Improvement of the Endodontic Treatment Efficiency of the Maxillary First Molars Using Differentiated Instrumental Preparation of the Apical Part and Additional Sealing of Root Canal Orifices

Abstract

Introduction. Endodontic treatment of maxillary first molars (MFMs) is very challenging due to the anatomical complexity of root canals which makes it difficult to do the proper cleaning, shaping, and obturation. Aim was to study the effectiveness of a proposed endodontic treatment of maxillary first molars, compared to the traditional method, in patients with and without concomitant generalized periodontitis. Methods. Endodontic treatment of 176 maxillary first molars was carried out according to the traditional method and proposed one, which included a differentiated approach to the instrumental preparation of the apical part of the root canal, and additional sealing of the root canals orifices using glass-ionomer cement. Obturation was conducted by lateral compaction of gutta-percha, combined with zinc-oxide-eugenol (ZOE) sealer and sealer based on epoxy resins. The effectiveness of endodontic treatment was evaluated based on the radiological comparison of the index, area of periapical destruction, and optical density of treated teeth roots immediately after, in 6 and 12 months. Results. In 12 months after the endodontic treatment in the subgroups where the proposed technique was used, in patients with chronic apical periodontitis, better positive dynamics of the % increase in densitometric indicators, % increase of ​​periapical bone destruction, and the decrease of PAI were noted. The % increase of the ​​destruction area in the subgroup with the proposed treatment in combination with ZOE sealer was (79.21±2.41) %, that characterizes the decrease in the area from 14.03±0.7 mm2 to 2.65±0.26 mm2. It was established that the index of endodontic treatment effectiveness is significantly lower in patients with generalized periodontitis of 2nd degree, compared to patients with healthy periodontium(p<0.05). Conclusions. It was established that the combination of the proposed method of treatment and ZOE sealer showed high effectiveness of endodontic treatment, due to the radiological picture in 12 months. It was found that there can be a possible negative effect of tooth mobility on the prognosis of endodontic treatment.