ENDODONTIC TREATMENT OUTCOMES IN ACUTE APICAL PERIODONTITIS: INFLUENCE OF PATIENT, SYSTEMIC, AND DENTAL FACTORS ON PAI CHANGE

Sorina G. Zahiu, Ovidiu Fratila

DOI : 10.62610/RJOR.2026.2.18.20

Abstract

To evaluate clinical-radiological outcomes after endodontic treatment in patients with acute apical periodontitis and to investigate associations between demographic, systemic, and dental characteristics and PAI evolution over time. Methods – This retrospective observational cohort study included 110 patients diagnosed with acute apical periodontitis, comprising a total of 128 affected teeth. The study was approved by the Ethics Committee of the Faculty of Medicine and Pharmacy Oradea (CEFMF/4/30.10.2023) and conducted in accordance with the Declaration of Helsinki. Outcomes were assessed using PAI at baseline, 12 months, and 24 months post-treatment. Teeth were classified at the final follow-up as healed, healing, or failed based on clinical signs/symptoms and radiographic PAI changes. Statistical analysis was performed using IBM SPSS 25, applying non-parametric tests and Spearman’s correlation (α = 0.05, with Bonferroni correction as appropriate). Results – At 12 months, outcomes were predominantly favorable, and by 24 months the proportion of healed teeth increased to 85.9%. Lower initial PAI scores were significantly associated with healing at both follow-up time points (p < 0.001), whereas higher or worsening PAI scores characterized unfavorable outcomes (p < 0.001). Age was significantly associated with a more unfavorable PAI change over time (Age vs PAI: p = 0.028, R = −0.194). In addition, smoking was associated with a higher number of teeth affected by apical periodontitis (p = 0.018). Systemic comorbidities and urban residence were linked to older patient age and greater periapical disease burden (p = 0.001 and p = 0.044, respectively). Conclusions – Endodontic treatment of AAP resulted in high healing rates, particularly by 24 months. Baseline disease severity (initial PAI) and patient age were key predictors of PAI evolution, while smoking and systemic comorbidities were associated with a greater burden of affected teeth.