Apical periodontitis in endodontically-treated teeth, association between the presence of missed canals and the quality of endodontic treatment in a Colombian population: A Cross-sectional study

Abstract

Objective: A high prevalence of post-treatment-apical periodontitis has been evidenced in 2D studies, associated to variables commonly evaluated as quality of endodontic treatment; currently, using CBCT the presence of missed canals is also one of the relevant variables associated to the failure of endodontic treatment. The objective was to evaluate the quality of endodontic treatment and the frequency of missed canals associated with teeth presenting apical periodontitis (AP) through CBCT in a Colombian sub-population. Methods: A cross-sectional study was conducted. CBCT scans with endodontically treated tooth (n = 318), were selected from 1100 exams from Colombian individuals between January 2017 and January 2020. The scans were taken using J Morita X550 CBCT Scanners (J Morita Corporation, Osaka, Japan), with voxel size between 0.125 and 0.20 mm. All endodontically treated teeth were analyzed for quality of treatment, the presence of missed canals and AP. All samples were independently analyzed by two endodontics specialists and an oral and maxillofacial radiology specialist. Chi-square or Fisher`s test and odds ratio calculation were applied to identify the association and risk relationship between the presence of AP and the study variables; P values <0.05 were considered statistically significant.Results: Missed canals were found in 18.61% (86/462) and 95.3% were associated with AP. The frequency of AP was 62.34% (288/462) for all the evaluated teeth. AP was found in 27.43 % (79/462) of the teeth with adequate endodontic treatment in contrast with 72.57% (209/462) of the teeth with inadequate ones (P < 0.01). The frequency of missed canals was highest in upper molars with 55.23% (58/105), with 96.55% presenting with AP. The second mesiobuccal canal was the most frequently missed canal, 88.52% (54/61), with AP in 90.74% (49/54) of the cases. Conclusion: There was a high risk of teeth with missed canal presenting AP. More than half of the teeth with missed canals were maxillary molars, the MB2 the most frequent missed canal, with apical periodontitis.