Ap Case Study

AP is an acute or chronic inflammatory process around the apex of a tooth root; it is primarily a sequel to microbial infection of the teeth pulp space. AP is a remarkably wide spread disease with an obvious cumulative economic impact, especially when we consider the cost and training need for its only viable treatment which is root canal treatment or retreatment. (Boucher et al. 2002; Buckley et al. 1995; Dugas et al. 2003; Figdor 2002; Kabak et al. 2005; Marcus et al. 2006; Tsuneishi M et al. 2005)
Diagnosis of AP requires assessment of the patient’s symptoms and signs. However, a majority of AP cases is a symptomatic, so the diagnosis is based mainly on the radiographic examination.(Paul et al. 2004)
A parameter is defined as a ‘risk indicator’

-All teeth have been recorded according to FDI nomenclature.
Radiographic Examination: A combination of panoramic and peri-apical radiographs was taken by a dental experienced radiologist, using Cranex 3+ Ceph (Sore dex orion corporation, Finland) X ray unit and Kodak (MXG and Dental Intra oral E- speed) films (Estman Kodak Company, Rochester New York USA). The prei-apical radiograph has been taken when the tooth apical area was not clear on the panoramic view. The paralleling technique was used for taking the peri-apical radiographs (using Endo Ray II film holder, Dentsply Rinn Corporation USA). An experienced dental assistant processed the films manually. Radiographic Evaluation: From the radiographic survey, all teeth excluding third molars were recorded according to the FDI nomenclature.
Teeth have been categorized as;


 Number and location of teeth with root filling having identifiable AP.
 Number and location of RF teeth.
 Satisfactory length extension of root filling: filling material present in the root canal within 0-2 mm of the radiographic apex.
 Unsatisfactory length extension of root filling: filling material present in the root canal more than 2 mm from the radiographic apex (shorter or extruded beyond the apex). The observer The radiographs were examined by one observer (AbdulRhman, I.) assisted by an experienced radiologist, under standardized conditions using uniformly illuminated viewing box. The intra-observer reproducibility was evaluated by a double scoring of randomly selected 50 patients. The intra-observer agreement test produced a Cohen’s Kappa value of 0.951. Data analysis The Statistical Package for social Sciences (SPSS) version 15 was used for data management. The data was then transferred to the software of the Epidemiologic Perspectives and Innovation programme (PEPI-for-Windows). The data was analysed using the chi-square test and odds ratio at confidence level of 95% and significant level of 5%. P value (probability) less than