent determinants (endodontic treatment or coronal restoration) is the most important to the periapical status remains scientifically debated. OBJECTIVES: This study investigated the relative importance of the technical qualities of root canal filling and marginal sealing of the coronal restoration on the periapical status and screened previously published data. METHODS: A retrospective study collected and analyzed clinical and radiological data on 246 endodontically-treated teeth. Six paired comparisons were carried out between groups combining good or poor endodontic treatment (G/P E) with good or poor coronal restoration G/P R). Results are displayed through forest plots of odds ratios for each comparison. RESULTS: In the retrospective study, the endodontic determinant seems to be more important than the restorative one (37.5% of diseased periapical status with GE versus 41.2% with PE). In the systematic review, odds ratio analyses showed that group GE+GR had 1.7 less periapical lesions than group PE+GR and 2.7 less lesions that group PE+PR. Belonging to group PE+PR was found significantly associated with ‘diseased’ periapical status. CONCLUSION: The retrospective study and the systematic review agreed that endodontic treatment (precisely, root canal filling) was found more important than coronal restoration (precisely, marginal sealing) for healthy periapical tissue. Periapical periodontitis Epidemiology Dental radiography Dental restoration failure Retrospective studies Root canal obturation. Figures Figure 1 Figure 2 Figure 3 Introduction Epidemiology in endodontics is the study of the distributions of endodontic diseases, their prevalence, and their determinants ( 1 ); it increases the knowledge about their etiology and therapy. Apical periodontitis (AP) is the most common endodontic disease whose most specific sign is apical radiolucency. A recent review has reported that the worldwide prevalence of individuals with at least one AP was 52% and that AP was more frequent in root-filled teeth (39%) than in non-treated teeth (5%) ( 2 ). Apical periodontitis is an inflammatory reaction to a bacterial contamination of the endodontic system. The goal of endodontic treatment is to prevent or cure apical periodontitis; the latter may be carried out by chemomechanical disinfection followed by filling of the root canal system and permanent coronal restoration. Good quality procedures (root canal filling and coronal restoration) are usually associated with healthy periapical status, whereas inadequate procedures are usually associated with pathological periapical status ( 3 ). However, the relative importance of each procedure versus the other are still unknown because cross-sectional studies of periapical health have reported contradictory results ( 3 – 5 ) published the first meta-analysis of data from nine studies without coming to a conclusion. This work investigated the relationship between the quality of tooth treatment (root canal filling and coronal restoration) and the periapical status in a French population and compared the results with previous ones extracted from the specialized literature. Materials And Methods The descriptive study Study setting and inclusion criteria An observational multicentric cross-sectional study (RESTO DATA, NTC03854525) (Decup et al. 2021) ( 6 ) was carried out in several French hospital dental departments. From March 2019 to September 2020, 422 new patients seeking routine (not emergency) dental care have been included in 13 hospital dental departments by 41 investigators. From this study, an ancillary survey aimed to analyze endodontically treated teeth and periapical status. X-rays were carried out on root-filled teeth. Only 249 patients have had endodontically treated teeth. The inclusion criteria were the agreement of the patient to participate and the availability of high quality X-rays. An endodontically treated tooth was defined as a tooth containing a radiopaque material in the root canal. The study excluded all teeth with filling material in the pulp chamber only as well as low quality X-rays. Finally, 92 patients with 250 X-rays were kept for analysis ( Appendix Fig. 1 ). Assessment criteria and evaluation method The periapical radiographs were independently examined by an experienced endodontist and a general dentist. Prior to the study onset, 120 periapical radiographs (not included in the analysis) were used to calibrate the examiners ( 7 ). The reproducibility of the scores was assessed by Cohen kappa statistics (for inter- and intra-observer agreement) at day 0, month 1, and month 6. Kappa statistics for inter-observer and intra-observer showed near-perfect agreements (> 0.81) ( 8 ). For each tooth, the following data were collected: i) the type of coronal restoration (direct filling, partial coverage crown, crown, temporary restoration, or none) and its quality (adequate vs. inadequate) ( 9 ); ii) the presence and type of post (screw, metal, fiber); iii) the Periapical Index (PAI) ( 10 ); and, iv) the quality of the root canal filling. The PAI was used to distinguish ‘healthy’ from ‘diseased’ (PAI 1 or 2 vs. PAI 3, 4, or 5). The quality of the filling included three parameters ( 11 ): i) the length of the root filling (‘adequate’ when the filling material was present in the root canal at ≤ 2 mm from the radiographic apex and ‘inadequate’ at > 2 mm or when the filling material extended beyond the apical foramen); ii) the density of the root filling (‘adequate’ when the root filling was homogenous without visible voids and ‘inadequate’ when voids were visible); iii) the shape of the root canal filling (‘adequate’ in case of regular increase of the transverse diameter from the apex to the canal entrance ( 12 ) and ‘inadequate’ in case of irregular increase. For multirooted teeth, the tooth PAI was that of the root with the highest PAI and the overall filling quality the lowest among all. A coronal restoration was considered as ‘good’ (GR) by an adequate marginal sealing as assessed either clinically or radiologically and ‘poor’ (PR) in case of clinical or radiological signs of open margins. An endodontic treatment was considered as ‘good’ (GE) in case of adequate length of filling material with no voids (adequate density) and consistent shape from the orifice to the apex and ‘poor’ (PE) when at least one of the above-mentioned parameters was inadequate. Teeth with one unassessable parameter were kept included. Before coming to 250 X-rays, the analysis excluded six radiographs with no PAI: one with fractured root and five with missing data on coronal restoration type or sealing quality. Statistical methods Categorical variables were described by numbers and percentages and continuous variables by medians and interquartile ranges. Group comparison used non-parametric tests: Fisher test for categorical variables and Wilcoxon test for continuous variables. Differences were considered significant at p < 0.05. All statistical analyses were performed with R software ( 13 ). The literature systematic review The search strategies This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020168471). It was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol (PRISMA-P statement) ( 14 ) in March 2022 by two independent evaluators. No protocol was registered. The search identified studies on the influence of quality of root canal filling and coronal restoration on periapical health. It was limited to PubMed, Web of Science, and Scopus databases, used the following associations of MeSH terms or keywords, and grouped the results: (((endodontic treatment AND periapical health) AND (coronal restoration AND periapical health)) OR ((root canal treatment AND periapical health) AND (coronal restoration AND periapical health)) OR ((root canal therapy AND periapical health) AND (coronal restoration AND periapical health)) OR ((root canal filling and periapical health) AND (coronal restoration AND periapical health))) (((endodontic treatment AND periapical status) AND (coronal restoration AND periapical status)) OR ((root canal treatment AND periapical status) AND (coronal restoration AND periapical status)) OR ((root canal therapy AND periapical status) AND (coronal restoration AND periapical status)) OR ((root canal filling and periapical status) AND (coronal restoration AND periapical status))). Eligibility criteria An article was eligible whenever: i) the endodontic filling, the coronal restoration, and the periapical status have been evaluated by retroalveolar radiography; and, ii) it associated the evaluation of both the quality of endodontic treatment of permanent mature teeth and the quality of their coronal restoration. Articles in which root canal treatments were performed by specialists were not included. Meta-analyses and literature reviews were excluded. Titles and abstracts were screened. The references of retained articles were screened to identify additional articles. Useful full-texts were independently assessed by two practitioners. The data collected from each retained article were: i) article identification: authors and type, country, and year of publication; ii) participants: age, sample size; iii) methods: image acquisition, assessment of AP and coronal restoration, and statistical analysis; and, iv) results: total number of teeth, number of root-filled teeth, number of non-treated teeth, number of teeth with AP, number of teeth with GE and PE, and number of teeth with PR and GR. After independent data collection, retrieved data were cross-checked. Disagreements were discussed with a third practitioner who took the final decisions. Assessment of risk of bias Two independent reviewers assessed the risk of bias using the JBI critical appraisal tool ( 15 ). The criteria were divided into five domains as follows: bias arising from the selection criteria of the sample, bias due to the description of the study sample, bias due to the validity of exposure measurement, bias of the objectivity of criteria used for measurement, bias in identification of confounding factors, bias in the statement of strategies dealing with confounding factors, bias on the validity of the outcomes’ measure and bias on the statistical analysis. The evaluation of the studies was performed by rating each domain as low risk of bias, unclear or high risk of bias. Disagreements between the two reviewers were solved by a third person. Statistical analysis For binary outcomes, estimates were summarized as odds ratio (OR) and 95% confidence interval (CI) and pooled using Mantel-Haenszel method. Between studies, heterogeneity was assessed using I 2 statistics, which describes the percentage of variation across studies that is due to heterogeneity rather than chance. Given the existence of between studies heterogeneity, a random-effect model was used to estimate pooled odds ratios and corresponding 95% CI from aggregate data. Estimates and 95% CIs were graphically presented using Forest plots. The following crossed comparisons have been performed: GE/GR vs GE/PR, GE/GR vs PE/GR, GE/GR vs PE/PR, GE/PR vs PE/GR, GE/PR vs PE/PR, PE/GR vs PE/PR. The statistical analysis used Review Manager (RevMan) software, Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Results Results of the descriptive study The present study included 92 patients whose characteristics are detailed in Table 1 . The mean patients’ age was 49 years (min: 19, max: 79). Women (68%), new patients (59%), and intermediate professions (36%) were the most numerous of their subgroups. Among the radiographs examined, the majority of root-filled teeth (59.4%) were located in the maxillary arch and were posterior teeth (67%). Table 1 Characteristics of the included population (92) and treated teeth (256). Characteristic N (%) Age 18–29 years 17 (18.5%) 30–59 years 43 (46.7%) ≥ 60 years 32 (34.8%) Sex Men 30 (32.6%) Women 62 (67.4%) Patients’ statuses within the clinic New patients 55 (59.8%) Referred patients 14 (15.2%) Established patients 23 (25%) Socio-professional category Farm operators 4 (4.3%) Craftsmen, merchants, business owners 6 (6.5%) Executives, higher intellectual professions 4 (4.3%) Intermediate professions 33 (35.9%) Employees 2 (2.2%) Workers 24 (26.1%) Retired 9 (9.8%) No professional activity 10 (10.9%) Reason for the dental visit Annual check-up 45 (48.9%) Toothache 17 (18.5%) Carious lesion 4 (4.3%) Failure of dental restoration 4 (4.3%) Failure of dental prosthesis 6 (6.5%) Periodontal disorder 6 (6.5%) Other 10 (10.9%) Site of the tooth Anterior + mandibular 21 (8.2%) Anterior + maxillary 62 (24.2%) Posterior + mandibular 83 (32.4%) Posterior + maxillary 90 (35.2%) Slightly more than one out of two examined teeth (55.2%, 138/250) had a ‘diseased’ periapical status. Most restorations consisted of crowns (71.5%). Regarding the quality of coronal restorations, 69% (171/248) of endodontically treated teeth had radiologically acceptable restorations with adequate marginal sealings, whereas only 34.8% (87/250) had clinically acceptable marginal sealings. Slightly more than one out of four root-filled teeth (27.4%, 68/248) had clinically and radiographically adequate coronal restoration (GR). Considering the type and quality of coronal restoration, only direct fillings with inadequate marginal sealings were significantly associated with a ‘diseased’ periapical status (Table 2 ). Neither the presence nor the type of post were significantly associated with a ‘diseased’ periapical status (p = 0.389). Regarding the quality of root canal filling, the shape was adequate in 61.8% (154/249), the density in 47.4% (118/249), and the length in 53% (132/249) of cases. Overall, 29.3% (73/249) of root-filled teeth had an adequate endodontic treatment (GE) (Table 2 ). Considering density, shape, or length separately or combined (overall quality of root canal filling or PE), all inadequate endodontics quality parameters were significantly associated with a ‘diseased’ periapical status. Consequently, the endodontic determinant seems to be more important than coronal restoration determinant for a ‘healthy’ periapical status (37.5% ‘diseased’ periapical status in group GE + PR versus 42% in group PE + GR). Table 2 Periapical status of root filled teeth relative to coronal and endodontic factors and to both coronal and endodontic factors. Periapical status Healthy Diseased p-value a Line totals Total of X-rays examined 112 138 250 Clinical assessment of marginal sealing of coronal restoration 0.005 Adequate 62 (38.0%) 101 (62.0%) 163 (100.0%) Inadequate 50 (57.5%) 37 (42.5%) 87 (100.0%) Radiographic assessment of marginal sealing of coronal restoration 0.27 Adequate 30 (39.0%) 47 (61.0%) 77 (100.0%) Inadequate 81 (47.4%) 90 (52.6%) 171 (100.0%) Radiographic & clinical assessment of marginal sealing of coronal restorations 0.015 Poor restoration (PR) 72 (40.0%) 108 (60%) 180 (100.0%) Good restoration (GR) 39 (57.4%) 29 (42.6%) 68 (100.0%) Type / quality of marginal sealing of coronal restorations 0.119 Direct filling / Inadequate 12 (34.3%) 23 (65.7%) 35 (100.0%) Direct filling / Adequate 2 (25.0%) 6 (75.0%) 8 (100.0%) Partial coverage crown / Inadequate 0 (0.0%) 2 (100.0%) 2 (100.0%) Partial coverage crown / Adequate 1 (50.0%) 1 (50.0%) 2 (100.0%) Crown / Inadequate 51 (42.5%) 69 (57.5%) 120 (100.0%) Crown / Adequate 34 (60.7%) 22 (39.3%) 56 (100.0%) Temporary restoration / Inadequate 5 (45.5%) 6 (54.5%) 11 (100.0%) Temporary restoration / Adequate 1 (100.0%) 0 (0.0%) 1 (100.0%) Absence of restoration 4 (36.4%) 7 (63.6%) 11 (100.0%) Nature of posts 0.389 Screwpost 12 (31.4%) 24 (68.6%) 36 (100.0%) Metal post 53 (49.1%) 55 (50.9%) 108 (100.0%) Fiber post 1 (50.0%) 1 (50.0%) 2 (100.0%) None 46 (44.7%) 57 (55.3%) 104 (100.0%) Length of root canal filling 0.005 Adequate (0–2 mm) 72 (54.5%) 60 (45.5%) 132 (100.0%) Underfilling (< 2mm) 30 (33.3%) 60 (66.7%) 90 (100.0%) Overfilling 10 (37.0%) 17 (63.0%) 27 (100.0%) Density of root canal filling 0.003 Inadequate 47 (35.9%) 84 (64.1%) 131 (100.0%) Adequate 65 (55.1%) 53 (44.9%) 118 (100.0%) Shape of root canal filling 0.049 Inadequate 35 (36.8%) 60 (63.2%) 95 (100.0%) Adequate 77 (50.0%) 77 (50.0%) 154 (100.0%) Overall quality of root canal filling 0.004 Good endodontic treatment (GE) 44 (60.3%) 29 (39.7%) 73 (100.0%) Poor endodontic treatment (PE) 68 (38.6%) 108 (61.4%) 176 (100.0%) Group combinations GE + GR 9 (52.9%) 8 (47.1%) 17 (100.0%) GE + PR 35 (62.5%) 21 (37.5%) 56 (100.0%) PE + GR 30 (58.8%) 21 (41.2%) 51 (100.0%) PE + PR 37 (30.1%) 86 (69.9%) 123 (100.0%) a Fischer test - GE/PE: Good/Poor endodontic treatment – GR/PR: Good/Poor coronal restoration. Row totals per apical status item might not be complete (= 112 or 138) because of missing values. Results of the systematic review The process of study selection for the systematic review is shown in Appendix Fig. 2 . Eight publications were finally analyzed (Moreno et al 2013; Hommez et al. 2002; Siqueira et al. 2005; Tronstad et al 2000; Song et al. 2014; Thampibul et al. 2019; Tavares et al. 2009; Dugas et al. 2003)( 4 , 16 – 22 ). Characteristics of the included studies are presented in the Appendix Table 1 . The assessment of the risk of bias of the included studies is summarized in Appendix Fig. 3 . The majority of the domains received low risk of bias. Six studies were classified with some risk for the description of the study sample because the age of the participants were not mentioned. Two were classified at high risk because they did not identify the confounding factors. The forest plots and the statistical results of the paired comparisons are shown in Figs. 1 , 2 and 3 . As no forest plot crosses the solid line of OR = 1, all comparisons showed statistically significant differences. I² analysis revealed a great heterogeneity between the studies in 4 of the 6 paired comparisons (72 to 93%). Only GE + PR vs. PE + GR and PE + GR vs. PE + PR comparisons showed a moderate heterogeneity (< 75%). Given this large heterogeneity, a random-effect analysis has been undertaken. Odds ratios analyses showed that group GE + GR had less periapical lesions than all other groups (6 times less than PE + PR, 3.8 times less than PE + GR, and 2.3 times less than GE + PR). Group GE + PR had less periapical lesions than PE + GR (1.7 times less) and PE + PR (2.7 times less). Finally, group PE + GR showed 1.5 less periapical lesions than group PE + PR. In all comparisons, the test p-values showed statistically significant differences. Group PE + PR appeared to have the worst radiologic situation regarding periapical lesion prevention. More widely, it seems that the quality of the endodontic treatment has more influence on the periapical health than the quality of the coronal restoration. With group GE + GR as ‘standard’, periapical lesions have been observed more frequently when the quality of the endodontic treatment was judged as poor as that of the coronal restoration (3.8 times vs. 2.3 times more periapical lesion). Moreover, group PE + GR showed 1.7 times more lesion than group GE + PR. Discussion This work attempted to determine which of two determinants (i.e., radiological quality of the root canal treatment or sealing of the coronal restoration) has a more positive effect on the periapical status. It associated a cross-sectional study and a literature systematic review. Stemming from a much larger dataset, the sample size were limited, particularly those of subgroups, which would explain some unexpected results; e.g., a high rate of periapical lesions in teeth with good endodontic treatment and good coronal restoration might be simply due to the small sizes of group GE + GR (only 17 cases). Otherwise, group GE + PR had less periapical lesions than group PE + GR (1.1 times less) or PE + PR (1.9 times less). This indicated that a ‘diseased’ periapical status would be more frequent after inadequate root canal treatment than after inadequate coronal restoration (37.5% ‘diseased’ periapical status with GE vs. 42% with GR). The systematic review confirmed these results: group GE + PR had less periapical lesions than group PE + GR (1.7 times less) or group PE + PR (2.7 times less). Though frequent in endodontics, cross-sectional studies seldom consider the kinetics of the periapical disease. Indeed, an X-ray revealed periapical lesion might be either in the process of development, in the process of healing, or a scar tissue (Kruse et al. 2017) ( 23 ). Besides, other clinical criteria might interfere with the interpretation of the data; e.g., initial pulp status, treatment procedure, time elapsed since treatment, time elapsed between the endodontic and the restorative procedure, etc.). Thus, cross-sectional studies might not answer all questions but help identifying potential risk factors for more rigorous clinical studies. Here, a special attention was paid to two aspects: the representativeness of the patient sample and the relevance of the assessment criteria. One asset was that, unlike other same-design monocentric studies, the data stemmed from 13 hospital centers located in various French regions. According to Tiburcio-Machado et al. (2021), hospital data would yield same prevalence results as private practice data (51%; 95% CI: 40–63; I 2 = 95.9% vs. 57%; 95% CI: 52–62%; I 2 = 97.8%, respectively) ( 2 ). Anyway, the prevalence of apical periodontitis (all teeth, non-treated and root filled) in the general population remains high (40%; 95% CI: 33–46%; I 2 = 96.5%) ( 2 ). Here, only root-filled teeth were considered and the prevalence of apical periodontitis was higher than 39% (95% CI: 36–43%; I 2 = 98.5%) found by recent worldwide data ( 2 ). Concerning quality criteria, those of root canal filling considered shape, density, and length( 11 ) (AAE 2009). However, so far, most publications in systematic reviews have reported only on density and length. Here, considering each quality criterion alone, only inadequate density and inadequate length of root filling were found statistically significantly associated with periapical lesion whereas shape did not seem to significantly affect the periapical status. More investigations are needed to confirm or refute this finding. Further, the present study assessed restoration quality on clinical and radiological criteria. This was found in only three studies kept by the systematic review (Dugas et al. 2003, Song et al. 2014, Hommez et al. 2002) ( 17 , 19 , 22 ). According to the FDI criteria, quality assessment of a coronal restoration should check for clinical or radiological evidence of hiatus between dental walls and the restoration material ( 9 , 24 ), which reflects an inadequate sealing. The present investigation found 30.3% inadequate coronal restorations as per the radiological examination and 65.2% as per the clinical examination and both percentages are higher than those reported by Hommez et al. (2002) (21.8% and 24.8%, respectively) ( 17 ). This discrepancy indicates that radiological assessment of coronal restoration quality is not sufficient because of the risk of quality overestimation. A reliable assessment should use both assessment types. This confirms previous conclusions by Craveiro et al. (2015) ( 25 ). Indeed, the percentage of inadequate coronal restoration in this study (72.8%) was higher than those found by other studies that used only radiology (Moreno et al. 2013, Siqueira et al. 2005, Thampibul et al. 2019, Tavares et al. 2009) ( 16 , 18 , 20 , 21 ). Still, the percentage of adequate restoration (27.2%) was lower than those found by Hommez et al. (2002) or Song et al. (2014) (67.4% and 68.5%, respectively) who used both assessment types ( 17 , 19 ). To assess periapical lesions, several recent epidemiological studies used Cone Beam Computed Tomography (CBCT) (Cakici et al. 2016; Gambarini et al. 2018; Gomes et al. 2015; Nur et al. 2014) ( 25 – 29 ) to overcome two conventional X-ray limitations: two-dimensional representation of three-dimensional structures (Bender 1997)( 30 ) and confusion of periapical lesions with lesions confined to cancellous bone (Bender and Seltzer 2003 a and b) ( 31 , 32 ). Despite CBCT superiority (Antony et al. 2020) ( 33 ), the current recommendations are not yet in favor of its systematic use (AAE and AAOMR Joint Position Statement 2015) ( 34 ) because of the ‘as low as reasonably achievable’ (ALARA) principle. Indeed, a small ‘field of view’ source exposes the patient to 10–100 times the radiation dose received with standard periapical radiography ( 35 ). Therefore, retroalveolar radiography remains the X-ray of choice, especially for epidemiological studies. In this study, the evaluation was as standard as possible (e.g., precluded X-rays without film holder) to avoid distorted images. Now, given that CBCT is not recommended, a more relevant approach to detect periapical lesions would be the use of artificial intelligence ( 36 ). The present study found 27.3% adequate endodontic treatments, which is lower quality versus data from the systematic review; i.e., 33% (Moreno et al 2013) ( 16 ), 34.4% (Hommez et al. 2002) ( 17 ), 56.9% (Siqueira et al. 2005) ( 18 ), 50.5% (Tronstad et al 2000) ( 4 ), 35.6% (Song et al. 2014) ( 19 ), 51.9% (Thampibul et al. 2019) ( 20 ), 27% (Tavares et al. 2009) ( 21 ), and 38.9% (Dugas et al. 2003) ( 22 ). However, the present work’s data illustrate a slight increase in the percentage of adequate treatments from 21% (Boucher et al. 2002)( 37 ) to 27% (Tavares et al. 2009)( 21 ). One important factor in quality is the level of experience of the practitioner. Craveiro et al. (2015) reported 82.9% of adequate root canal treatments by endodontists( 25 ). This percentage is probably much lower in general dental practice. This highlights the need for collecting data from general practitioners to prevent overestimating the quality of endodontic treatments. In this work, the literature review kept only eight studies. This low number is most probably due to the wide heterogeneity of the parameters evaluated, which is imposed by the multiple factors involved in endodontics. It is desirable that future prospective studies (in accordance with the ESE and FDI guidelines) be stratified on variables such as the type of tooth (indicative of the degree of technical difficulty), previous apical status, preoperative pulpal status, initial vs. secondary treatment, delay since last treatment, time elapsed before coronal seal, type of restoration (direct/indirect), or intra-operative factors. Such studies will highly clarify the importance of each variable in the quality of endodontic treatment. Conclusion The above-displayed results of the cross-sectional study among omnipractitioners and the systematic review confirm the conclusion made by Craveiro et al. (2015) among endodontists that an adequate endodontic treatment seems to have a more positive effect on the periapical health than an adequate coronal restoration. Nevertheless, the practitioners should care for both determinants to improve the overall quality of all restorative treatments. Declarations Knowledge Transfer Statement: This original article combines an observational study and a systematic review in order to identify which of endodontic treatment or coronal restoration is most important for periapical health. Conclusions of both reported that a good endodontic treatment seems to be more important than a good restoration for periapical health. Other: This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42020168471). Acknowledgments The authors would like to thank all the investigators of hospital centers of RESTO DATA study: Abid Sarah, Becavin Thibault, Becquart Mathilde, Berbel Fanny, Bertrand Marie-France, Blanc Cécile, Boudeau Mathilde, Bouyahmed Lydia, Canceill Thibault, Ceinos Romain, Collignon Anne-Margaux, David Alexandra, Decaup Pierre-Hadrien, Decerle Nicolas, Decup Franck, Domejean Sophie, Douchy Laura, Drouhet Thibault, Florimond Marion, Fouillen Kevin-John, Gasqui Marie-Agnès, Gastineau Richard, Gaucher Céline, Kerouredan Olivia, Khoury Claudine, Le Clerc Justine, Lefrançois Etienne, Lesieur Charlène, Maillet Christina, Mesgouez-Menez Catherine, Pérard Matthieu, Pradelle Nelly, Préaubert Estelle, Robberecht Lieven, Vallaeys Karen, Ziouani-Taïr Nawel. The authors declare the study was conducted according to the International Committee of Medical Journal Editors guidelines for the Ethical Considerations in the Conduct and Report of Research. This study was supported by Hospices Civils de Lyon (Lyon, France), Dentsply Sirona (Versailles, France), Procter & Gamble (Asnières-sur-Seine, France), and U-Lab (Rueil-Malmaison, France). The sponsors had no roles in the study design; the collection, analysis, and interpretation of the data; the writing of the report; or the decision to submit the article for publication. Author contributions: M.-A. Gasqui: investigator of RESTO DATA study; contributed to study conception and design, data acquisition, analysis and interpretation, and drafted the manuscript; M. Pérard: investigator of RESTO DATA study; contributed to data interpretation and drafted the discussion section of the manuscript; F. Decup: co-principal investigator of RESTO DATA study; contributed to data acquisition and interpretation and drafted the discussion section of manuscript; C. Villat: contributed to data acquisition, analysis and interpretation, manuscript drafting and critical revision; C. Chevalier: contributed to data acquisition; P. Nony: contributed to data interpretation and discussion drafting; F. Gueyffier: contributed to data interpretation and discussion drafting; J. Iwaz: contributed to drafting and critical revision of the manuscript; L. Roche: contributed to data acquisition, analysis and interpretation S. Aslanian: contributed to data acquisition, analysis and interpretation B. Grosgogeat: principal investigator of RESTO DATA study; contributed to conception and design, data acquisition and interpretation, and manuscript drafting; M. Zanini: contributed to conception and design, data interpretation, manuscript drafting. All authors gave final approval and agree to be accountable for all aspects of the work. The authors declare having no conflicts of interest. References Eriksen HM, Kirkevang LL, Petersson K. Endodontic epidemiology and treatment outcome: general considerations: Endodontic epidemiology and treatment outcome. Endod Top. juill 2002;2(1):1–9. Tibúrcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. mai 2021;54(5):712–35. Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J. janv 1995;28(1):12–8. Tronstad L, Asbjørnsen K, Døving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Dent Traumatol. oct 2000;16(5):218–21. Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, et al. 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The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. févr 1986;2(1):20–34. ENDODONTICS: Colleagues for Excellence - American Assoc of Endodontists, newsletter 2009 https://www.aae.org/specialty/publications-research/endodontics-colleagues-excellence/ Schilder H. Cleaning and shaping the root canal - PubMed. Dent Clin North Am 18(2):269–296 https://pubmed.ncbi.nlm.nih.gov/4522570/ R Core Team 2020. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria https://www.r-project.org/ Cohen J, Deeks J, Hooft L, Salameh J, Korevaar D, C G, et al. Preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts): checklist, explanation, and elaboration. BMJ 15 mars 2021 https://pubmed.ncbi.nlm.nih.gov/33722791/ Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk. In: JBI Manual for Evidence Synthesis. Munn Z. 2020. (Aromataris E). Moreno JO, Alves FRF, Gonçalves LS, Martinez AM, Rôças IN, Siqueira JF. Periradicular Status and Quality of Root Canal Fillings and Coronal Restorations in an Urban Colombian Population. J Endod. mai 2013;39(5):600–4. Hommez GMG, Coppens CRM, De Moor RJG. Periapical health related to the quality of coronal restorations and root fillings. Int Endod J. août 2002;35(8):680–9. Siqueira JF, Rôças IN, Alves FRF, Campos LC. Periradicular status related to the quality of coronal restorations and root canal fillings in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. sept 2005;100(3):369–74. Song M, Park M, Lee CY, Kim E. Periapical Status Related to the Quality of Coronal Restorations and Root Fillings in a Korean Population. J Endod. févr 2014;40(2):182–6. Thampibul P, Jantarat J, Arayasantiparb R. Post-treatment apical periodontitis related to the technical quality of root fillings and restorations in Thai population. Aust Endod J. août 2019;45(2):163–70. Tavares PBL, Dds EB, Dds TB, Jr JFS, Lasfargues JJ. Prevalence of Apical Periodontitis in Root Canal-Treated Teeth From an Urban French Population: Influence of the Quality of Root Canal Fillings and Coronal Restorations. Clin Res. 2009;35(6):4. Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S. Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations: Prevalence of apical disease. Int Endod J. mars 2003;36(3):181–92. Kruse C, Spin-Neto R, Reibel J, Wenzel A, Kirkevang LL. Diagnostic validity of periapical radiography and CBCT for assessing periapical lesions that persist after endodontic surgery. Dento Maxillo Facial Radiol. oct 2017;46(7):20170210. Hickel R, Peschke A, Tyas M, Mjör I, Bayne S, Peters M, et al. FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples. Clin Oral Investig. août 2010;14(4):349–66. Craveiro MA, Fontana CE, de Martin AS, Bueno CE da S. Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod. juin 2015;41(6):836–40. Cakici EB, Yildirim E, Cakici F, Erdogan AS. Assessment of periapical health, quality of root canal filling, and coronal restoration by using cone-beam computed tomography. Niger J Clin Pract. oct 2016;19(5):673–7. Gambarini G, Piasecki L, Miccoli G, Gaimari G, Nardo DD, Testarelli L. Cone-beam computed tomography in the assessment of periapical lesions in endodontically treated teeth. Eur J Dent. janv 2018;12(01):136–43. Gomes AC, Nejaim Y, Silva AIV, Haiter-Neto F, Cohenca N, Zaia AA, et al. Influence of Endodontic Treatment and Coronal Restoration on Status of Periapical Tissues: A Cone-beam Computed Tomographic Study. J Endod. oct 2015;41(10):1614–8. Nur BG, Ok E, Altunsoy M, Ağlarci OS, Çolak M, Güngör E. Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT. J Appl Oral Sci Rev FOB. déc 2014;22(6):502–8. Bender IB. Factors influencing the radiographic appearance of bony lesions. J Endod. janv 1997;23(1):5–14. Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: I. 1961. J Endod. nov 2003;29(11):702–6; discussion 701. Bender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: II. 1961. J Endod. nov 2003;29(11):707–12; discussion 701. Antony DP, Thomas T, Nivedhitha MS. Two-dimensional Periapical, Panoramic Radiography Versus Three-dimensional Cone-beam Computed Tomography in the Detection of Periapical Lesion After Endodontic Treatment: A Systematic Review. Cureus. 19 avr 2020;12(4):e7736. AAE and AAOMR Joint Position Statement: Use of Cone Beam Computed Tomography in Endodontics 2015 Update. J Endod. sept 2015;41(9):1393–6. Wenzel A. Radiographic display of carious lesions and cavitation in approximal surfaces: Advantages and drawbacks of conventional and advanced modalities. Acta Odontol Scand. mai 2014;72(4):251–64. Aminoshariae A, Kulild J, Nagendrababu V. Artificial Intelligence in Endodontics: Current Applications and Future Directions. J Endod. sept 2021;47(9):1352–7. Boucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J. mars 2002;35(3):229–38. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2008630\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":133928729,\"identity\":\"d800d842-c621-4185-8524-4f4c85c03ef6\",\"order_by\":0,\"name\":\"Gasqui MA\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Faculté d’Odontologie, Université Claude Bernard Lyon 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Grosgogeat\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABOklEQVRIie2Rv0vDQBTH3xG4LK3n+Eqh/gsnAWsxtP/KhYN0cevi1kDhpv6Y/SPcHQuBTIWuiiANBXWsW1o6+BKhSlI7O9xnuB/fx4d3vAOwWP4hElgEqhSyFYVwVpz9PxQlf2eOI3OFF5fwiJJTUjieUtrNePSRZvsWiIc0zXZ+d+Yuk7vtYwwcdbIC9VpWOtPAXNPDPMB3z6tPQ30/1vx5ssiVsC9BDSoPWzAjSQkiTHiTjWMt55q/MBMPDd5eIcvKszkow1xpbEnpLdd8QAp1IYVGc0QZrUhRIAzHWhZ3JWrunFI6Y2ZAhd6lQe549ShU+LT2GhPTB157C1FVlXbNXX9mfutCiITR5PyemAXpZmtuQLg6wU1VITh+r1SjjkF0KJxTckygn9sUm5jTsofeT6FILBaLxQJf1wZqqzscEh4AAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Faculté d’Odontologie, Université Claude Bernard Lyon 1\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"B\",\"middleName\":\"\",\"lastName\":\"Grosgogeat\",\"suffix\":\"\"},{\"id\":133928743,\"identity\":\"977bcbbf-8a95-4639-a32c-e2240004f7ed\",\"order_by\":11,\"name\":\"M Zanini\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Unité de Formation et de Recherche en odontologie, Université de Paris Cité\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"M\",\"middleName\":\"\",\"lastName\":\"Zanini\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-08-29 07:14:36\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-2008630/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-2008630/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":26190489,\"identity\":\"3f9a2dc4-e00f-4907-92ad-68cb0c60b40d\",\"added_by\":\"auto\",\"created_at\":\"2022-09-07 17:12:51\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":42568,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plots of odds ratios (and their 95% confidence intervals) for the comparison of GE/GR vs. GE/PR (upper panel), GE/GR vs. PE/GR (lower panel). GE = Good Endodontics, GR = Good Restoration, PE = Poor Endodontics, PR = Poor Restoration. “Events” means that the combined treatment (endodontic quality + restoration quality) shows a periapical lesion. The results of each publication are represented by a black square (whose size indicates its weight in the overall effect) and a black horizontal line (the 95% confidence interval). The overall effect size (black diamond) is based on data collected from the 8 publications; its size depends on the 95% confidence intervals for the overall combined result.\\u003c/p\\u003e\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2008630/v1/e96ece36f2449924bc4bc6a6.png\"},{\"id\":26190800,\"identity\":\"4ddd0054-d18d-4e6f-9bf7-6ac775eba132\",\"added_by\":\"auto\",\"created_at\":\"2022-09-07 17:17:51\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":42804,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plots of odds ratios (and their 95% confidence intervals) for the comparison of GE/GR vs. PE/PR (upper panel), GE/PR vs. PE/GR (lower panel). GE = Good Endodontics, GR = Good Restoration, PE = Poor Endodontics, PR = Poor Restoration. “Events” means that the combined treatment (endodontic quality + restoration quality) shows a periapical lesion. The results of each publication are represented by a black square (whose size indicates its weight in the overall effect) and a black horizontal line (the 95% confidence interval). The overall effect size (black diamond) is based on data collected from the 8 publications; its size depends on the 95% confidence intervals for the overall combined result.\\u003c/p\\u003e\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2008630/v1/a700e33a3add45437cdad3e6.png\"},{\"id\":26191077,\"identity\":\"f6868d16-94a9-4aec-b371-fbc234c3ae64\",\"added_by\":\"auto\",\"created_at\":\"2022-09-07 17:22:51\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":42791,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plots of odds ratios (and their 95% confidence intervals) for the comparison of GE/PR vs. PE/PR (upper panel) and PE/GR vs. PE/PR (lower panel). GE = Good Endodontics, GR = Good Restoration, PE = Poor Endodontics, PR = Poor Restoration. “Events” means that the combined treatment (endodontic quality + restoration quality) shows a periapical lesion. The results of each publication are represented by a black square (whose size indicates its weight in the overall effect) and a black horizontal line (the 95% confidence interval). The overall effect size (black diamond) is based on data collected from the 8 publications; its size depends on the 95% confidence intervals for the overall combined result.\\u0026nbsp;\\u003c/p\\u003e\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2008630/v1/a398d517b3a81c2c8200fdf0.png\"},{\"id\":32347053,\"identity\":\"e9cc4c06-a4ad-4fac-a855-1b3c3de40f1e\",\"added_by\":\"auto\",\"created_at\":\"2023-02-01 19:29:31\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":468122,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2008630/v1/e36e8f16-7701-4b51-8218-2044681aa31b.pdf\"},{\"id\":26190492,\"identity\":\"00e107bc-056f-4939-83f5-12c21427249d\",\"added_by\":\"auto\",\"created_at\":\"2022-09-07 17:12:51\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":189966,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplementalappendix.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2008630/v1/234d7bdcb236113ac3dc2420.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Endodontic versus coronal treatment quality on the periapical status\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eEpidemiology in endodontics is the study of the distributions of endodontic diseases, their prevalence, and their determinants (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e); it increases the knowledge about their etiology and therapy. Apical periodontitis (AP) is the most common endodontic disease whose most specific sign is apical radiolucency. A recent review has reported that the worldwide prevalence of individuals with at least one AP was 52% and that AP was more frequent in root-filled teeth (39%) than in non-treated teeth (5%) (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eApical periodontitis is an inflammatory reaction to a bacterial contamination of the endodontic system. The goal of endodontic treatment is to prevent or cure apical periodontitis; the latter may be carried out by chemomechanical disinfection followed by filling of the root canal system and permanent coronal restoration. Good quality procedures (root canal filling and coronal restoration) are usually associated with healthy periapical status, whereas inadequate procedures are usually associated with pathological periapical status (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). However, the relative importance of each procedure versus the other are still unknown because cross-sectional studies of periapical health have reported contradictory results (\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e) published the first meta-analysis of data from nine studies without coming to a conclusion.\\u003c/p\\u003e \\u003cp\\u003eThis work investigated the relationship between the quality of tooth treatment (root canal filling and coronal restoration) and the periapical status in a French population and compared the results with previous ones extracted from the specialized literature.\\u003c/p\\u003e\"},{\"header\":\"Materials And Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe descriptive study\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eStudy setting and inclusion criteria\\u003c/h2\\u003e \\u003cp\\u003eAn observational multicentric cross-sectional study (RESTO DATA, NTC03854525) (Decup et al. 2021) (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e) was carried out in several French hospital dental departments. From March 2019 to September 2020, 422 new patients seeking routine (not emergency) dental care have been included in 13 hospital dental departments by 41 investigators. From this study, an ancillary survey aimed to analyze endodontically treated teeth and periapical status.\\u003c/p\\u003e \\u003cp\\u003eX-rays were carried out on root-filled teeth. Only 249 patients have had endodontically treated teeth. The inclusion criteria were the agreement of the patient to participate and the availability of high quality X-rays. An endodontically treated tooth was defined as a tooth containing a radiopaque material in the root canal. The study excluded all teeth with filling material in the pulp chamber only as well as low quality X-rays. Finally, 92 patients with 250 X-rays were kept for analysis (\\u003cem\\u003eAppendix\\u003c/em\\u003e Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eAssessment criteria and evaluation method\\u003c/h2\\u003e \\u003cp\\u003eThe periapical radiographs were independently examined by an experienced endodontist and a general dentist. Prior to the study onset, 120 periapical radiographs (not included in the analysis) were used to calibrate the examiners (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). The reproducibility of the scores was assessed by Cohen kappa statistics (for inter- and intra-observer agreement) at day 0, month 1, and month 6. Kappa statistics for inter-observer and intra-observer showed near-perfect agreements (\\u0026gt;\\u0026thinsp;0.81) (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eFor each tooth, the following data were collected: i) the type of coronal restoration (direct filling, partial coverage crown, crown, temporary restoration, or none) and its quality (adequate vs. inadequate) (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e); ii) the presence and type of post (screw, metal, fiber); iii) the Periapical Index (PAI) (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e); and, iv) the quality of the root canal filling.\\u003c/p\\u003e \\u003cp\\u003eThe PAI was used to distinguish \\u0026lsquo;healthy\\u0026rsquo; from \\u0026lsquo;diseased\\u0026rsquo; (PAI 1 or 2 vs. PAI 3, 4, or 5). The quality of the filling included three parameters (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e): i) the length of the root filling (\\u0026lsquo;adequate\\u0026rsquo; when the filling material was present in the root canal at \\u0026le;\\u0026thinsp;2 mm from the radiographic apex and \\u0026lsquo;inadequate\\u0026rsquo; at \\u0026gt;\\u0026thinsp;2 mm or when the filling material extended beyond the apical foramen); ii) the density of the root filling (\\u0026lsquo;adequate\\u0026rsquo; when the root filling was homogenous without visible voids and \\u0026lsquo;inadequate\\u0026rsquo; when voids were visible); iii) the shape of the root canal filling (\\u0026lsquo;adequate\\u0026rsquo; in case of regular increase of the transverse diameter from the apex to the canal entrance (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) and \\u0026lsquo;inadequate\\u0026rsquo; in case of irregular increase.\\u003c/p\\u003e \\u003cp\\u003eFor multirooted teeth, the tooth PAI was that of the root with the highest PAI and the overall filling quality the lowest among all.\\u003c/p\\u003e \\u003cp\\u003eA coronal restoration was considered as \\u0026lsquo;good\\u0026rsquo; (GR) by an adequate marginal sealing as assessed either clinically or radiologically and \\u0026lsquo;poor\\u0026rsquo; (PR) in case of clinical or radiological signs of open margins. An endodontic treatment was considered as \\u0026lsquo;good\\u0026rsquo; (GE) in case of adequate length of filling material with no voids (adequate density) and consistent shape from the orifice to the apex and \\u0026lsquo;poor\\u0026rsquo; (PE) when at least one of the above-mentioned parameters was inadequate.\\u003c/p\\u003e \\u003cp\\u003eTeeth with one unassessable parameter were kept included. Before coming to 250 X-rays, the analysis excluded six radiographs with no PAI: one with fractured root and five with missing data on coronal restoration type or sealing quality.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eStatistical methods\\u003c/h2\\u003e \\u003cp\\u003eCategorical variables were described by numbers and percentages and continuous variables by medians and interquartile ranges. Group comparison used non-parametric tests: Fisher test for categorical variables and Wilcoxon test for continuous variables.\\u003c/p\\u003e \\u003cp\\u003eDifferences were considered significant at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. All statistical analyses were performed with R software (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe literature systematic review\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eThe search strategies\\u003c/h2\\u003e \\u003cp\\u003eThis systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020168471). It was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol (PRISMA-P statement) (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) in March 2022 by two independent evaluators. No protocol was registered.\\u003c/p\\u003e \\u003cp\\u003eThe search identified studies on the influence of quality of root canal filling and coronal restoration on periapical health. It was limited to PubMed, Web of Science, and Scopus databases, used the following associations of MeSH terms or keywords, and grouped the results:\\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003e(((endodontic treatment AND periapical health) AND (coronal restoration AND periapical health)) \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003eOR\\u003c/span\\u003e ((root canal treatment AND periapical health) AND (coronal restoration AND periapical health)) \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003eOR\\u003c/span\\u003e ((root canal therapy AND periapical health) AND (coronal restoration AND periapical health)) \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003eOR\\u003c/span\\u003e ((root canal filling and periapical health) AND (coronal restoration AND periapical health)))\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003e(((endodontic treatment AND periapical status) AND (coronal restoration AND periapical status)) \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003eOR\\u003c/span\\u003e ((root canal treatment AND periapical status) AND (coronal restoration AND periapical status)) \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003eOR\\u003c/span\\u003e ((root canal therapy AND periapical status) AND (coronal restoration AND periapical status)) \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003eOR\\u003c/span\\u003e ((root canal filling and periapical status) AND (coronal restoration AND periapical status))).\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eEligibility criteria\\u003c/h2\\u003e \\u003cp\\u003eAn article was eligible whenever: i) the endodontic filling, the coronal restoration, and the periapical status have been evaluated by retroalveolar radiography; and, ii) it associated the evaluation of both the quality of endodontic treatment of permanent mature teeth and the quality of their coronal restoration. Articles in which root canal treatments were performed by specialists were not included. Meta-analyses and literature reviews were excluded.\\u003c/p\\u003e \\u003cp\\u003eTitles and abstracts were screened. The references of retained articles were screened to identify additional articles. Useful full-texts were independently assessed by two practitioners.\\u003c/p\\u003e \\u003cp\\u003eThe data collected from each retained article were: i) article identification: authors and type, country, and year of publication; ii) participants: age, sample size; iii) methods: image acquisition, assessment of AP and coronal restoration, and statistical analysis; and, iv) results: total number of teeth, number of root-filled teeth, number of non-treated teeth, number of teeth with AP, number of teeth with GE and PE, and number of teeth with PR and GR.\\u003c/p\\u003e \\u003cp\\u003eAfter independent data collection, retrieved data were cross-checked. Disagreements were discussed with a third practitioner who took the final decisions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eAssessment of risk of bias\\u003c/h2\\u003e \\u003cp\\u003eTwo independent reviewers assessed the risk of bias using the JBI critical appraisal tool (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). The criteria were divided into five domains as follows: bias arising from the selection criteria of the sample, bias due to the description of the study sample, bias due to the validity of exposure measurement, bias of the objectivity of criteria used for measurement, bias in identification of confounding factors, bias in the statement of strategies dealing with confounding factors, bias on the validity of the outcomes\\u0026rsquo; measure and bias on the statistical analysis. The evaluation of the studies was performed by rating each domain as low risk of bias, unclear or high risk of bias. Disagreements between the two reviewers were solved by a third person.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eFor binary outcomes, estimates were summarized as odds ratio (OR) and 95% confidence interval (CI) and pooled using Mantel-Haenszel method. Between studies, heterogeneity was assessed using I\\u003csup\\u003e2\\u003c/sup\\u003e statistics, which describes the percentage of variation across studies that is due to heterogeneity rather than chance. Given the existence of between studies heterogeneity, a random-effect model was used to estimate pooled odds ratios and corresponding 95% CI from aggregate data. Estimates and 95% CIs were graphically presented using Forest plots. The following crossed comparisons have been performed: GE/GR vs GE/PR, GE/GR vs PE/GR, GE/GR vs PE/PR, GE/PR vs PE/GR, GE/PR vs PE/PR, PE/GR vs PE/PR. The statistical analysis used Review Manager (RevMan) software, Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eResults of the descriptive study\\u003c/h2\\u003e \\u003cp\\u003eThe present study included 92 patients whose characteristics are detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. The mean patients\\u0026rsquo; age was 49 years (min: 19, max: 79). Women (68%), new patients (59%), and intermediate professions (36%) were the most numerous of their subgroups. Among the radiographs examined, the majority of root-filled teeth (59.4%) were located in the maxillary arch and were posterior teeth (67%).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCharacteristics of the included population (92) and treated teeth (256).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eAge\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;29 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (18.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e30\\u0026ndash;59 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43 (46.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;60 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32 (34.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSex\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMen\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30 (32.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWomen\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62 (67.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ePatients\\u0026rsquo; statuses within the clinic\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNew patients\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e55 (59.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eReferred patients\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14 (15.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEstablished patients\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23 (25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSocio-professional category\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFarm operators\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (4.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCraftsmen, merchants, business owners\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (6.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eExecutives, higher intellectual professions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (4.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntermediate professions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33 (35.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmployees\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (2.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWorkers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24 (26.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRetired\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9 (9.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo professional activity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (10.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReason for the dental visit\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnnual check-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e45 (48.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eToothache\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (18.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCarious lesion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (4.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFailure of dental restoration\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (4.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFailure of dental prosthesis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (6.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePeriodontal disorder\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (6.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (10.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSite of the tooth\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnterior\\u0026thinsp;+\\u0026thinsp;mandibular\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21 (8.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnterior\\u0026thinsp;+\\u0026thinsp;maxillary\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62 (24.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePosterior\\u0026thinsp;+\\u0026thinsp;mandibular\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e83 (32.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePosterior\\u0026thinsp;+\\u0026thinsp;maxillary\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e90 (35.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eSlightly more than one out of two examined teeth (55.2%, 138/250) had a \\u0026lsquo;diseased\\u0026rsquo; periapical status. Most restorations consisted of crowns (71.5%). Regarding the quality of coronal restorations, 69% (171/248) of endodontically treated teeth had radiologically acceptable restorations with adequate marginal sealings, whereas only 34.8% (87/250) had clinically acceptable marginal sealings. Slightly more than one out of four root-filled teeth (27.4%, 68/248) had clinically and radiographically adequate coronal restoration (GR). Considering the type and quality of coronal restoration, only direct fillings with inadequate marginal sealings were significantly associated with a \\u0026lsquo;diseased\\u0026rsquo; periapical status (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eNeither the presence nor the type of post were significantly associated with a \\u0026lsquo;diseased\\u0026rsquo; periapical status (p\\u0026thinsp;=\\u0026thinsp;0.389).\\u003c/p\\u003e \\u003cp\\u003eRegarding the quality of root canal filling, the shape was adequate in 61.8% (154/249), the density in 47.4% (118/249), and the length in 53% (132/249) of cases. Overall, 29.3% (73/249) of root-filled teeth had an adequate endodontic treatment (GE) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Considering density, shape, or length separately or combined (overall quality of root canal filling or PE), all inadequate endodontics quality parameters were significantly associated with a \\u0026lsquo;diseased\\u0026rsquo; periapical status. Consequently, the endodontic determinant seems to be more important than coronal restoration determinant for a \\u0026lsquo;healthy\\u0026rsquo; periapical status (37.5% \\u0026lsquo;diseased\\u0026rsquo; periapical status in group GE\\u0026thinsp;+\\u0026thinsp;PR versus 42% in group PE\\u0026thinsp;+\\u0026thinsp;GR).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePeriapical status of root filled teeth relative to coronal and endodontic factors and to both coronal and endodontic factors.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePeriapical status\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHealthy\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDiseased\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLine totals\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eTotal of X-rays examined\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e112\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e138\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e250\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eClinical assessment of marginal sealing of coronal restoration\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.005\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62 (38.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e101 (62.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e163 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e50 (57.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37 (42.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e87 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eRadiographic assessment of marginal sealing of coronal restoration\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30 (39.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e47 (61.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e77 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e81 (47.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90 (52.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e171 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eRadiographic \\u0026amp; clinical assessment of marginal sealing of coronal restorations\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePoor restoration (PR)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e72 (40.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e108 (60%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e180 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood restoration (GR)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e39 (57.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29 (42.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e68 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eType / quality of marginal sealing of coronal restorations\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.119\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDirect filling / Inadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (34.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23 (65.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDirect filling / Adequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (25.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6 (75.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePartial coverage crown / Inadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePartial coverage crown / Adequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCrown / Inadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e51 (42.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69 (57.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e120 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCrown / Adequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e34 (60.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22 (39.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e56 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTemporary restoration / Inadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5 (45.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6 (54.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTemporary restoration / Adequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbsence of restoration\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (36.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 (63.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eNature of posts\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.389\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eScrewpost\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (31.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24 (68.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e36 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMetal post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e53 (49.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55 (50.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e108 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFiber post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e46 (44.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e57 (55.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e104 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eLength of root canal filling\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.005\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdequate (0\\u0026ndash;2 mm)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e72 (54.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60 (45.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e132 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnderfilling (\\u0026lt;\\u0026thinsp;2mm)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30 (33.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60 (66.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e90 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOverfilling\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (37.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17 (63.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eDensity of root canal filling\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.003\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e47 (35.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84 (64.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e131 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e65 (55.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e53 (44.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e118 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eShape of root canal filling\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.049\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInadequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35 (36.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60 (63.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e95 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdequate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e77 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e77 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e154 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eOverall quality of root canal filling\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.004\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood endodontic treatment (GE)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44 (60.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29 (39.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e73 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePoor endodontic treatment (PE)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e68 (38.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e108 (61.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e176 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eGroup combinations\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGE\\u0026thinsp;+\\u0026thinsp;GR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9 (52.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8 (47.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGE\\u0026thinsp;+\\u0026thinsp;PR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35 (62.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21 (37.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e56 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePE\\u0026thinsp;+\\u0026thinsp;GR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30 (58.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21 (41.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e51 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePE\\u0026thinsp;+\\u0026thinsp;PR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e37 (30.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e86 (69.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e123 (100.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003csup\\u003ea\\u003c/sup\\u003e Fischer test - GE/PE: Good/Poor endodontic treatment \\u0026ndash; GR/PR: Good/Poor coronal restoration.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eRow totals per apical status item might not be complete (=\\u0026thinsp;112 or 138) because of missing values.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eResults of the systematic review\\u003c/h2\\u003e \\u003cp\\u003eThe process of study selection for the systematic review is shown in \\u003cem\\u003eAppendix\\u003c/em\\u003e Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Eight publications were finally analyzed (Moreno et al 2013; Hommez et al. 2002; Siqueira et al. 2005; Tronstad et al 2000; Song et al. 2014; Thampibul et al. 2019; Tavares et al. 2009; Dugas et al. 2003)(\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR17 CR18 CR19 CR20 CR21\\\" citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Characteristics of the included studies are presented in the \\u003cem\\u003eAppendix\\u003c/em\\u003e Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. The assessment of the risk of bias of the included studies is summarized in \\u003cem\\u003eAppendix\\u003c/em\\u003e Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e. The majority of the domains received low risk of bias. Six studies were classified with some risk for the description of the study sample because the age of the participants were not mentioned. Two were classified at high risk because they did not identify the confounding factors.\\u003c/p\\u003e \\u003cp\\u003eThe forest plots and the statistical results of the paired comparisons are shown in Figs.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e and \\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e. As no forest plot crosses the solid line of OR\\u0026thinsp;=\\u0026thinsp;1, all comparisons showed statistically significant differences.\\u003c/p\\u003e \\u003cp\\u003eI\\u0026sup2; analysis revealed a great heterogeneity between the studies in 4 of the 6 paired comparisons (72 to 93%). Only GE\\u0026thinsp;+\\u0026thinsp;PR vs. PE\\u0026thinsp;+\\u0026thinsp;GR and PE\\u0026thinsp;+\\u0026thinsp;GR vs. PE\\u0026thinsp;+\\u0026thinsp;PR comparisons showed a moderate heterogeneity (\\u0026lt;\\u0026thinsp;75%). Given this large heterogeneity, a random-effect analysis has been undertaken.\\u003c/p\\u003e \\u003cp\\u003eOdds ratios analyses showed that group GE\\u0026thinsp;+\\u0026thinsp;GR had less periapical lesions than all other groups (6 times less than PE\\u0026thinsp;+\\u0026thinsp;PR, 3.8 times less than PE\\u0026thinsp;+\\u0026thinsp;GR, and 2.3 times less than GE\\u0026thinsp;+\\u0026thinsp;PR). Group GE\\u0026thinsp;+\\u0026thinsp;PR had less periapical lesions than PE\\u0026thinsp;+\\u0026thinsp;GR (1.7 times less) and PE\\u0026thinsp;+\\u0026thinsp;PR (2.7 times less). Finally, group PE\\u0026thinsp;+\\u0026thinsp;GR showed 1.5 less periapical lesions than group PE\\u0026thinsp;+\\u0026thinsp;PR. In all comparisons, the test p-values showed statistically significant differences.\\u003c/p\\u003e \\u003cp\\u003eGroup PE\\u0026thinsp;+\\u0026thinsp;PR appeared to have the worst radiologic situation regarding periapical lesion prevention.\\u003c/p\\u003e \\u003cp\\u003eMore widely, it seems that the quality of the endodontic treatment has more influence on the periapical health than the quality of the coronal restoration. With group GE\\u0026thinsp;+\\u0026thinsp;GR as \\u0026lsquo;standard\\u0026rsquo;, periapical lesions have been observed more frequently when the quality of the endodontic treatment was judged as poor as that of the coronal restoration (3.8 times vs. 2.3 times more periapical lesion). Moreover, group PE\\u0026thinsp;+\\u0026thinsp;GR showed 1.7 times more lesion than group GE\\u0026thinsp;+\\u0026thinsp;PR.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis work attempted to determine which of two determinants (i.e., radiological quality of the root canal treatment or sealing of the coronal restoration) has a more positive effect on the periapical status. It associated a cross-sectional study and a literature systematic review.\\u003c/p\\u003e \\u003cp\\u003eStemming from a much larger dataset, the sample size were limited, particularly those of subgroups, which would explain some unexpected results; e.g., a high rate of periapical lesions in teeth with good endodontic treatment and good coronal restoration might be simply due to the small sizes of group GE\\u0026thinsp;+\\u0026thinsp;GR (only 17 cases). Otherwise, group GE\\u0026thinsp;+\\u0026thinsp;PR had less periapical lesions than group PE\\u0026thinsp;+\\u0026thinsp;GR (1.1 times less) or PE\\u0026thinsp;+\\u0026thinsp;PR (1.9 times less). This indicated that a \\u0026lsquo;diseased\\u0026rsquo; periapical status would be more frequent after inadequate root canal treatment than after inadequate coronal restoration (37.5% \\u0026lsquo;diseased\\u0026rsquo; periapical status with GE vs. 42% with GR). The systematic review confirmed these results: group GE\\u0026thinsp;+\\u0026thinsp;PR had less periapical lesions than group PE\\u0026thinsp;+\\u0026thinsp;GR (1.7 times less) or group PE\\u0026thinsp;+\\u0026thinsp;PR (2.7 times less).\\u003c/p\\u003e \\u003cp\\u003eThough frequent in endodontics, cross-sectional studies seldom consider the kinetics of the periapical disease. Indeed, an X-ray revealed periapical lesion might be either in the process of development, in the process of healing, or a scar tissue (Kruse et al. 2017) (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). Besides, other clinical criteria might interfere with the interpretation of the data; e.g., initial pulp status, treatment procedure, time elapsed since treatment, time elapsed between the endodontic and the restorative procedure, etc.). Thus, cross-sectional studies might not answer all questions but help identifying potential risk factors for more rigorous clinical studies.\\u003c/p\\u003e \\u003cp\\u003eHere, a special attention was paid to two aspects: the representativeness of the patient sample and the relevance of the assessment criteria. One asset was that, unlike other same-design monocentric studies, the data stemmed from 13 hospital centers located in various French regions. According to Tiburcio-Machado et al. (2021), hospital data would yield same prevalence results as private practice data (51%; 95% CI: 40\\u0026ndash;63; \\u003cem\\u003eI\\u003c/em\\u003e\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;95.9% vs. 57%; 95% CI: 52\\u0026ndash;62%; \\u003cem\\u003eI\\u003c/em\\u003e\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;97.8%, respectively) (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Anyway, the prevalence of apical periodontitis (all teeth, non-treated and root filled) in the general population remains high (40%; 95% CI: 33\\u0026ndash;46%; \\u003cem\\u003eI\\u003c/em\\u003e\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;96.5%) (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Here, only root-filled teeth were considered and the prevalence of apical periodontitis was higher than 39% (95% CI: 36\\u0026ndash;43%; \\u003cem\\u003eI\\u003c/em\\u003e\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;98.5%) found by recent worldwide data (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eConcerning quality criteria, those of root canal filling considered shape, density, and length(\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e) (AAE 2009). However, so far, most publications in systematic reviews have reported only on density and length. Here, considering each quality criterion alone, only inadequate density and inadequate length of root filling were found statistically significantly associated with periapical lesion whereas shape did not seem to significantly affect the periapical status. More investigations are needed to confirm or refute this finding.\\u003c/p\\u003e \\u003cp\\u003eFurther, the present study assessed restoration quality on clinical and radiological criteria. This was found in only three studies kept by the systematic review (Dugas et al. 2003, Song et al. 2014, Hommez et al. 2002) (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). According to the FDI criteria, quality assessment of a coronal restoration should check for clinical or radiological evidence of hiatus between dental walls and the restoration material (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e), which reflects an inadequate sealing. The present investigation found 30.3% inadequate coronal restorations as per the radiological examination and 65.2% as per the clinical examination and both percentages are higher than those reported by Hommez et al. (2002) (21.8% and 24.8%, respectively) (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). This discrepancy indicates that radiological assessment of coronal restoration quality is not sufficient because of the risk of quality overestimation. A reliable assessment should use both assessment types. This confirms previous conclusions by Craveiro et al. (2015) (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). Indeed, the percentage of inadequate coronal restoration in this study (72.8%) was higher than those found by other studies that used only radiology (Moreno et al. 2013, Siqueira et al. 2005, Thampibul et al. 2019, Tavares et al. 2009) (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). Still, the percentage of adequate restoration (27.2%) was lower than those found by Hommez et al. (2002) or Song et al. (2014) (67.4% and 68.5%, respectively) who used both assessment types (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eTo assess periapical lesions, several recent epidemiological studies used Cone Beam Computed Tomography (CBCT) (Cakici et al. 2016; Gambarini et al. 2018; Gomes et al. 2015; Nur et al. 2014) (\\u003cspan additionalcitationids=\\\"CR26 CR27 CR28\\\" citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) to overcome two conventional X-ray limitations: two-dimensional representation of three-dimensional structures (Bender 1997)(\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e) and confusion of periapical lesions with lesions confined to cancellous bone (Bender and Seltzer 2003 a and b) (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Despite CBCT superiority (Antony et al. 2020) (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e), the current recommendations are not yet in favor of its systematic use (AAE and AAOMR Joint Position Statement 2015) (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e) because of the \\u0026lsquo;as low as reasonably achievable\\u0026rsquo; (ALARA) principle. Indeed, a small \\u0026lsquo;field of view\\u0026rsquo; source exposes the patient to 10\\u0026ndash;100 times the radiation dose received with standard periapical radiography (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e). Therefore, retroalveolar radiography remains the X-ray of choice, especially for epidemiological studies. In this study, the evaluation was as standard as possible (e.g., precluded X-rays without film holder) to avoid distorted images. Now, given that CBCT is not recommended, a more relevant approach to detect periapical lesions would be the use of artificial intelligence (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe present study found 27.3% adequate endodontic treatments, which is lower quality versus data from the systematic review; i.e., 33% (Moreno et al 2013) (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e), 34.4% (Hommez et al. 2002) (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e), 56.9% (Siqueira et al. 2005) (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e), 50.5% (Tronstad et al 2000) (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e), 35.6% (Song et al. 2014) (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), 51.9% (Thampibul et al. 2019) (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e), 27% (Tavares et al. 2009) (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e), and 38.9% (Dugas et al. 2003) (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). However, the present work\\u0026rsquo;s data illustrate a slight increase in the percentage of adequate treatments from 21% (Boucher et al. 2002)(\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e) to 27% (Tavares et al. 2009)(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eOne important factor in quality is the level of experience of the practitioner. Craveiro et al. (2015) reported 82.9% of adequate root canal treatments by endodontists(\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). This percentage is probably much lower in general dental practice. This highlights the need for collecting data from general practitioners to prevent overestimating the quality of endodontic treatments.\\u003c/p\\u003e \\u003cp\\u003eIn this work, the literature review kept only eight studies. This low number is most probably due to the wide heterogeneity of the parameters evaluated, which is imposed by the multiple factors involved in endodontics. It is desirable that future prospective studies (in accordance with the ESE and FDI guidelines) be stratified on variables such as the type of tooth (indicative of the degree of technical difficulty), previous apical status, preoperative pulpal status, initial vs. secondary treatment, delay since last treatment, time elapsed before coronal seal, type of restoration (direct/indirect), or intra-operative factors. Such studies will highly clarify the importance of each variable in the quality of endodontic treatment.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe above-displayed results of the cross-sectional study among omnipractitioners and the systematic review confirm the conclusion made by Craveiro et al. (2015) among endodontists that an adequate endodontic treatment seems to have a more positive effect on the periapical health than an adequate coronal restoration. Nevertheless, the practitioners should care for both determinants to improve the overall quality of all restorative treatments.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eKnowledge Transfer Statement:\\u003c/u\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eThis original article combines an observational study and a systematic review in order to identify which of endodontic treatment or coronal restoration is most important for periapical health. Conclusions of both reported that a good endodontic treatment seems to be more important than a good restoration for periapical health.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eOther:\\u003c/u\\u003e\\u003c/strong\\u003e This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42020168471).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to thank all the investigators of hospital centers of RESTO DATA study: Abid Sarah, Becavin Thibault, Becquart Mathilde, Berbel Fanny, Bertrand Marie-France, Blanc C\\u0026eacute;cile, Boudeau Mathilde, Bouyahmed Lydia, Canceill Thibault, Ceinos Romain, Collignon Anne-Margaux, David Alexandra, Decaup Pierre-Hadrien, Decerle Nicolas, Decup Franck, Domejean Sophie, Douchy Laura, Drouhet Thibault, Florimond Marion, Fouillen Kevin-John, Gasqui Marie-Agn\\u0026egrave;s, Gastineau Richard, Gaucher C\\u0026eacute;line, Kerouredan Olivia, Khoury Claudine, Le Clerc Justine, Lefran\\u0026ccedil;ois Etienne, Lesieur Charl\\u0026egrave;ne, Maillet Christina, Mesgouez-Menez Catherine, P\\u0026eacute;rard Matthieu, Pradelle Nelly, Pr\\u0026eacute;aubert Estelle, Robberecht Lieven, Vallaeys Karen, Ziouani-Ta\\u0026iuml;r Nawel.\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare the study was conducted according to the International Committee of Medical Journal Editors guidelines for the Ethical Considerations in the Conduct and Report of Research.\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was supported by Hospices Civils de Lyon (Lyon, France), Dentsply Sirona (Versailles, France), Procter \\u0026amp; Gamble (Asni\\u0026egrave;res-sur-Seine, France), and U-Lab (Rueil-Malmaison, France). The sponsors had no roles in the study design; the collection, analysis, and interpretation of the data; the writing of the report; or the decision to submit the article for publication.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eM.-A. Gasqui: investigator of RESTO DATA study; contributed to study conception and design, data acquisition, analysis and interpretation, and drafted the manuscript;\\u003c/p\\u003e\\n\\u003cp\\u003eM. P\\u0026eacute;rard: investigator of RESTO DATA study; contributed to data interpretation and drafted the discussion section of the manuscript;\\u003c/p\\u003e\\n\\u003cp\\u003eF. Decup: co-principal investigator of RESTO DATA study; contributed to data acquisition and interpretation and drafted the discussion section of manuscript;\\u003c/p\\u003e\\n\\u003cp\\u003eC. Villat: contributed to data acquisition, analysis and interpretation, manuscript drafting and critical revision;\\u003c/p\\u003e\\n\\u003cp\\u003eC. Chevalier: contributed to data acquisition;\\u003c/p\\u003e\\n\\u003cp\\u003eP. Nony: contributed to data interpretation and discussion drafting;\\u003c/p\\u003e\\n\\u003cp\\u003eF. Gueyffier: contributed to data interpretation and discussion drafting;\\u003c/p\\u003e\\n\\u003cp\\u003eJ. Iwaz: contributed to drafting and critical revision of the manuscript;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eL. Roche: contributed to data acquisition, analysis and interpretation\\u003c/p\\u003e\\n\\u003cp\\u003eS. Aslanian: contributed to data acquisition, analysis and interpretation\\u003c/p\\u003e\\n\\u003cp\\u003eB. Grosgogeat: principal investigator of RESTO DATA study; contributed to conception and design, data acquisition and interpretation, and manuscript drafting;\\u003c/p\\u003e\\n\\u003cp\\u003eM. Zanini: contributed to conception and design, data interpretation, manuscript drafting.\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors gave final approval and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare having no conflicts of interest.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eEriksen HM, Kirkevang LL, Petersson K. Endodontic epidemiology and treatment outcome: general considerations: Endodontic epidemiology and treatment outcome. Endod Top. juill 2002;2(1):1\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTib\\u0026uacute;rcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. mai 2021;54(5):712\\u0026ndash;35.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRay HA, Trope M. 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J Endod. mai 2013;39(5):600\\u0026ndash;4.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHommez GMG, Coppens CRM, De Moor RJG. Periapical health related to the quality of coronal restorations and root fillings. Int Endod J. ao\\u0026ucirc;t 2002;35(8):680\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSiqueira JF, R\\u0026ocirc;\\u0026ccedil;as IN, Alves FRF, Campos LC. Periradicular status related to the quality of coronal restorations and root canal fillings in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. sept 2005;100(3):369\\u0026ndash;74.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSong M, Park M, Lee CY, Kim E. Periapical Status Related to the Quality of Coronal Restorations and Root Fillings in a Korean Population. J Endod. f\\u0026eacute;vr 2014;40(2):182\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThampibul P, Jantarat J, Arayasantiparb R. Post-treatment apical periodontitis related to the technical quality of root fillings and restorations in Thai population. Aust Endod J. ao\\u0026ucirc;t 2019;45(2):163\\u0026ndash;70.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTavares PBL, Dds EB, Dds TB, Jr JFS, Lasfargues JJ. Prevalence of Apical Periodontitis in Root Canal-Treated Teeth From an Urban French Population: Influence of the Quality of Root Canal Fillings and Coronal Restorations. Clin Res. 2009;35(6):4.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S. Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations: Prevalence of apical disease. 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J Endod. juin 2015;41(6):836\\u0026ndash;40.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCakici EB, Yildirim E, Cakici F, Erdogan AS. Assessment of periapical health, quality of root canal filling, and coronal restoration by using cone-beam computed tomography. Niger J Clin Pract. oct 2016;19(5):673\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGambarini G, Piasecki L, Miccoli G, Gaimari G, Nardo DD, Testarelli L. Cone-beam computed tomography in the assessment of periapical lesions in endodontically treated teeth. Eur J Dent. janv 2018;12(01):136\\u0026ndash;43.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGomes AC, Nejaim Y, Silva AIV, Haiter-Neto F, Cohenca N, Zaia AA, et al. Influence of Endodontic Treatment and Coronal Restoration on Status of Periapical Tissues: A Cone-beam Computed Tomographic Study. J Endod. oct 2015;41(10):1614\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNur BG, Ok E, Altunsoy M, Ağlarci OS, \\u0026Ccedil;olak M, G\\u0026uuml;ng\\u0026ouml;r E. Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT. J Appl Oral Sci Rev FOB. d\\u0026eacute;c 2014;22(6):502\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBender IB. Factors influencing the radiographic appearance of bony lesions. J Endod. janv 1997;23(1):5\\u0026ndash;14.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: I. 1961. J Endod. nov 2003;29(11):702\\u0026ndash;6; discussion 701.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBender IB, Seltzer S. Roentgenographic and direct observation of experimental lesions in bone: II. 1961. J Endod. nov 2003;29(11):707\\u0026ndash;12; discussion 701.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAntony DP, Thomas T, Nivedhitha MS. Two-dimensional Periapical, Panoramic Radiography Versus Three-dimensional Cone-beam Computed Tomography in the Detection of Periapical Lesion After Endodontic Treatment: A Systematic Review. Cureus. 19 avr 2020;12(4):e7736.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAAE and AAOMR Joint Position Statement: Use of Cone Beam Computed Tomography in Endodontics 2015 Update. J Endod. sept 2015;41(9):1393\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWenzel A. Radiographic display of carious lesions and cavitation in approximal surfaces: Advantages and drawbacks of conventional and advanced modalities. Acta Odontol Scand. mai 2014;72(4):251\\u0026ndash;64.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAminoshariae A, Kulild J, Nagendrababu V. Artificial Intelligence in Endodontics: Current Applications and Future Directions. J Endod. sept 2021;47(9):1352\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBoucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J. mars 2002;35(3):229\\u0026ndash;38. \\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Periapical periodontitis, Epidemiology, Dental radiography, Dental restoration failure, Retrospective studies, Root canal obturation.\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2008630/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2008630/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eINTRODUCTION:\\u003c/strong\\u003e Coronal sealing, quality of root canal treatment, and periapical status have been widely investigated. However, which of two practitioner-dependent determinants (endodontic treatment or coronal restoration) is the most important to the periapical status remains scientifically debated. \\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eOBJECTIVES: \\u003c/strong\\u003eThis study investigated the relative importance of the technical qualities of root canal filling and marginal sealing of the coronal restoration on the periapical status and screened previously published data. \\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eMETHODS:\\u003c/strong\\u003e A retrospective study collected and analyzed clinical and radiological data on 246 endodontically-treated teeth. Six paired comparisons were carried out between groups combining good or poor endodontic treatment (G/P E) with good or poor coronal restoration G/P R). Results are displayed through forest plots of odds ratios for each comparison.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eRESULTS: \\u003c/strong\\u003eIn the retrospective study, the endodontic determinant seems to be more important than the restorative one (37.5% of diseased periapical status with GE versus 41.2% with PE). In the systematic review, odds ratio analyses showed that group GE+GR had 1.7 less periapical lesions than group PE+GR and 2.7 less lesions that group PE+PR. Belonging to group PE+PR was found significantly associated with ‘diseased’ periapical status. \\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eCONCLUSION:\\u003c/strong\\u003e The retrospective study and the systematic review agreed that endodontic treatment (precisely, root canal filling) was found more important than coronal restoration (precisely, marginal sealing) for healthy periapical tissue.\\u0026nbsp;\\u003c/p\\u003e\",\"manuscriptTitle\":\"Endodontic versus coronal treatment quality on the periapical status\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-09-07 17:12:49\",\"doi\":\"10.21203/rs.3.rs-2008630/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ce2f7334-242b-4ef0-a399-0f69f4c818ec\",\"owner\":[],\"postedDate\":\"September 7th, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-02-01T19:29:24+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2022-09-07 17:12:49\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2008630\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2008630\",\"identity\":\"rs-2008630\",\"version\":[\"v1\"]},\"buildId\":\"7rjqhiLT3MXkJMwkYKINL\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}