COMPARATIVE STUDY OF TREATMENT OUTCOME IN APICECTOMIES WITH OR WITHOUT ROOT-END FILLING.

BACKGROUND: High success rate has been reported widely with conventional endodontic. When failure occurs, re-treatment alone or with surgical endodontics is the recommended treatment. OBJECTIVE: To compare the treatment outcome following apicectomy techniques, apicectomy with and without retrograde root - end filling. METHODOS: Fifty three patients presenting with clinical and radiological evidence of pulpal and periapical pathology ≥5mm that will require apicectomy were randomly recruited into the study groups A or B over a period of 12 month. In group A apicectomy was performed without root - end filling and in group B apicectomy was performed with root - end filling. Patients were recalled 12 months and assessed clinically and radiologically. RESULTS: 35 out of 53 recruited patients reported for 12 month re-call visit. Two were excluded because of missing baseline radiographs. 33 patients that reported at 12months recall visit with complete radiographs were used for analysis. Patients age ranged from 16 - 66 years, with those in age group 21 - 30 years predominant, Majority (57.6%) were males. Forty teeth were treated, 14 had root - end filling and 26 without root - end filling. Maxillary incisors were the most frequently apicectomized teeth. 32 (80%) out of 40 apicectomized teeth were successful, 14 (88.5%) out of 26 teeth treated without root end filling were successful, while 9 (64.3%) out of 14 teeth treated with apicectomy with retrofil were successful. CONCLUSION: Though apicectomized teeth without root-end filling had a higher percentage of success it was not statistically significant (p=0.15).

Risk Factors for Apical Periodontitis Sub-Urban Adult Population.

AIMS AND OBJECTIVES: To assess the risk factors of apical periodontitis (AP) in a Nigerian sub-urban adult population and to compare the findings with those previously reported for various population groups. MATERIALS AND METHODS: The study was based on a full mouth radiographic survey of 285 patients. Patients' age ranged from 18-60 years. All teeth were assessed individually and data recorded for caries, fractured / cracked teeth, root fillings, and tooth restorations. The gender, smoking habit, and frequency of dental visit were also recorded. Multiple logistic regression analyses were performed to identify predictors of AP in the individual. RESULTS: The prevalence of AP was 74.4%. The average number of teeth with AP per patient was 2.8 (range 1-5). AP was found to be more prevalent among people 40- 49 years old (87.2%). Primary carious lesions, fractured / cracked teeth, root fillings and coronal fillings were associated with the incidence of AP in the individual. Fractured teeth had a higher risk of developing AP than carious teeth. The presence of root fillings and coronal restorations were also associated with the development of AP. Smoking (OR=3.82; CI=2.17-6.75) and irregular dental visit (OR=6.73; CI=3.75-12.06) were statistically significant risk factors for developing AP. Gender was not a risk factor for AP (OR=0.86; CI=0.50-1.46). CONCLUSION: The prevalence of AP among adult Nigerians is slightly higher than reported figures for many Western societies. Fractured/cracked teeth had a higher risk of developing AP than carious teeth; hence patients with fractured / cracked teeth should seek treatment early to prevent the development of AP.

Pulp stones: a review.

Pulp stones are a frequent finding on bitewing and periapical radiographs but receive relatively little attention in textbooks. A review of the literature was therefore performed, initially using the PubMed database and beginning the search with 'pulp calcifications' and 'pulp stones'. Each term provided more than 400 references, many of which related to pulp calcification in general rather than pulp stones, and focussed largely on the problems these changes presented to clinicians. A manual search using references from this source was carried out. Contemporary textbooks in endodontology were also consulted, and an historic perspective gained from a number of older books and references. The factors involved in the development of the pulp stones are largely unknown. Further research may determine the reasons for their formation, but with current endodontic instruments and techniques this is unlikely to alter their relevance to clinicians.

Signs and symptoms of temporomandibular disorders in Nigerian adult patients with and without occlusal tooth wear.

OBJECTIVES: The purpose of this study was to investigate the prevalence of signs and symptoms of temporomandibular disorders in Nigerian patients with and without occlusal tooth wear, and to relate the signs and symptoms with the severity of occlusal tooth wear. METHODS: One hundred and fifty patients with occlusal tooth wear, and 100 control subjects participated in this study (mean age 40.8 +/- 12.2 years, range 18-65 years). Exclusion criteria included patients and subjects with more than one missing opposing pair of premolars or molars, restorations covering the entire incisal edge, canine cusps and occlusal surfaces of premolars and molars. The severity of occlusal wear was assessed using the tooth wear index (TWI) designed by Smith and Knight (1984). Chi-square test was used to compare the differences in signs and symptoms of TMD. P < 0.05 was defined as significant. RESULTS: Although more females reported pain than males the difference was not statistically significant (p = 0.05). Except for impaired range of movement, tooth wear patients and controls differ significantly with respect to the variables; pain report, pain on palpation, TMJ sound and deviation on opening (p < 0.001). Patients with mean occlusal TWI score of > or =3 differ significantly from those with TWI score < or =2 with respect to pain on palpation and TMJ sound (p < 0.001). CONCLUSIONS: Posterior occlusal wear (mean TWI scores of 3 or 4) was significantly associated with pain on palpation and TMJ sound. Hence there may be a clinically relevant risk of TMD among Nigerian patients with occlusal tooth wear.

Dental caries in 12-year-old suburban Nigerian school children.

BACKGROUND: Dental caries is one of the commonest oral diseases in children. Despite this fact, not much attention has been given to studies on this issue among suburban Nigerian children. OBJECTIVE: To investigate the prevalence of dental caries, dental attendance and oral health behaviours among the 12- year-old suburban Nigerian children. SUBJECTS AND METHODS: Four hundred and two schoolchildren (349 boys, 153 girls) from both private and public schools age 12-year-old participated in the study in 2003. One examiner was calibrated and performed the screening procedures using standard method of WHO diagnostic criteria. RESULTS: The prevalence of caries was 13.9 % and mean DMFT was 0.14. The decayed component accounted for 77.2 % of the DMFT while filling and missing teeth accounted for 15.8% and 7% respectively. Over 85 % of the children examined were caries free. Seventy seven per cent of the teeth affected by caries were untreated. The probability of having caries experience DMFT> 0 was significantly associated with the type of school and regular sweet consumption p < 0.05. The children who had not visited the dentist had higher caries prevalence than other children. This was statistically significant p < 0.05. Dental attendance was generally poor in both public (90.6%) and private (83.1%) school children. CONCLUSION: The findings in this study for the caries prevalence in 12 year-old suburban Nigerian schoolchildren was as low as in developed countries of central Europe and lower than the global standard according to WHO references for the year 2000.

Dental care needs and demands in patients attending the dental hospital of the Obafemi Awolowo University Teaching Hospital's Complex Ile-Ife, Nigeria.

BACKGROUND: To compare the pattern of need and demand for dental care in settings where services are paid for through government sponsored insurance programs and out of pocket by individuals. METHODS: Study consisted of first visit patients attending the Dental Hospital. The assessment of normative treatment needs was done. The tooth based treatment needs were assessed by the WHO basic methods and the periodontal needs were assessed by the periodontal need systems PTNS. RESULTS: More males had sought treatment than females. In both sexes, most of the patients demanding treatment belonged to the 17-34 year age group. There was no statistically significant difference between age groups (P = 0.65). 55.4, 8.1 and 1.4 percents sought care for toothache, caries without concomitant pain and dental check-up respectively. Oral surgical care was considered necessary for the main complaint in 50.1% of cases. However, the age group 17-34 year old needed more restorative care than periodontal and the > 65 age group requested more extractions. CONCLUSION: The expressed need or demand for dental care falls short of the normative need. It should therefore be the aspiration of appropriate government ministry and health care providers to attempt converting normative needs into demand for care.

Non-carious cervical lesions in a Nigerian population: abrasion or abfraction?

OBJECTIVES: To determine the proportion of non-carious cervical lesions (NCCL) that were either abrasion or abfraction like and to test the validity of the assumption that right-handed patients cause more abrasion on the cervical surfaces of teeth on the left side of the mouth. SETTING: Ile-lfe, Southwestern Nigeria. PARTICIPANTS: 106 first time patients diagnosed as having any form of NCCL. DESIGN: Patients were subjected to intra-oral examination followed by the administration of a questionnaire. The cervical lesions were examined and scored using the tooth wear index designed by Smith & Knight 1984. NCCL was diagnosed as abrasion or abfraction like based on established clinical features plus positive history of possible associated aetiological factors. OUTCOME MEASURES: Abrasion and abfraction like lesions. RESULTS: Abrasion was the diagnosis in 630 (62.3%) of the 1,012 tooth sites with NCCL that had no associated occlusal surface wear facet. This constituted about two-thirds of the NCCL. Three hundred and eighty two (37.7%) of the NCCL occurred in association with an occlusal surface wear facet and presented the typical wedge shaped defects with sharp margins characteristic of abfraction. These abfraction like lesions constituted about one-third of the NCCL. 50.8% of abrasive NCCL in right-handed brushers were located on the left side of the mouth. CONCLUSIONS: About one-third of NCCL in the present study presents an abfraction component, and two-thirds abrasion. Although, right-handed brushers had more severe lesions on the opposite side of the mouth, the difference was not statistically significant.

Prosthetic parameters among dental patients in Ile-Ife, Nigeria.

The purpose of this study was to determine the Rest Vertical Dimension (RVD), Occlusal Vertical Dimension (OVD), Freeway Space (FWS) and their importance in the fabrication of dental prostheses. These prosthetic parameters were determined in 310 dentate patients attending the Dental Hospital of the Obafemi Awolowo University Teaching Hospitals' Complex Ile-Ife. The MMO was obtained by measuring inter-incisal distance. RVD and OVD were derived using Willis gauge. The FWS was taken as 'RVD minus OVD'. Of the 310 attendees, twenty-seven (8.7%) were denture wearers. There was no statistically significant difference between the genders with regards to the use of dentures (P = 0.17). The mean values (+/- standard deviation) for MMO was found to be 50.5 +/- 7.9 mm (range 18.0 to 70.0 mm). The RVD was 73.0 +/- 8.4 mm (range 50.0 to 94.0 mm) and OVD was 69.8 +/- 8.2 mm (range 47.0 t 92.0 mm). The mean FWS was 3.3 +/- 1.4 mm (range 1 to 9 mm). Following the loss of most of the posterior teeth or in a state of complete edentulism, the face profile appears squashed and the vertical dimensions are altered. To provide an efficient and functional prosthesis, the facial dimensions have to be restored to or near pre-edentulous state. The establishment of values for these facial dimensions in given population will assist in the provision of satisfactory prosthesis.

Root malformation in mandibular premolars: an endodontic difficulty-report of two cases.

Much of the literature is concerned with variation in root canal morphology rather than variation in root morphology. The present communication reports two rare cases of patients with aberrant root morphology in all their mandibular premolars examined. The role of intra-oral preoperative radiographs of diagnostic value is emphasized, without which unexpected complications during endodontic treatment or extraction may occur. Failure of endodontic treatment as a result of the inability to negotiate and instrument one of the canals in the aberrant root is an important difficulty that may be encountered with such variant teeth.

Follow-up study of apicectomised anterior teeth.

A retrospective study was carried out on anterior teeth which had undergone apicectomy between 1995 and 1997. More maxillary teeth were treated (94.7%) than mandibular teeth (5.3%). Radicular cyst was the most frequently diagnosed reason for the treatment (47.3%), followed by chronic apical infection/granuloma (44.0%). The overall success rate was 71.9%, while treatment outcome was doubtful in 14.0% of the apicectomised teeth. The presence of pre- or postoperative signs and symptoms did not have any statistically significant effect on the treatment outcome. A higher percentage of roots with retrograde amalgam fillings healed successfully than roots with orthograde fillings, but the difference was not statistically significant (P > 0.05). More lesions classified histopathologically as radicular cysts healed successfully than those classified as granulomas (Fisher exact test, 2-tailed P value = 1.0).

A survey of amalgam restorations in a south-western Nigerian population.

The present survey assessed the proportion of replacement restorations in comparison with new restorations because of primary caries in a setting where the caries experience had been reported to be low but probably on the increase. Also the relative importance of the main reasons for the replacements among other things was established. A total of 488 amalgam restorations were surveyed. About 25% of all restorations were replacements of failed restorations. The main reason for the replacement was bulk amalgam fracture, which accounted for 47.1% of all restorations. These show a reversal of what had been reported in settings where the caries experience was high but now is on the decrease. The importance of bitewing radiograph of all failed restorations was emphasized in order to minimize under or over treatment. The median age of failed restorations was 5.0 years. More than half (60.3%) of replaced restorations had failed during the first 5 years of use.

Patients' attitudes to wearing of gloves by dentists in Nigeria.

OBJECTIVE: To evaluate patient's attitudes to the use of gloves by dentists. DESIGN: This consisted of a four-item questionnaire administered to 445 consecutive patients attending our dental clinic. SETTING: . Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. SUBJECTS: Four hundred and forty five patients above the age of fifteen years attending the dental clinic for the first time. RESULTS: Majority of the patients were in the 20-30 year age group and over 93% had formal education. Most of the respondents (88.8%) stated that glove wearing was essential and over 63% considered that glove wearing protected both the operator and the patient. Whilst about one-third of respondents would attend for treatment when gloves were not worn, 81.3% felt that gloves should be changed after each patient. There were statistically significant differences (p<0.05) in responses in relation to age-groups and educational attainment, however no sex differences (p>0.05) were reported. CONCLUSION: This survey showed a high level of awareness by patients on the use of gloves by dentists. It also found that age-groups and levels of educational attainment influenced patients attitude to glove use.

A survey of cases of cancrum oris seen in Ile-Ife, Nigeria.

AIM: To review the records of child patients with cancrum oris who presented at a teaching hospital in Nigeria. SETTING: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. SAMPLE AND METHODS: The study was carried out through review of records of child patients diagnosed as having cancrum oris or post-cancrum oris defects between 1982 and 1996. Age, gender, site distribution, treatment and its outcome were recorded. RESULTS: One hundred and forty-two cases were diagnosed during the study period. Mean age was 4.65 years (range 2-16 years). The maxillary quadrants were affected more often than the mandibular. Seventeen patients completed treatment satisfactorily, but 55 failed to do so. All patients had evidence of malnutrition. CONCLUSIONS: The findings of this and other studies demonstrate the need for major initiatives to address the underlying causes of cancrum oris and to promote the utilization of health care.