Aust Endod J 2018

ORIGINAL RESEARCH

Post-treatment apical periodontitis related to the technical

quality of root fillings and restorations in Thai population
Panupong Thampibul, DDS1; Jeeraphat Jantarat, DDS, MDSc, PhD1 ; and Raweewan Arayasantiparb, DDS, PhD2
1 Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
2 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand

Keywords
apical periodontitis, endodontic treatment,
restorations, root fillings, treatment outcome.
Correspondence
Dr Jeeraphat Jantarat, Endodontic Division,
Department of Operative Dentistry and
Endodontics, Faculty of Dentistry, Mahidol
University, 6 Yothi Road, Ratchathewi District,
Bangkok 10400, Thailand.
Email: jeeraphat.jan@mahidol.ac.th
doi: 10.1111/aej.12302
(Accepted for publication 13 July 2018.)
Abstract
The aim of this study was to investigate the post-treatment apical periodontitis
in endodontically treated teeth related to the technical quality of root fillings
and restorations in Thai population. Full-mouth periapical radiographs from
Thai patients attending the Faculty of Dentistry, Mahidol University, Thailand
were examined. The periapical status, quality of root fillings and coronal
restorations, existence of intraradicular post and its relationship to the root fill-
ings were evaluated. Among 1586 patients, 37.4% presented endodontically
treated teeth. The total number of endodontically treated teeth was 1511, and
35% presented apical periodontitis. Combined data for root filling and coronal
restoration qualities revealed significantly better outcome in teeth with ade-
quate qualities of both parameters than the other combinations (P < 0.001).
The prevalence of post-treatment apical periodontitis among Thai population
was relatively high and significantly associated with substandard technical
quality of root fillings and restorations.

(13–15). To the best of our knowledge, no study has yet

Introduction
Post-treatment disease is the term suggested by Friedman
to describe the presence of periapical radiolucency in
endodontically treated teeth (ETT) (1). This pathology
has been reported to be widespread among the popula-
tions of various countries (2,3). Longitudinal studies of
endodontic treatment outcomes have been reported with
very high success rates (more than 80%) in teeth without
apical periodontitis (1,4,5). However, the majority of
these studies were performed at educational institutes
and dental schools. In addition, the treatment was per-
formed or supervised by specialists or experts under
favourable conditions, far from clinical reality (6). In con-
trast, cross-sectional studies conducted in several coun-
tries indicated that the prevalence of apical periodontitis
in ETT is relatively high, approximately 25%–>60% (3,7–
9). This dissonance is considerably alarming because it
reflects the realistic outcomes of endodontic treatments
in the general population.
The majority of cross-sectional studies assessing the
periapical status of ETT have been conducted in Europe
and the Americas (9–12). Only a limited number of stud-
ies performed in Asian countries have been published
evaluated the post-treatment apical periodontitis in
Southeast Asia, specifically in Thailand. Consequently,
the purpose of this study was to investigate the post-
treatment apical periodontitis in ETT in Thai population
and to determine the associations between prognostic
factors and the periapical status of these teeth.
Materials and methods
The study protocols were approved by the Ethics Com-
mittee of the Faculty of Dentistry and Faculty of Phar-
macy, Mahidol University Institutional Review Board
(MU-DT/PY-IRB). The first full-mouth periapical radio-
graphs of Thai patients attending the Faculty of Dentistry,
Mahidol University, Thailand, from January 2015 to
December 2016 were evaluated. The radiographs of ETT
with no endodontic-periodontal condition and root-end
surgery were examined. All radiographs were taken at
the Oral and Maxillofacial Radiology Clinic using the
Planmeca Intra (Planmeca Oy, Asentajankatu, Helsinki,
Finland) to obtain digital images, which were processed
with VistaScan Mini (D€ urr-dental, Bietigheim, Ger-
many). The gender, age, and tooth number of each

© 2018 Australian Society of Endodontology Inc 1

Post-Treatment Apical Periodontitis in Thai P. Thampibul et al.

patient were recorded. The teeth were categorised as ETT
only when the pulp chamber and at least one root canal
were filled with radiopaque material.
Radiographic examination
All radiographs were analysed using PACS (Picture Archiv-
ing and Communication System) software installed in a
computer running Microsoft Windows XP (Microsoft Cor-
poration, Redmond, WA, USA) and displayed on a 29-
inch RadiForce RX430 EIZO monitor (Eizo Nanao Corpo-
ration, Ishiwaka, Japan) with a 2560*1600 pixel resolu-
tion. The periapical status, quality of root filling and
coronal restoration, existence of an intraradicular post
and its relationship to the remaining root filling were
evaluated according to the criteria listed in Table 1 (in
cases of multirooted teeth, the root with the most severe
periapical condition was selected). For examiners calibra-
tion, one set of 50 reference teeth radiographs was used.
Interexaminer agreement for periapical status and other
parameters were assessed by calculating Cohen’s Kappa
scores. All Kappa scores were higher than 0.9, indicating
very good agreement. Therefore, it was justified to use the
score of one examiner for further examination. The
intraexaminer agreement with a 1-month interval was
performed, which the PAI calibration yielded Kappa
scores of 0.959 and 0.918 for the homogeneity of root fill-
ing and 0.905 for the quality of coronal restoration.
Statistical analysis
The data were analysed using each tooth as the unit of
analysis. All data were processed and analysed with SPSS,
version 18.0 (Statistical Presentation System Software;
SPSS Inc., Chicago, IL, USA). The study parameters were
characterised using univariate description. Then, simple
logistic regression was performed to evaluate the effect of
each parameter on periapical conditions, and multivari-
ate logistic regression was employed to identify signifi-
cant outcome predictors. The level of significance was
established at 5% (P < 0.05).
Results
The 1586 patients included in this study, included 540
(34%) males and 1046 (66%) females. The age range
was 15–89 years, and most patients were distributed in
the 15–24 year age band (Fig. 1). Regarding the

Table 1 Parameters scored in ETT

Parameters Registration and codes

Periapical status (16) 0 = Absence of apical periodontitis (PAI score = 1, 2)

Length of root filling (24)
Homogeneity of root filling (25)
Quality of root filling† (12)
Type of coronal restoration
Quality of coronal restoration (12)
Existence of intracanal post
Remaining root filling
Distance between post – remaining
root filling (28)
Combined quality of root filling and
coronal restoration† (12)
†
The parameter was statistically analysed using only the simple logistic regression model. ETT, endodontically treated teeth.
1 = Presence of apical periodontitis (PAI score = 3, 4, 5)
0 = Adequate: root filling terminating 0–2 mm within the radiographic apex
1 = Short: root filling terminating >2 mm short from the radiographic apex
2 = Long: root filling extending beyond the radiographic apex
0 = Satisfactory: uniform radiodensity and adaptation of the filling to the root canal walls
1 = Unsatisfactory: visible canal space laterally along the filling or voids within the filling mass
0 = Adequate: satisfactory root filling with terminating 0–2 mm within the radiographic apex
1 = Inadequate: if one or more of the criteria in ‘adequate quality root filling’ were not met
0 = Filling
1 = Crown
2 = Absence of coronal restoration
0 = Adequate: radiographically intact restoration without signs of leakage
1 = Inadequate: radiographic leakage signs, such as an open margin/recurrent caries and overhangs
0 = Absence of a (metal or fibre) post in the root canal
1 = Presence of a metal post in the root canal
2 = Presence of a fibre post in the root canal
0 = Presence of a remaining apical root filling ≥4 mm after post space preparation
1 = Presence of a remaining apical root filling <4 mm after post space preparation
2 = No post space preparation
0 = Absence of a gap between the root filling and post
1 = Presence of gap >0–2 mm between the root filling and post
2 = Presence of gap >2 mm between the root filling and post
0 = Adequate root filling/adequate coronal restoration
1 = Adequate root filling/inadequate coronal restoration
2 = Inadequate root filling/adequate coronal restoration
3 = Inadequate root filling/inadequate coronal restoration

2 © 2018 Australian Society of Endodontology Inc

P. Thampibul et al. Post-Treatment Apical Periodontitis in Thai

had apical periodontitis. No significant difference was

Figure 1 Distribution of the patients according to age bands and
genders.
Figure 2 Number of endodontically treated teeth (ETT) in various
patients.
prevalence of ETT, 994 patients (62.7%) exhibited
absence of ETT, while 592 patients (37.3%) had ETT, of
which 57.2% had at least two ETT in the oral cavity
(Fig. 2).
Of the 1511 ETT subjected to further investigation in
this study, the distribution included 499 anterior teeth
(33%), 487 premolar teeth (32.2%) and 525 molar teeth
(34.8%; Table 2). According to the PAI scoring system
(16), the periapical status of 984 teeth (65%) showed an
absence of apical periodontitis, while 527 teeth (35%)
observed in the periapical status of ETT between genders
(P = 0.39). The overall quality of root fillings was rated as
adequate in 784 teeth (51.9%). Of these teeth, 664
(84.7%) showed absence of apical periodontitis. The
group of teeth with inadequate root fillings comprised
727 teeth (48.1%), of which only 320 (44%) presented
no apical periodontitis. Molars had the highest frequency
of inadequate root fillings at 61.5%, followed by premo-
lars (41.9%) and incisors (40.1%). A significant differ-
ence was observed in the periapical status among types of
teeth (P < 0.001).
Regarding the quality of coronal restoration, a highly
significant difference was observed when comparing
teeth with adequate and inadequate restoration
(P < 0.001). Combined data for the quality of both root
filling and restoration were also investigated (Table 3),
and 9.9% of teeth with both adequate root filling and
restoration exhibited apical periodontitis. According to
the statistical analysis, this condition showed the best
result (P < 0.001). Teeth with both inadequate root fill-
ing and restoration exhibited the highest prevalence of
apical periodontitis at 73.6%, which was significantly
higher than the other conditions (P < 0.001). No signifi-
cant difference was observed between teeth with ade-
quate root filling/inadequate restoration and inadequate
root filling/adequate restoration (P = 0.09). Regarding
the length of the root filling, teeth with adequate lengths
of root filling were significantly superior to those with
short or long root fillings (P < 0.001). No significant dif-
ferences were observed between teeth with short or long
root fillings (P = 0.06). The homogeneity of the root fill-
ing was also evaluated, with a highly significant differ-
ence observed between teeth with satisfactory and
unsatisfactory root fillings (P < 0.001).
Regarding the type of restoration, the worst results
were observed among teeth with an absence of restora-
tion; these teeth showed a significantly higher prevalence
of apical periodontitis than teeth with crowns or fillings
(P < 0.001). For the existence of intracanal posts, no sig-
nificant difference was observed between teeth with no

Table 2 Distribution of teeth with differences in the quality of root filling and periapical status according to the tooth type

Quality of root filling Periapical status

No. of Adequate Inadequate Absence Presence

Tooth type teeth (n) root; filling (n (%)) root filling (n (%)) of AP (n (%)) of AP (n (%))

Total
Anterior 499 299 (59.9) 200 (40.1) 355 (71.1) 144 (28.9)
Premolar 487 283 (58.1) 204 (41.9) 340 (69.8) 147 (30.2)
Molar 525 202 (38.5) 323 (61.5) 289 (55.0) 236 (45.0)
Total 1511 784 (51.9) 727 (48.1) 984 (65.0) 527 (35.0)

AP, apical periodontitis.

© 2018 Australian Society of Endodontology Inc 3

Post-Treatment Apical Periodontitis in Thai P. Thampibul et al.

Table 3 Univariate logistic regression analysis of the association between the periapical status and combined quality of both the root filling and coro-
nal restoration

Coronal No. of Absence Presence Crude odds ratio

Root filling restoration teeth (n) of AP (n (%)) of AP (n (%)) P value (95% CI)

Adequate Adequate 637 574 (90.1) 63 (9.9) <0.001* 1

Adequate Inadequate 147 90 (61.2) 57 (38.8) 5.77 (3.78–8.79)
Inadequate Adequate 477 254 (53.2) 223 (46.8) 7.99 (5.83–10.97)
Inadequate Inadequate 250 66 (26.4) 184 (73.6) 25.40 (17.31–37.25)

*Statistically significant. AP, apical periodontitis.

Table 4 Univariate logistic regression analysis of the associations of various parameters with the periapical status

No. of Absence Presence Crude odds ratio

Parameters teeth (n) of AP (n (%)) of AP (n (%)) P value (95% CI)

Gender
Female 982 647 (65.9) 335 (34.1) 0.396 1
Male 529 337 (63.7) 192 (36.3) 1.10 (0.88–1.37)
Type of teeth
Anterior 499 355 (71.1) 144 (28.9) <0.001* 1
Premolar 487 340 (69.8) 147 (30.2) 1.06 (0.81–1.40)
Molar 525 289 (55.0) 236 (45.0) 2.01 (1.55–2.60)
Length of the root filling
Adequate 1110 828 (74.6) 282 (25.4) <0.001* 1
Short 322 118 (36.6) 204 (63.4) 5.07 (3.90–6.61)
Long 79 38 (48.1) 41 (51.9) 3.16 (1.99–5.06)
Homogeneity of the root filling
Satisfactory 933 749 (80.3) 184 (19.7) <0.001* 1
Unsatisfactory 578 235 (40.7) 343 (59.3) 5.94 (4.71–7.48)
Type of coronal restoration
Filling 499 355 (71.1) 144 (28.9) <0.001* 1
Crown 965 608 (63.0) 357 (37.0) 1.44 (1.14–1.82)
Absence of coronal restoration 47 21 (44.7) 26 (55.3) 3.05 (1.66–5.56)
Existence of post
Absence of post 689 463 (67.2) 226 (32.8) 0.143 1
Metal post 580 360 (62.1) 220 (37.9) 1.25 (0.99–1.57)
Fibre post 242 161 (66.5) 81 (33.5) 1.03 (0.75–1.40)
Remaining root filling
≥4 mm 581 408 (70.2) 173 (29.8) <0.001* 1
<4 mm 241 113 (46.9) 128 (53.1) 2.67 (1.96–3.64)
No post space preparation 689 463 (67.2) 226 (32.8) 1.15 (0.90–1.46)
Gap between post-root filling
Absence of gap 334 224 (67.1) 110 (32.9) 0.184 1
>0–2 mm 452 276 (61.1) 176 (38.9) 1.29 (0.96–1.74)
>2 mm 36 21 (58.3) 15 (41.7) 1.45 (0.72–2.93)
Quality of the coronal restoration
Adequate 1114 828 (74.3) 286 (25.7) <0.001* 1
Inadequate 397 156 (39.3) 241 (60.7) 4.47 (3.51–5.69)

*Statistically significant. AP, apical periodontitis.

post or teeth restored with various types of posts
(P = 0.143). The relationship of post to the root filling
was investigated. The prevalence of apical periodontitis
in post-core restoration teeth with a remaining root fill-
ing <4 mm was significantly higher than teeth with the
other conditions (P < 0.001). No significant differences
were observed between teeth with a remaining root
filling of at least 4 mm and teeth with no post-core
restoration (P = 0.24). Regarding the gap between the
post and root filling, no significant difference was
observed between post-core restoration teeth with vari-
ous gaps between post and root filling (P = 0.184).
The results of simple (univariate model) and multi-
variate logistic regression (multivariate model) analyses

4 © 2018 Australian Society of Endodontology Inc

P. Thampibul et al. Post-Treatment Apical Periodontitis in Thai

Table 5 Multivariate logistic regression analysis of the associations of

various parameters with the periapical status Discussion

No. of Adjusted The current study investigated the post-treatment apical

Parameters teeth (n) P value odds ratio 95% CI periodontitis in ETT among Thai patients to improve the
Type of teeth
outcomes and benefits related to the oral health of the
Anterior 499 0.003* 1 population. The overall prevalence of post-treatment api-
Premolar 487 0.94 0.68–1.30 cal periodontitis was 35%, rather high considering the
Molar 525 1.54 1.13–2.10 potential for success of endodontic treatment. However,
Length of the root filling this frequency remained within the range reported by
Adequate 1110 <0.001* 1 related cross-sectional studies (7,8,11,12).
Short 322 2.85 2.09–3.88
The ages of most patients were distributed in the range
Long 79 3.86 2.27–6.57
Homogeneity of the root filling
of 15–24 years, because the majority of the patients
Satisfactory 933 <0.001* 1 receiving full-mouth periapical radiographs were
Unsatisfactory 578 3.90 3.00–5.08 orthodontic patients in early adulthood. The prevalence
Type of coronal restoration of ETT in the Thai population studied here was 37% of
Filling 499 0.371 1 patients, a value that was within the range reported by
Crown 965 1.15 0.81–1.64 related studies conducted in other countries (7,10,17).
Absence of coronal 47 1.58 0.78–3.23
Additionally, approximately 57% of the patients pre-
restoration
Remaining root filling
sented ETT had at least two ETT in the oral cavity. Thus,
≥4 mm 581 0.001* 1 the prevalence of ETT was relatively high, reflecting a
<4 mm 241 1.66 1.16–2.39 problem with the oral health of this population.
No post space 689 0.78 0.54–1.11 In the present study, approximately 50% of ETT were
preparation categorised as having substandard root filling quality. A
Quality of the coronal restoration similarly high prevalence has also been reported in
Adequate 1114 <0.001* 1
other studies (8,9,14,18), and could be considered the
Inadequate 397 4.15 3.11–5.55
primary factor responsible for the high frequency of
*
Statistically significant. post-treatment apical periodontitis. More than 60% of
molar teeth had an inadequate root filling quality, and
are presented in Tables 4 and 5. Only the covariates molars yielded the highest prevalence of apical
with significant associations in the univariate model periodontitis (45%). This finding might be due to the
were included in the multivariate analysis (Table 5). difficulty encountered in treatment approaches. Inter-
Five significant predictors of the presence of apical peri- estingly, the nationwide dental licensure examination
odontitis were identified: type of teeth, length of the in Thailand does not include root canal treatment of
root filling, homogeneity of the root filling, remaining molars as a requirement for graduation. Moreover, only
root filling and quality of restoration. The odds ratio for a few educational institutes have included the clinical
the presence of apical periodontitis was 2.85 times practice of root canal treatment for molars in their cur-
higher when the length of root filling was short, and ricula. These limitations may be the primary explana-
3.86 times higher when it was long, than that for teeth tions why the majority of molars had a substandard
with adequate root fillings. Regarding the type of teeth, root filling quality.
the odds ratio of apical periodontitis was 1.54 times The quality of the coronal restoration was another fac-
higher when the treated teeth were molars than when tor that impacted the periapical health of ETT (9,12). Sig-
they were anterior teeth. Regarding the homogeneity nificantly, fewer teeth with an adequate restoration
of the root filling, the odds ratio of apical periodontitis exhibited apical periodontitis than teeth with an inade-
was 3.90 times higher when teeth had an unsatisfac- quate restoration. Furthermore, combined data for the
tory root filling than when they were satisfactory. For quality of both root filling and restoration were also
the remaining root filling, the odds ratio of apical peri- investigated. As expected, the lowest prevalence of apical
odontitis was 1.66 times higher among teeth with a periodontitis was observed in teeth with both an ade-
remaining root filling <4 mm than among teeth with a quate root filling and an adequate restoration. The worst
remaining root filling ≥4 mm. Finally, regarding the outcome was observed for teeth with both an inadequate
quality of the coronal restoration, the odds ratio of api- root filling and restoration. No significant difference was
cal periodontitis was 4.15 times higher when the qual- observed between teeth with an adequate root filling/
ity of the coronal restoration was inadequate than inadequate restoration and inadequate root filling/ade-
when it was adequate. quate restoration. Therefore, the qualities of root filling

© 2018 Australian Society of Endodontology Inc 5

Post-Treatment Apical Periodontitis in Thai
and restoration were equally important for achieving a
good prognosis, a finding supported by Gillen et al. (19).
Teeth with an adequate length of the root filling exhib-
ited a significantly lower prevalence of apical periodonti-
tis than teeth with either short or long root fillings. The
results were supported by related studies (4,5,20), in
which the treatment was completed as close to the apex
as possible to achieve sufficient disinfection. Teeth with
short root fillings were likely to have an unclean apical
segment and were not sealed, serving as a potential habi-
tat for microorganisms invading the periapical tissue (5).
Meanwhile, the poor outcomes observed for teeth with
long root fillings may have results ranging from overin-
strumentation of the infected dentine to the periapical
tissue or loss of the apical seal, allowing tissue fluids to
leak into the root canal (21). Regarding the homogeneity
of the root filling, various studies have reported the
importance of a good technical quality root filling to pro-
vide an effective seal in ETT (22,23). Significantly, better
results were observed among teeth rated as having a sat-
isfactory root filling than teeth with an unsatisfactory
root filling. This outcome was also consistent with related
studies (24,25).
One-half of the ETT in the present study were restored
with intracanal posts. Some previous studies have
reported an increased rate of apical periodontitis in post-
core restoration teeth, because the root canal becomes
contaminated during restoration procedures (1,7).
Nonetheless, we did not observe a significant difference
between teeth with or without a post, which is consistent
with the findings from other studies (5,9,18,26). More-
over, a significant difference was not observed between
teeth restored with metal or fibre posts. Therefore, the
presence of a post does not appear to impact the periapi-
cal health of ETT.
The relations between post-root filling in ETT were
examined. Teeth with a remaining root filling <4 mm
displayed a significantly higher prevalence of periapical
disease than teeth with a greater remaining root filling.
The results were also consistent with other studies sug-
gesting that at least 4 mm of root filling should be left to
prevent interference with the apical seal integrity
(26,27). In addition, the gap between post-root filling
was also evaluated. This factor is significantly associated
with periapical health (28), based on root canal reinfec-
tion after post space preparation. However, in the pre-
sent study, we did not observe a significant difference
between teeth with various gaps between the post and
root filling. These contradictory data may be attributed
to the adequate root filling of the teeth with gaps
between the post and root fillings to provide a favour-
able seal, and thus, this factor did not significantly
impact periapical health. The type of coronal restoration
6 © 2018 Australian Society of Endodontology Inc
P. Thampibul et al.
was gradually excluded from the multivariate analysis.
The latter results might be due to the underlying influ-
ence of other significant factors in the multivariate logis-
tic regression.
Cross-sectional studies collect data within a particular
timeframe without knowing their temporal relation-
ships. Therefore, one critical limitation of the present
study is that the time elapsed between endodontic treat-
ment and radiographic image acquisition was not speci-
fied (6). When the date of treatment is unknown, the
prevalence of apical periodontitis may be overestimated
because clinicians are unable to determine whether
lesions were healing (2). On the other hand, when the
ETT initially presented periapical disease, the lesion
could have been detected more obviously over time.
Therefore, based on the limitations associated with this
type of study, the data must be interpreted with caution.
However, in the study by Petersson et al. (29), the over-
all outcome did not differ significantly after an 11-year
follow-up because the number of ETT with healed peri-
apical disease was approximately the same as the num-
ber of ETT with newly developed disease. Thus, cross-
sectional studies can provide reliable information to
assess the outcomes of endodontic treatment, as sup-
ported by Hugoson et al. (30). Most longitudinal studies
have been conducted at teaching institutions or dental
schools. However, the data reported in cross-sectional
studies are collected from the community or general
population, which closer to realistic conditions and rep-
resent the overall outcomes of populations (6). This lat-
ter type of study represents a vital data source because it
can estimate the overall health state by collecting
numerous data and has the potential to dilute bias in
the analysis. Based on these advantages, cross-sectional
studies are the most appropriate method for epidemio-
logical investigations (3). Thus, these data may serve as
important tools for further improvements in service
plans and healthcare strategies.
In summary, the findings from this Thai population
regrettably concurred with other epidemiological studies
because a considerably high prevalence of apical peri-
odontitis in ETT was observed in the general population.
The main cause of this finding was a correspondingly
high prevalence of treatments with substandard technical
quality. The findings from this study enhance an aware-
ness to academic staff and related authorities to collabo-
rate managing this problem judiciously to achieve better
treatment outcomes. Improvements should be intro-
duced into the curricular structure of undergraduate pro-
grams. For example, training in NiTi rotary file systems
and the clinical practice of endodontic treatment for
molars should be included in the academic curriculum of
every institution. Moreover, the results from the current
P. Thampibul et al.
study confirmed that the periapical conditions of ETT
were strongly associated with the technical quality of
both the root fillings and restorations, indicating that the
proposed training would definitely have a beneficial
effect on treatment outcomes of the patients.
Conclusions
Within the limitations of this study, the prevalence of
post-treatment apical periodontitis in Thai population
was considerably high at 35% and inadequate root filling
was observed in 48.1% of ETT. Molars, short and long
root fillings, unsatisfactory root filling, remaining root
filling <4 mm and inadequate coronal restoration were
significantly correlated with the presence of apical peri-
odontitis in ETT.
Acknowledgements
This study was funded by the Endodontic Division, Fac-
ulty of Dentistry, Mahidol University. We are immeasur-
ably grateful to Asst. Prof. Dr. Chulaluk Komoltri and Dr.
Sittichoke Osiri for their assistance with the statistical
analysis.
Disclosure statement
The authors deny any conflicts of interest related to this
study.
Authorship declaration
The authors acknowledge (i) that they all have con-
tributed significantly, and (ii) they are in agreement with
the manuscript.
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