Şahin Pelinsu, Gündüz Hüseyin
Department of Endodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey.
Department of Endodontics, Faculty of Dentistry, Bilecik Şeyh Edebali University, Bilecik, Turkey.
Oral Radiol. 2025 Jul 12. doi: 10.1007/s11282-025-00844-z.
This study investigated the relationship between root canal treatment quality and the development and severity of periapical radiolucency in maxillary and mandibular molars using cone beam computed tomography (CBCT).
A retrospective analysis was conducted on CBCT images of 396 maxillary and mandibular first and second molars. High-quality imaging records confirmed the absence of preoperative periapical lesions, with root canal treatments performed at least 4 years prior. The Periapical and Endodontic Status Scale was used to evaluate root canal filling length and homogeneity, coronal restoration seal, treatment complications, lesion size, relationship between root and lesion, and bone destruction location across axial, sagittal, and coronal CBCT sections.
Endodontic treatment quality significantly influenced periapical lesion development, lesion size, relationship between root and lesion, and bone destruction location (p < 0.05). The prevalence of periapical radiolucencies was higher in teeth with short root canal fillings, inadequate filling homogeneity, insufficient coronal restorations, root perforations, or missed canals (p < 0.05). Larger lesions (> 5 mm) correlated with short root canal fillings, inadequate filling homogeneity, and inadequate restorations, which were also associated with cortical bone destruction and furcation involvement (p < 0.05). Apical radiolucency was more frequently observed in mandibular first molars than in second molars, with the lesions tending to be smaller, involving multiple roots, and located around the root structures.
This study highlights the critical influence of endodontic treatment quality on periapical lesion development, lesion size, relationship between root and lesion, and bone destruction location. Increased lesion severity compromises retreatment success, underscoring the importance of understanding periapical radiolucency risk factors for improved outcomes.
本研究利用锥形束计算机断层扫描（CBCT）调查上颌和下颌磨牙根管治疗质量与根尖周透射影的发生及严重程度之间的关系。
对396颗上颌和下颌第一、第二磨牙的CBCT图像进行回顾性分析。高质量成像记录证实术前不存在根尖周病变，根管治疗至少在4年前进行。使用根尖周和牙髓状态量表评估根管充填长度和均匀性、冠部修复体封闭性、治疗并发症、病变大小、牙根与病变的关系以及轴向、矢状和冠状CBCT断层上的骨破坏位置。
牙髓治疗质量显著影响根尖周病变的发生、病变大小、牙根与病变的关系以及骨破坏位置（p < 0.05）。根管充填短、充填均匀性不足、冠部修复体不足、根管穿孔或遗漏根管的牙齿根尖周透射影的发生率更高（p < 0.05）。较大的病变（> 5 mm）与根管充填短、充填均匀性不足和修复体不足相关，这些也与皮质骨破坏和根分叉受累有关（p < 0.05）。下颌第一磨牙比第二磨牙更常观察到根尖透射影，病变往往较小，累及多个牙根，并位于牙根结构周围。
本研究强调了牙髓治疗质量对根尖周病变发生、病变大小、牙根与病变的关系以及骨破坏位置的关键影响。病变严重程度增加会影响再治疗成功率，强调了解根尖周透射影风险因素对改善治疗结果很重要。
