Annual Research Grant 2024

31 January 2025

Annual Research Grant 2024

Monitoring Apical Periodontitis in Root-Filled Teeth

Abstract

Background and Rationale
Apical periodontitis (AP) is common in root-filled teeth. While most of these teeth remain asymptomatic, some may develop symptoms or expansion of the lesion. Despite extensive research, the natural progression of AP in these teeth remains poorly understood, and few prospective studies have explored this issue.
Current Clinical Practice
There is no consensus on managing asymptomatic root-filled teeth with AP. Some clinicians recommend treatment, while others advocate monitoring smaller lesions. Root canal retreatment or apical surgery are potential options but specialist endodontic treatments can be costly, and the necessity for intervention in asymptomatic cases remains debated.
Study Aim
This study aims to evaluate whether asymptomatic root-filled teeth with AP can be safely monitored over five years and to identify risk factors for adverse outcomes.
Material and Methods
The study follows a cohort of patients with root-filled teeth exhibiting AP, for five years without intervention. Participants, recruited from two Swedish endodontic clinics, are assessed based on strict inclusion and exclusion criteria. Clinical and radiographic evaluations, including optional CBCT, are performed at 1, 3, and 5 years. The primary outcome is the development of symptoms, with secondary outcomes focusing on changes in lesion size and treatment reasons unrelated to AP.
Results and Follow-up
Recruitment occurred from 2015 to 2023, with 171 patients enrolled. One-year follow-up data were available for 157 patients (94%). Among these, 3 (1.9%) developed symptomatic AP and received treatment, while 8 (5.1%) reported occasional mild symptoms.
Importance and Implications
This study has the potential to impact clinical practice by providing evidence on the management of asymptomatic root-filled teeth with AP. If monitoring proves safe, it could reduce unnecessary retreatments, optimise resource use, and enhance patient care, ultimately aiding decision-making in endodontics.

CV

Professor Thomas Kvist specialised in endodontics in 1993 and obtained his PhD in 2001 at the Department of Endodontology, University of Gothenburg, Sweden, where he is currently Head of Department. He has authored numerous articles in peer-reviewed journals, focusing on decision-making and clinical outcomes in endodontics. He has also contributed several textbook chapters and edited a comprehensive book on apical periodontitis in root-filled teeth.

He was a member of the project group for the 2010 report Methods of Diagnosis and Treatment in Endodontics, published by the Swedish Council on Health Technology Assessment (SBU). Furthermore, he serves on the editorial board of the International Endodontic Journal and is an active participant in the Endodontic Research Collaboration in Scandinavia (EndoReco).