Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Clinical relevance
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.
Similar content being viewed by others
References
Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD (2014) Characterization of successful root canal treatment. Braz Dent J 25(1):3–11. https://doi.org/10.1590/0103-6440201302356
Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J 44(7):583–609. https://doi.org/10.1111/j.1365-2591.2011.01872.x
Siqueira JF Jr (2001) Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J 34(1):1–10. https://doi.org/10.1046/j.1365-2591.2001.00396.x
Lin LM, Rosenberg PA, Lin J (2005) Do procedural errors cause endodontic treatment failure? J Am Dent Assoc 136(2):187–193. https://doi.org/10.14219/jada.archive.2005.0140
Moura MS, Guedes OA, Alencar AH, Azevedo BC, Estrela C (2009) Influence of length of root canal obturation on apical periodontitis detected by periapical radiography and cone beam computed tomography. J Endod 35(6):805–809. https://doi.org/10.1016/j.joen.2009.03.013
Durack C, Patel S (2012) Cone beam computed tomography in endodontics. Braz Dent J 23(3):179–191. https://doi.org/10.1590/S0103-64402012000300001
Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K (2015) Cone beam computed tomography in endodontics—a review. Int Endod J 48(1):3–15. https://doi.org/10.1111/iej.12270
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
Kabak Y, Abbott PV (2005) Prevalence of apical periodontitis and the quality of endodontic treatment in an adult Belarusian population. Int Endod J 38(4):238–245. https://doi.org/10.1111/j.1365-2591.2005.00942.x
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
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
Moreno JO, Alves FR, Gonçalves LS, Martinez AM, Rôças IN, Siqueira JF Jr (2013) Periradicular status and quality of root canal fillings and coronal restorations in an urban Colombian population. J Endod 39(5):600–604. https://doi.org/10.1016/j.joen.2012.12.020
Craveiro MA, Fontana CE, de Martin AS, Bueno CE (2015) Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod 41(6):836–840. https://doi.org/10.1016/j.joen.2015.02.017
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
Liang YH, Li G, Wesselink PR, Wu MK (2011) Endodontic predictors identified with periapical radiographs and cone-beam computed tomography scans. J Endod 37(3):326–331. https://doi.org/10.1016/j.joen.2010.11.032
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
Van der Veken D, Curvers F, Fieuws S, Lambrechts P (2017) Prevalence of apical periodontitis and root filled teeth in a Belgian subpopulation found on CBCT images. Int Endod J 50(4):317–329. https://doi.org/10.1111/iej.12631
Lemagner F, Maret D, Peters OA, Arias A, Coudrais E, Georgelin-Gurgel M (2015) Prevalence of apical bone defects and evaluation of associated factors detected with cone-beam computed tomographic images. J Endod 41(7):1043–1047. https://doi.org/10.1016/j.joen.2015.03.011
Karabucak B, Bunes A, Chehoud C, Kohli MR, Setzer F (2016) Prevalence of apical periodontitis in endodontically treated premolars and molars with untreated canal: a cone-beam computed tomography study. J Endod 42(4):538–541. https://doi.org/10.1016/j.joen.2015.12.026
Nascimento EH, Pontual ML, Pontual AA, Freitas DQ, Perez DE, Ramos-Perez FM (2016) Association between odontogenic conditions and maxillary sinus disease: a study using cone-beam computed tomography. J Endod 42(10):1509–1515. https://doi.org/10.1016/j.joen.2016.07.003
Landis JR, Kock GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174. https://doi.org/10.2307/2529310
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
Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. Int Endod J 44(7):610–625. https://doi.org/10.1111/j.1365-2591.2011.01873.x
Patel S, Dawood A, Mannocci F, Wilson R, Pitt Ford T (2009) Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography. Int Endod J 42(6):507–515. https://doi.org/10.1111/j.1365-2591.2008.01538.x
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
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
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
Tyndall DA, Kohltfarber H (2012) Application of cone beam volumetric tomography in endodontics. Aust Dent J 57(Suppl 1):72–81. https://doi.org/10.1111/j.1834-7819.2011.01654.x
Schulze R, Heil U, Gross D et al (2011) Artefacts in CBCT: a review. Dentomaxillofac Radiol 40(5):265–273. https://doi.org/10.1259/dmfr/30642039
Kruse C, Spin-Neto R, Wenzel A, Kirkevang LL (2015) Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model. Int Endod J 48(9):815–828. https://doi.org/10.1111/iej.12388
Tsai P, Torabinejad M, Rice D, Azevedo B (2012) Accuracy of cone-beam computed tomography and periapical radiography in detecting small periapical lesions. J Endod 38(7):965–970. https://doi.org/10.1016/j.joen.2012.03.001
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):77–84
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
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
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
Metska ME, Liem VM, Parsa A, Koolstra JH, Wesselink PR, Ozok AR (2014) Cone-beam computed tomographic scans in comparison with periapical radiographs for root canal length measurement: an in situ study. J Endod 40(8):1206–1209. https://doi.org/10.1016/j.joen.2013.12.036
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
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
Betancourt P, Navarro P, Muñoz G, Fuentes R (2016) Prevalence and location of the secondary mesiobuccal canal in 1,100 maxillary molars using cone beam computed tomography. BMC Med Imaging 16(1):66. https://doi.org/10.1186/s12880-016-0168-2
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
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
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
Pak JG, Fayazi S, White SN (2012) Prevalence of periapical radiolucency and root canal treatment: a systematic review of cross-sectional studies. J Endod 38(9):1170–1176. https://doi.org/10.1016/j.joen.2012.05.023
Funding
This work was supported by the Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Campinas, SP, Brazil.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
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
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Nascimento, E.H.L., Gaêta-Araujo, H., Andrade, M.F.S. et al. Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis. Clin Oral Invest 22, 2495–2503 (2018). https://doi.org/10.1007/s00784-018-2344-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-018-2344-y