Prevalence of Missed Canals and Their Association with Apical Periodontitis in Posterior Endodontically Treated Teeth: A CBCT Study

Abstract

Background. This study aimed to assess the prevalence of missed canals in endodontically treated teeth and their association with apical periodontitis in a Saudi Arabian population using CBCT. Materials and Methods. A total of 208 CBCT radiographs were investigated. For each tooth, radiographs of axial, coronal, and sagittal segments were acquired to appraise the external as well as the internal structure of the root canal system and apical area. In root canal-treated teeth, unfilled canals appearing from the cementoenamel junction to the apex were defined as missed untreated canals; and a periapical lesion was considered when disruption of the lamina dura was detected, and the low-density area associated with the radiographic apex was at least twice the width of the periodontal ligament space. The data were presented as frequencies and percentages. The Z-test was used to analyze the differences in proportions with the significance level set at P value <0.05. Results. The overall prevalence of missed canals among endodontically treated teeth was 18%. The prevalence of missed canals was higher in maxillary first molars with 40.6%. The overall prevalence of apical periodontitis among teeth with missed canals was 90%. It was 84.2% in the maxilla and 100% in the mandible. The second mesiobuccal canal in the maxillary first molars and mesiobuccal and distobuccal canals in mandibular teeth were the most missed canals. Conclusion. Apical periodontitis in root canal-treated teeth with missed canals was high (90%), with most identified missed canals in maxillary and mandibular first molars.

Prevalence of Endodontically Treated Premolars and Molars With Untreated Canals and Their Association With Apical Periodontitis Using Cone-Beam Computed Tomography

“…Hoen and Pink [ 8 ] detected untreated canals in 42% of all non-surgically retreated teeth. Moreover, Karabucak et al [ 7 ] reported a 23% overall frequency, while Mashyakhy et al [ 19 ] found an 18% overall prevalence of untreated canals. Costa et al [ 6 ] and Baruwa et al [ 5 ] found a lower prevalence of 12%.…”

“…Baruwa et al [ 5 ] and Karabucak et al [ 7 ] reported 82.6% and 82.8% of untreated canals associated with AP, respectively. Furthermore, Mashyakhy et al [ 19 ] and Costa et al [ 6 ] found a very high incidence of AP (90% and 98%, respectively) among teeth with untreated canals. All previous investigations [ 5 - 7 , 19 ] have illustrated a strong association between untreated canals and AP compared to the current findings.…”

“…Maxillary molars exhibit a complicated root canal system with two canals in the mesiobuccal root (the second one is known as MB2) [ 38 - 41 ]. Previous investigations have reported that the mesiobuccal root has the highest incidence of untreated canals at 62.8%, 85%, 65%, and 61%, respectively [ 5 - 7 , 19 ]. These findings are comparable to our findings where 22 (84.6%) of the mesiobuccal canals in maxillary molars had untreated canals (Table 4 ).…”

“…In mandibular teeth, most untreated canals were the mesiobuccal ones in the seven first molars (31.8%), and eight second molars (36.4%). In contrast, a recent investigation on mandibular first molars revealed that 27.3% of untreated canals were in the mesiobuccal canals [ 19 ]. The increased incidence of untreated mesiobuccal canals in mandibular first molars in the current investigation might be attributed to the larger sample size compared to other studies (31.8% vs. 27.3%) [ 19 ].…”

“…However, there is a lack of data within Middle Eastern countries, especially Saudi Arabia [ 6 , 7 , 18 ]. A recent investigation was conducted in Jazan, Saudi Arabia, utilizing CBCT to assess the prevalence of untreated canals and their association with AP [ 19 ]. This research sheds light on the importance of understanding root canal geometry before initiating endodontic therapy, as well as identifying the most likely canals to be missed and treating them properly.…”