Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis
- 227 Downloads
The aims of this study are to identify the most frequent technical errors in endodontically treated teeth and to determine which root canals were most often associated with those errors, as well as to relate endodontic technical errors and the presence of coronal restorations with periapical status by means of cone-beam computed tomography images.
Six hundred eighteen endodontically treated teeth (1146 root canals) were evaluated for the quality of their endodontic treatment and for the presence of coronal restorations and periapical lesions. Each root canal was classified according to dental groups, and the endodontic technical errors were recorded. Chi-square’s test and descriptive analyses were performed.
Six hundred eighty root canals (59.3%) had periapical lesions. Maxillary molars and anterior teeth showed higher prevalence of periapical lesions (p < 0.05). Endodontic treatment quality and coronal restoration were associated with periapical status (p < 0.05). Underfilling was the most frequent technical error in all root canals, except for the second mesiobuccal root canal of maxillary molars and the distobuccal root canal of mandibular molars, which were non-filled in 78.4 and 30% of the cases, respectively.
There is a high prevalence of apical radiolucencies, which increased in the presence of poor coronal restorations, endodontic technical errors, and when both conditions were concomitant. Underfilling was the most frequent technical error, followed by non-homogeneous and non-filled canals.
Evaluation of endodontic treatment quality that considers every single root canal aims on warning dental practitioners of the prevalence of technical errors that could be avoided with careful treatment planning and execution.
KeywordsEndodontics Cone-beam computed tomography Periapical diseases Root canal obturation
This work was supported by the Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Campinas, SP, Brazil.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study were conducted in accordance with the ethical standards of the institutional Research Ethics Committee of the Piracicaba Dental School, UNICAMP (#073/2015), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 8.Sousa TO, Haiter-Neto F, Nascimento EHL, Peroni LV, Freitas DQ, Haiter-Neto F (2017) Diagnostic accuracy of periapical radiography and cone-beam computed tomography in identifying root canal configuration of human premolars. J Endod 43(7):1176–1179. https://doi.org/10.1016/j.joen.2017.02.021 CrossRefPubMedGoogle Scholar
- 10.Kayahan MB, Malkondu O, Canpolat C, Kaptan F, Bayirli G, Kazazoglu E (2008) Periapical health related to the type of coronal restorations and quality of root canal fillings in a Turkish subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105(1):e58–e62. https://doi.org/10.1016/j.tripleo.2007.07.044 CrossRefPubMedGoogle Scholar
- 11.Siqueira JF Jr, Rôças IN, Alves FR, Campos LC (2005) Periradicular status related to the quality of coronal restorations and root canal fillings in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100(3):369–374. https://doi.org/10.1016/j.tripleo.2005.03.029 CrossRefPubMedGoogle Scholar
- 14.Gomes AC, Nejaim Y, Silva AI, Haiter-Neto F, Cohenca N, Zaia AA, Silva EJ (2015) Influence of endodontic treatment and coronal restoration on status of periapical tissues: a cone-beam computed tomographic study. J Endod 41(10):1614–1618. https://doi.org/10.1016/j.joen.2015.07.008 CrossRefPubMedGoogle Scholar
- 16.Venskutonis T, Plotino G, Tocci L, Gambarini G, Maminskas J, Juodzbalys G (2015) Periapical and endodontic status scale based on periapical bone lesions and endodontic treatment quality evaluation using cone-beam computed tomography. J Endod 41(2):190–196. https://doi.org/10.1016/j.joen.2014.10.017 CrossRefPubMedGoogle Scholar
- 22.Al-Nuaimi N, Patel S, Davies A, Bakhsh A, Foschi F, Mannocci F (2017) Pooled analysis of 1-year recall data from three root canal treatment outcome studies undertaken using cone beam computed tomography. Int Endod J. https://doi.org/10.1111/iej.12844
- 25.Weissman J, Johnson JD, Anderson M, Hollender L, Huson T, Paranjpe A, Patel S, Cohenca N (2015) Association between the presence of apical periodontitis and clinical symptoms in endodontic patients using cone-beam computed tomography and periapical radiographs. J Endod 41(11):1824–1829. https://doi.org/10.1016/j.joen.2015.06.004 CrossRefPubMedGoogle Scholar
- 26.SEDENTEXCT Project (2012) Radiation protection: cone beam CT for dental and maxillofacial radiology. Evidence based guidelines. Geneva, Switzerland: European Commission. http://www.sedentexcteu/guidelines. Acessed 12 June 2017
- 27.Fayad MI, Nair M, Levin MD, Benavides E, Rubinstein RA, Barghan S, Hirschberg CS, Ruprecht A (2015) AAE and AAOMR joint position statement. Use of cone beam computed tomography in Endodontics 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol 120(4):508–512. https://doi.org/10.1016/j.oooo.2015.07.033 CrossRefGoogle Scholar
- 32.Sakhdari S, Talaeipour AR, Talaeipour M, Pazhutan M, Tehrani SH, Kharazifard MJ (2016) Diagnostic accuracy of CBCT with different voxel sizes and intraoral digital radiography for detection of periapical bone lesions: an ex-vivo study. J Dent (Tehran) 13(2):77–84Google Scholar
- 33.Leonardi Dutra K, Haas L, Porporatti AL, Flores-Mir C, Nascimento Santos J, Mezzomo LA, Corrêa M, de Luca Canto G (2016) Diagnostic accuracy of cone-beam computed tomography and conventional radiography on apical periodontitis: a systematic review and meta-analysis. J Endod 42(3):356–364. https://doi.org/10.1016/j.joen.2015.12.015 CrossRefPubMedGoogle Scholar
- 34.Silva EJ, Nejaim Y, Silva AI, Haiter-Neto F, Zaia AA, Cohenca N (2014) Evaluation of root canal configuration of maxillary molars in a Brazilian population using cone-beam computed tomographic imaging: an in vivo study. J Endod 40(2):173–176. https://doi.org/10.1016/j.joen.2013.10.002 CrossRefPubMedGoogle Scholar
- 35.Kojima K, Inamoto K, Nagamatsu K, Hara A, Nakata K, Morita I, Nakagaki H, Nakamura H (2004) Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97(1):95–99. https://doi.org/10.1016/S1079210403004803 CrossRefPubMedGoogle Scholar
- 37.Møller L, Wenzel A, Wegge-Larsen AM, Ding M, Væth M, Hirsch E, Kirkevang LL (2013) Comparison of images from digital intraoral receptors and cone beam computed tomography scanning for detection of voids in root canal fillings: an in vitro study using micro-computed tomography as validation. Oral Surg Oral Med Oral Pathol Oral Radiol 115(6):810–818. https://doi.org/10.1016/j.oooo.2013.03.008 CrossRefPubMedGoogle Scholar
- 38.Chugal NM, Clive JM, Spångberg LS (2003) Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(1):81–90. https://doi.org/10.1067/moe.2003.S1079210402917038 CrossRefPubMedGoogle Scholar
- 40.de Freitas JV, Baratto-Filho F, Coelho BS, Tomazinho FSF, Crozeta BM, de Sousa Neto MD, MCL G (2017) Efficacy of different cone-beam computed tomographic protocols in the identification of Mesiobuccal canals of maxillary first molars: a tomographic and ex vivo study. J Endod 43(5):810–815. https://doi.org/10.1016/j.joen.2016.12.011 CrossRefPubMedGoogle Scholar
- 41.Ramos Brito AC, Verner FS, Junqueira RB, Yamasaki MC, Queiroz PM, Freitas DQ, Oliveira-Santos C (2017) Detection of fractured endodontic instruments in root canals: comparison between different digital radiography systems and cone-beam ComputedTomography. J Endod 43(4):544–549. https://doi.org/10.1016/j.joen.2016.11.017 CrossRefPubMedGoogle Scholar
- 42.D'Addazio PS, Campos CN, Özcan M, Teixeira HG, Passoni RM, Carvalho AC (2011) A comparative study between cone-beam computed tomography and periapical radiographs in the diagnosis of simulated endodontic complications. Int Endod J 44(3):218–224. https://doi.org/10.1111/j.1365-2591.2010.01802.x CrossRefPubMedGoogle Scholar