Prevalence of Technical Errors and Their Relationship with Periapical Radiolucencies in Endodontically Treated Teeth: A CBCT Analysis

Imaging advancements such as introduction of cone-beam computed tomography (CBCT) provides the possibility of viewing the tooth in different planes and as a result, a more detailed examination of the internal anatomy of the tooth and intra-operative mishaps. The aim of this study was to evaluate the prevalence of technical errors and periapical radiolucencies in endodontically treated teeth by means of CBCT images.

Methods and Materials:

 A number of 235 CBCT images were obtained from Iranian patients (93 males; 142 females;mean age = 45.36 years). A total of 737 teeth (1141 root canals) were examined for periapical radiolucency, coronal restoration, and endodontic treatment quality (length of obturation, homogeneity of obturation, and presence of technical errors). Prevalence and correlation between tooth group, age and gender distribution were analyzed statistically with chi-square test. The level of significance was considered as 0.05.

Overall, 623 root canals (44.1%) contained technical errors. A number of 291 case for underfilling (20.6%), 120 missed canal (8.5%), 99 overfilling (7%) and 82 non-homogenous obturation (5.8%) were the most prevalent errors, respectively. Maxillary molars showed the highest number of errors (P-value=0.001). 45.1% of root canals had periapical radiolucencies. Maxillary molars were also associated with the most periapical radiolucencies. 62 teeth lacked proper restoration. Perforation, root resorption, root fracture and deviation were observed in less than 2% of root canals.

Endodontic errors and accidents are relatively common in endodontically treated teeth. The prevalence of periapical radiolucencies increases when endodontic errors and procedural accidents are present. Underfilling, missed canal, overfilling and non-homogenous obturation were the most prevalent errors found. Maxillary molars were mostly associated with these errors and accidents.