, Volume 103, Issue 2, pp 185–193 | Cite as

Long-term outcome of non-surgical root canal treatment: a retrospective analysis

  • Chiara PiraniEmail author
  • Stefano Chersoni
  • Lucio Montebugnoli
  • Carlo Prati
Original Article


This study investigated the long-term clinical outcome of root canal treatment. 240 root-treated teeth (n = 61 patients) were initially classified on the basis of radiographic presence/absence of initial apical periodontitis (IAP) and clinical data. The final outcome measure was the periapical healing (healed/disease). The outcome at 6–9 months was correlated with the outcome at 10 years following treatment. Prognostic factors for the periapical healing were assessed. Extraction data were recorded. Univariate and multivariate logistic regression analysis was used to identify risk indicators for apical periodontitis (AP) development. Chi-square analysis was performed to evaluate a possible relationship between the 6–9 months outcome and the final outcome related to IAP. Mean observation time was 14 ± 3.7 years. Survival rate was 84.6 % and healing rate was 79 % (10–19 years). Predictors of outcome (p < .05) were considered statistically significant. Multivariate logistic regression analysis showed that initial pulpal and periapical status and the quality of root canal filling as assessed two-dimensionally were independent predictors of outcome. The 6–9 months evaluation appears to be an indicator for the final outcome of primary root canal treatment both in the presence and in the absence of IAP. An initial radiolucency associated with an unsatisfactory quality and extent of root canal filling significantly diminishes the possibility of achieving long-term radiographic success. For those with uncertain healing at 6–9 months (91 %), clinicians should consider the high healing rate when estimating the prognosis and adjust the decision making accordingly.


Root canal treatment Periapical healing Periapical radiolucency Root canal filling Survival 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sjögren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16:498–504.PubMedCrossRefGoogle Scholar
  2. 2.
    Stoll R, Betke K, Stachniss V. The influence of different factors on the survival of root canal fillings: a 10-year retrospective study. J Endod. 2005;31:783–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature—Part 1. Effects of study characteristics on probability of success. Int Endod J. 2007;40:921–39.PubMedCrossRefGoogle Scholar
  4. 4.
    Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature—Part 2. Influence of clinical factors. Int Endod J. 2007;41:6–31.PubMedGoogle Scholar
  5. 5.
    Kirkevang LL, Væth M, Hörsted-Bindslev P, Bahrami G, Wenzel A. Risk factors for developing apical periodontitis in a general population. Int Endod J. 2007;40:290–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Imura N, Pinheiro ET, Gomes B, Zaia AA, Ferraz CCR, Souza-Filho FJ. The outcome of endodontic treatment: a retrospective study of 2000 cases performed by a specialist. J Endod. 2007;33:1278–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Tavares PBL, Bonte E, Boukpessi T, Siqueira JF, Lasfargues JJ. Prevalence of apical periodontitis in root canal-treated teeth from an urban French population: influence of the quality of root canal fillings and coronal restorations. J Endod. 2009;35:810–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Chugal NM, Clive JM, Spångberg LS. A prognostic model for assessment of the outcome of endodontic treatment: effect of biologic and diagnostic variables. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:342–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J. 2010;43:171–89.PubMedCrossRefGoogle Scholar
  10. 10.
    Lumley PJ, Lucarotti PSK, Burke FJT. Ten-year outcome of root fillings in the General Dental Service in England and Wales. Int Endod J. 2008;41:577–85.PubMedCrossRefGoogle Scholar
  11. 11.
    European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39:921–30.CrossRefGoogle Scholar
  12. 12.
    Molven O, Halse A, Fristad I, Mac-Donald-Jankowski D. Periapical changes following root-canal treatment observed 20–27 years postoperatively. Int Endod J. 2002;35:784–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Hannahan JP, Eleazer PD. Comparison of success of implants versus endodontically treated teeth. J Endod. 2008;34:1302–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Gesi A, Hakeberg M, Warfvinge J, Bergenholtz G. Incidence of periapical lesions and clinical symptoms after pulpectomy-A clinical and radiographic evaluation of 1- versus 2-session treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:379–88.PubMedCrossRefGoogle Scholar
  15. 15.
    Prati C, Selighini M, Ferrieri P, Mongiorgi R. Scanning electron microscopic evaluation of different endodontic procedures on dentin morphology of human teeth. J Endod. 1994;20:174–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Friedman S, Abitbol S, Lawrence HP. Treatment outcome in endodontics: the Toronto Study. Phase I: initial treatment. J Endod. 2003;29:787–93.PubMedCrossRefGoogle Scholar
  17. 17.
    de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto study—phase 4: initial treatment. J Endod. 2008;34:258–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Ørstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986;2:20–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Molander A, Warfvinge J, Reit C, Kvist T. Clinical and radiographic evaluation of one- and two-visit endodontic treatment of asymptomatic necrotic teeth with apical periodontitis: a randomized clinical trial. J Endod. 2007;33:1145–8.PubMedCrossRefGoogle Scholar
  20. 20.
    von Arx T, Jensen SS, Hänni S. Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery. J Endod. 2007;33:123–8.CrossRefGoogle Scholar
  21. 21.
    Mindiola MJ, Mickel AK, Sami C, Jones JJ, Lalumandier JA, Nelson SS. Endodontic treatment in an American Indian population: a 10-year retrospective study. J Endod. 2006;32:828–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod. 2009;35:930–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Wu MK, Shemesh H, Wesselink PR. Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment. Int Endod J. 2009;42:656–66.PubMedCrossRefGoogle Scholar
  24. 24.
    Ricucci D, Siqueira JF Jr, Bate AL, Pitt Ford TR. Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients. J Endod. 2009;35:493–502.PubMedCrossRefGoogle Scholar
  25. 25.
    Kojima K, Inamoto K, Nagamatsu K, et al. Success rate of endodontic treatment of teeth with vital and nonvital pulps. A meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:95–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Hepworth MJ, Friedman S. Treatment outcome of surgical and non-surgical management of endodontic failures. J Can Dent Assoc. 1997;63:364–71.PubMedGoogle Scholar
  27. 27.
    Wu MK, Wesselink PR, Walton RE. Apical terminus location of root canal treatment procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:99–103.PubMedCrossRefGoogle Scholar
  28. 28.
    Schaeffer MA, White RR, Walton RE. Determining the optimal obturation length: a meta-analysis of literature. J Endod. 2005;31:71–4.CrossRefGoogle Scholar
  29. 29.
    Wu MK, Wesselink PR. Timeliness and effectiveness in the surgical management of persistent post-treatment periapical pathosis. Endod Topics. 2005;11:25–31.CrossRefGoogle Scholar
  30. 30.
    Eckerbom M, Flygare L, Magnusson T. A 20-year follow-up study of endodontic variables and apical status in a Swedish population. Int Endod J. 2007;40:940–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Prati C, Nucci C, Montanari G. Effects of acid and cleansing agents on shear bond strength and marginal microleakage of glass-ionomer cements. Dent Mater. 1989;5:260–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Prati C, Tao L, Simpson M, Pashley DH. Permeability and microleakage of Class II resin composite restorations. J Dent. 1994;22:49–56.PubMedCrossRefGoogle Scholar
  33. 33.
    Katebzadeh N, Sigurdsson A, Trope M. Radiographic evaluation of periapical healing after obturation of infected root canals: an in vivo study. Int Endod J. 2000;33:60–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Nair PNR, Sjögren U, Figdor D, Sundqvist G. Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments and periapical scars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:617–27.PubMedCrossRefGoogle Scholar
  35. 35.
    Love RM, Firth N. Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin. Int Endod J. 2009;42:198–202.PubMedCrossRefGoogle Scholar
  36. 36.
    Kvist T, Heden G, Reit C. Endodontic retreatment strategies used by general dental practioners. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:502–7.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of The Nippon Dental University 2014

Authors and Affiliations

  • Chiara Pirani
    • 1
    Email author
  • Stefano Chersoni
    • 1
  • Lucio Montebugnoli
    • 2
  • Carlo Prati
    • 1
  1. 1.Department of Biomedical and Neuromotor Sciences (DIBINEM), School of Dentistry, Endodontic Clinical Section, Alma Mater StudiorumUniversity of BolognaBolognaItaly
  2. 2.Department of Biomedical and Neuromotor Sciences (DIBINEM), School of Dentistry, Oral Pathology Section, Alma Mater StudiorumUniversity of BolognaBolognaItaly

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