Association of Age and Gender of Patients Who Underwent Perforation Repair Done in Mandibular First Molar
Sandhya. A1, S. Delphine Priscilla Antony2*, Senthil Murugan. P3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Senior Lecturer, Department of Conservative and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Associate Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Dr. S. Delphine Priscilla Antony,
Senior Lecturer, Department of Conservative and Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha
University, Chennai 600077, Tamil Nadu, India.
Tel: +91-9790856274.
E-mail: delphine.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 18, 2021
Citation:Sandhya. A, S. Delphine Priscilla Antony, Senthil Murugan. P. Association of Age and Gender of Patients Who Underwent Perforation Repair Done in Mandibular First Molar. Int J Dentistry Oral Sci. 2021;8(8):3906-3910. doi: dx.doi.org/10.19070/2377-8075-21000799
Copyright: Dr. S. Delphine Priscilla Antony©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Perforation is an artificial communication between the root canal system and supporting tissues of the teeth. Root perforation complicates the treatment and deprives the prognosis if not properly managed. Literature shows many reviews on diagnosis, treatment plan and factors affecting prognosis of perforation repair; but none of these articles elaborated upon age and gender association of patients undergoing perforation repair. The present article aims to evaluate the association between age and gender of patients who underwent perforation repair in mandibular first molar. The study sample consists of all patients between the age group 18-60 years who underwent perforation repair in mandibular first molar from June 2019 – April 2020 at the SDC. The data collected were analysed for the number, age, gender and material used for perforation repair. For a comparison between different variables, statistical package IBM SPSS version 21.0, SPSS, Chicago II, USA software analyzer was used and the statistics were obtained. Chi - square analysis was done and there was no statistically significant association between age and gender. (Pearson chi - square value: 0.027, df: 1, p-value: 0.869>0.05) Whereas there is a statistically significant association between gender and tooth number. (Pearson chi - square value: 4.267, df: 1, p-value: 0.039<0.05) In this study, we can contemplate that females have undergone more perforation repair when compared to males. Whereas, people of age groups 30-60 years have undergone more perforation repair in the mandibular first molar. In addition, bio aggregate material is the most used perforation repair material when compared to RMGIC and GIC. Within the limitations, the age group 30 years and above underwent more perforation repair in the mandibular first molar than the age group 18-30 years. The female population seems to have undergone more perforation repair in the mandibular first molar.
2.Introduction
3.Conclusion
4.References
Keywords
Age; Bio Aggregate Material; Gender; Mandibular 1St Molar; Perforation Repair.
Introduction
Root perforations can occur pathologically as a result of resorption
and caries or iatrogenically during root canal treatment [28].
Such perforations might compromise the treatment outcome and
persist as a significant complication if not repaired. Perforation
might occur during preparation of access cavities, post space or
may occur as a result of extension of internal resorption into
peri radicular tissues [2]. In multi-rooted teeth where the furcation
is perforated, the prognosis differs according to the factors
described for single-rooted teeth.
Accidental root perforations do occur in approximately 2–12% of
endodontically treated teeth that might have serious implications
[13, 48, 19, 23, 51, 9]. This perforation acts as an open channel
encouraging bacterial entry either from root canal or periodontal
tissues or both eliciting inflammatory response that results in
fistulae including bone resorptive processes may follow. When
perforation occurs laterally or in the furcation area there might
be overgrowth of gingival epithelium towards the perforation site
worsening prognosis of the tooth [54].
Sufficient data is available regarding the prognosis of a tooth with
perforation defects. Factors determining the prognosis include
size and location of the defect, time, duration of exposure to contamination,
the material used to repair it, the possibility of sealing
the perforation and the accessibility to the main canal [16, 4].
The different material used to seal the perforation includes amalgam,
gutta-percha, zinc oxide and glass ionomer cements, calcium
hydroxide, composites were used. Newer materials such as MTA,
biodentine, dentin chips, bioceramics, calcium enriched material,
with and without the use of barrier could be used to seal the perforation
[35]. Bio aggregate is a bio ceramic material composed of
tricalcium silicate, dicalcium silicate, calcium phosphate monobasic,
amorphous silicon dioxide and tantalumpent oxide [49]. It induces
mineralized tissue formation and precipitation of apatite
crystals that become larger with increasing immersion time suggesting
it to be bioactive. It has comparable biocompatibility and
sealing ability to MTA [59]. In a study by Hashem et al., concluded
that MTA is more influenced by acidic pH than bio aggregate
when used as perforation repair material [12].
Factors of significance to the prognosis for treatment are time,
size, and shape of the perforation as well as its location impacts
the potentials to control infection at the perforation site. The factor
that is within the control of the operator is the choice of
material to be utilized for furcation repair. Certain studies were
done in the institutions (Ramamoorthi, Nivedhitha and Divyanand,
2015 [38]; Ramanathan and Solete, 2015 [40]; Noor, S Syed
Shihaab and Pradeep, 2016 [29]; Kumar and Delphine Priscilla
Antony, 2018 [22]; Manohar and Sharma, 2018 [24]; Nasim and
Nandakumar, 2018 [27]; Nasim et al., 2018 [26]; Ramesh, Teja and
Priya, 2018 [42]; Ravinthar and Jayalakshmi, 2018 [43]; Rajendran
et al., 2019 [36]; R, Rajakeerthi and Ms, 2019 [45]; Siddique and
Jayalakshmi, 2019 [50]; Teja. K., 2019 [53]; Janani, Palanivelu and
Sandhya, 2020 [15]; Jose, P. and Subbaiyan, 2020 [17]). Frequently,
the cause is iatrogenic as a result of the misaligned use of rotary
burs amid endodontic access preparation and search for root canal
orifices.
Previously our team has a rich experience in working
on various research projects across multiple disciplines.
(Jain, 2017 [14]); (Varghese, Ramesh and Veeraiyan, 2019 [55]);
(Ashok and Ganapathy, 2019 [2]); (Padavala and Sukumaran, 2018
[30]); (Ke et al., 2019 [20]); (Ezhilarasan, 2018 [6]); (Krishnan et
al., 2018 [21]); (Ezhilarasan, Sokal and Najimi, 2018 [8]); (Pandian,
Krishnan and Kumar, 2018 [32]); (Ramamurthy and Mg, 2018
[39]); (Gupta, Ariga and Deogade, 2018 [11]); (Vikram et al., 2017
[58]); (Paramasivam, Vijayashree Priyadharsini and Raghunandhakumar,
2020 [33]); (Palati et al., 2020 [31]); (Samuel, Acharya and
Rao, 2020 [47]). Now the growing trend in this area motivated us
to pursue this project.
Thus this study aims to evaluate age and gender of patients who
underwent perforation repair and also the material predominantly
used.
Materials And Methods
Study Setting and Sampling:
This study is a single-center retrospective study, carried out in
the Department of Conservative and endodontic dentistry at the
SDC. The pro of the study includes flexibility of the study, less
time consumption and accessibility. The cons of the study are
limitations in the population group. Our study was approved by
the ethical board of Saveetha dental college – Institutional ethical
committee [IEC]. Ethical approval number SDC/SIHEC/2020/
DIASDATA/0619-0320. All available records of endodontic patients
treated from June 2019 – April 2020, were examined and
included in our data collection. A total of 16 case sheets were reviewed.
The data was cross verified by another examiner to avoid
errors. Cross verification of data was done using photographs
and RVGs. Sampling bias was minimized by verifying the photographs
and radiographs by an external reviewer. Simple random
sampling was done to minimize sampling bias. It was generalized
to the south Indian population. Two examiners were involved in
the study.
Data Collection/Tabulation:
After verification acquisition of data was done from the hospital
digital database which records all patients details such as name,
age, gender, tooth number and the number of patients undergoing
perforation repair in mandibular first molar were tabulated in
Microsoft Excel. The data was then entered in excel manually and
imported to SPSS for analysis. Incomplete data and radiographs
which were not adequate diagnostic accuracy were excluded from
the study.
Statistical Analysis:
Descriptive statistics were used to summarize the demographic
information of the patients included in this study. Descriptive statistics
is used for the acquisition of frequency of distribution of
the data. The number of patients underwent perforation repair
in mandibular first molar and clinical variables such as gender,
and age at the start of treatment were collected. The statistical
analysis was done using SPSS software (SPSS version 21.0, SPSS,
Chicago II, USA). The data was analyzed using a chi- square test.
The p value of less than 0.05 was considered to be statistically
significant.
Results & Discussion
It is observed that there is an equal number of patients undergone
perforation repair in 36 and 46 (50%). (Graph 1) A higher
number of patients who have undergone perforation repair were
above 30 years of age (81.25%).(Graph 2) The graph shows that
37.50% of males and 62.50% of females have undergone perforation
repair in the mandibular first molar. From which it is
observed that females have undergone more perforation repair
in the mandibular first molar when compared to males. (Graph 3)
Out of 16 patients 13 of them have undergone perforation repair
with bio aggregate material (81.25%), 2 of them with RMGIC
(12.50%) and remaining 1 of them with GIC(6.255). From the
chart it is observed that most of the patients were treated using
the bio aggregate repair material.(81.25%) (Graph 4) It is observed
that people of age group above 30 years have undergone
more perforation repair than people of 18-30 years There was no
significant difference between age and tooth number. (Graph 5)
chi square analysis was done and P value was 0.039. This depicts
that there is statistically significant association between gender and tooth number. (p value: 0.039<0.005).(Table 1) It is observed
that females (43.75%) have undergone more perforation repair in
36 than males (6.25%). The male populations (31.25%) have undergone
more perforation repair in 46 than the female population
(18.75%). (Graph 6).
The etiology of root perforations can be pathological, i.e. secondary
to resorption or caries, or iatrogenic, occurring during root
canal treatment. Approximately 2–12% of endodontically treated
teeth show accidental root perforations. These act as an open
channel between the root canal and surrounding periodontium
facilitating bacterial entry. When the perforation occurs laterally
or in the furcation area, it might be followed by an overgrowth of
gingival epithelium towards the perforation site. Perforations may
occur during access cavity preparation, post space preparation or
as a result of pathological internal resorption extending into the
periradicular tissues [12].
In this study, the female population had undergone more perforation
repair in the mandibular first molar. The perforation may
occur during access cavity preparation, post space preparation or
as a result of pathological internal resorption extending into the
peri radicular tissues. Fuss & Trope have proposed a classification
of root perforations based on the level at which the defect occurs
[10].
The people of age groups 30-60 years have more Root, furcal perforation
and have undergone perforation repair in the mandibular
first molar. This can be overcome by Kvinnsland [23] found that
attempts to negotiate calcified canals resulted in 42% of the reported
perforations in their study.
The life of an endodontically treated tooth is associated with correct
diagnosis and treatment planning, root canal shaping, sanitization,
sealing, and, lastly, tooth rehabilitation. The successful
treatment of a root perforation depends on certain factors, like
sealing material, perforation extent and location, time between
diagnosis and treatment, presence of contamination and related
operator experience, presence of preoperative lesions, communication
of the perforation with the oral environment, and type and
quality of the final restoration. The material recommended for
treatment of root canal perforations should have good physicochemical
and biological properties, proper sealing capacity, antimicrobial
activity and osteogenic potential [5].
In this study, bio aggregate material is predominantly used as perforation
materials when compared to GIC and RMGIC. The sealing
ability and biocompatibility of bio aggregate is compared to
that of the MTA which has been considered as an ideal material
for perforation repair, apexification etc [18].
Our institution is passionate about high quality evidence based
research and has excelled in various fields ( (Pc, Marimuthu and
Devadoss, 2018 [34]; Ramesh et al., 2018 [41]; Vijayashree Priyadharsini,
Smiline Girija and Paramasivam, 2018 [57]; Ezhilarasan,
Apoorva and Ashok Vardhan, 2019 [7]; Ramadurai et al., 2019
[37]; Sridharan et al., 2019 [52]; Vijayashree Priyadharsini, 2019
[56]; Chandrasekar et al., 2020 [3]; Mathew et al., 2020 [25]; R et
al., 2020 [44]; Samuel, 2021 [46]). We hope this study adds to this
rich legacy.
Graph 1: The Bar chart shows the frequency of tooth wise distribution of study population. X axis represents the tooth number - 36 & 46. Y Axis represents the number of patients with perforation repair. It is observed that high prevalence was noted in both 36 - 50% and 46 - 50%.
Graph 2: The Bar chart shows the frequency of age wise distribution of study population. X Axis represents the age group ranging - 18-30 years and above 30 years. Y Axis represents the number of patients with perforation repair. The highest frequency was noted at the age group above 30 years 81.25% followed by 18-30 years 18.75%.
Graph 3: The Bar chart shows the frequency of gender wise distribution of study population. X Axis represents the gender - males and females. Y Axis represents the number of patients undergone perforation repair. The highest frequency was noted in females - 62.50% followed by males - 37.50%.
Graph 4: The Bar chart shows the frequency of perforation repair material. X Axis represents the perforation repair material - bio aggregate material; RMGIC; GIC. Y Axis represents the number of patients undergone perforation repair. It was observed that higher frequency was noted with bio aggregate - 81.25% followed by RMGIC - 12.50% and GIC 6.25%.
Graph 5: The Bar chart represents the association between gender and teeth number. X Axis represents the tooth number and Y Axis represents the age. It is observed that people of age group above 30 years have undergone more perforation repair than people of 18-30 years There was no significant difference between age and tooth number.(Chi-Square test, p value:0.522 (p>0.05 statistically non-significant)).
Graph 6: The Bar chart represents the association between gender and teeth number. X Axis represents the tooth number and Y Axis represents the number of patients undergone perforation repair. It is observed that a higher number of female patients have undergone perforation repair than male patients There was a significant difference between gender and tooth number.(Chi-Square test, p value:0.039 (p<0.05 statistically significant)).
Table 1: This table shows that out of 16 patients 7 female patients and 1 male patient have undergone perforation repair in 36 and 5 male patients and 3 female patients have undergone perforation repair in 46. Female patients had undergone more perforation repair in the mandibular first molar when compared to male patients. P value was 0.039. This depicts that there is statistically significant association between gender and tooth number. (p value: 0.039<0.005).
Conclusion
Within the limitations of the current study, the age group 30years
and above underwent more perforation repair in the mandibular
first molar than the age group 18-30 years. There is no statistically
significant difference between the age and gender of the patients
who underwent perforation repair in mandibular first molar. The
female population seems to have undergone more perforation repair
in the mandibular first molar. There is statistically significant
difference between the gender and tooth number of the patients
who underwent perforation repair in mandibular first molar.
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