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Valverde Haro HP, Rupaya CRG, Alves FRF. Procedural errors detected by cone beam tomography in cases with indication for retreatment: in vivo cross-sectional study. Restor Dent Endod 2024; 49:e26. [PMID: 39247645 PMCID: PMC11377879 DOI: 10.5395/rde.2024.49.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 09/10/2024] Open
Abstract
Objectives This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis. Materials and Methods The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling. Results The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction. Conclusions CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.
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Affiliation(s)
- Henry Paul Valverde Haro
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Postgraduate Program in Dentistry, Cayetano Heredia University, Lima, Peru
| | | | - Flávio R F Alves
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
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Arman S, Nouroloyouni A, Salem Milani A, Sheikhfaal B, Noorolouny S, Saleh Haghgou F, Xiavi HM. Prevalence of Isthmi and Root Canal Configurations in Mandibular Permanent Teeth Using Cone-Beam Computed Tomography. BIOMED RESEARCH INTERNATIONAL 2024; 2024:9969860. [PMID: 39118804 PMCID: PMC11306724 DOI: 10.1155/2024/9969860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
While root canal anatomy in Middle Eastern populations is well-studied, research on isthmi in mandibular permanent teeth from this region is limited. This retrospective study used cone-beam computed tomography (CBCT) to examine isthmi prevalence and location, as well as root canal morphologies (per Vertucci's classification) in mandibular permanent teeth from a subpopulation in Ardabil, Iran. The study is aimed at enhancing our understanding of dental anatomical variations in Middle Eastern populations. A total of 3566 teeth from 384 CBCT scans were evaluated in this retrospective study. Mandibular teeth were evaluated on sagittal, coronal, and axial sections regarding the presence of isthmus and root morphology (Vertucci's classification). CBCT scans of 197 males (51.3%) and 187 females (48.7%) were evaluated, with a mean age of 41.1 ± 11.4 years. Isthmi were most prevalent in molar mesial roots, typically located in the middle third for anterior teeth and first premolars and cervical third for posterior teeth. While gender did not play a significant role, the presence of an isthmus in the mesial root of the left second molars was associated with a younger mean patient age (p < 0.05). Root morphology varied across tooth types. Central and lateral incisors predominantly showed Vertucci's Types I and III. Canines and premolars were mostly Type I, with some variation. Molar mesial roots frequently exhibited Types IV and II, while distal roots were predominantly Type I. Statistically significant differences were found between morphology and gender in the first left premolar (Type I more common in women; Type V in men; p < 0.001) and in the right canine (Type I more prevalent in men; Types III and V more prevalent in women; p < 0.001). The results revealed wide variations in root canal morphology and a relatively high prevalence of isthmi in the study population. Our findings suggest a potential difference in tooth anatomy based on sex and a relationship between age and the presence of isthmi.
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Affiliation(s)
- Sherwin Arman
- Orofacial Pain ProgramSection of Oral MedicineOral Pathology and Orofacial PainUniversity of CaliforniaLos AngelesSchool of Dentistry, Los Angeles, California, USA
| | - Ahmad Nouroloyouni
- Orofacial Pain ProgramSection of Oral MedicineOral Pathology and Orofacial PainUniversity of CaliforniaLos AngelesSchool of Dentistry, Los Angeles, California, USA
- Department of EndodonticsSchool of DentistryArdabil University of Medical Science, Ardabil Po. Code 5618985991, Iran
| | - Amin Salem Milani
- Department of EndodonticsSchool of DentistryTabriz University of Medical Science, Tabriz Po. Code 5165665931, Iran
| | - Behzad Sheikhfaal
- Department of EndodonticsSchool of DentistryArdabil University of Medical Science, Ardabil Po. Code 5618985991, Iran
| | - Sara Noorolouny
- Department of Pediatric DentistrySchool of DentistryArdabil University of Medical Science, Ardabil Po. Code 5618985991, Iran
| | - Faraz Saleh Haghgou
- Department of RadiologyArdabil University of Medical Science, Ardabil Po. Code 5618985991, Iran
| | - Hesam Mikaieli Xiavi
- Department of RadiologyArdabil University of Medical Science, Ardabil Po. Code 5618985991, Iran
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Zargar N, Khosravi K, Zadsirjan S, Safi Y, Vatankhah M, Akbarzadeh Baghban A, Aghajani Varzaneh F. The association of endodontic prognostic factors with the presence of periapical lesion, its volume, and bone characteristics in endodontically treated molars: a cross-sectional study. BMC Oral Health 2024; 24:28. [PMID: 38183066 PMCID: PMC10771002 DOI: 10.1186/s12903-023-03818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND This study intended to evaluate the association between several endodontic prognostic factors with the presence of periapical lesions (PLs), their volume, and bone characteristics including cortical bone destruction (CBD) and buccal plate bone height (BPBH) in root-filled molar teeth using cone-beam computed tomography. METHODS A collection of 143 scans of endodontically treated maxillary/mandibular first or second molars recorded over 8 years, were obtained from a specialized radiology center. Data on prognostic factors including tooth number, gender, jaw type, the status and number of missed canals, obturation length, restoration type, presence of a separated instrument, presence of a post or screw in the canals, and presence of perforation were collected. The assessed outcomes included PL presence, PL volume, CBD, and BPBH. The association between prognostic factors and outcomes was evaluated using multiple logistic regression models with adjusted covariates and multifactorial ANOVA at a significance level of 0.05. RESULTS A total of 282 molars from 82 women and 50 men with a mean age of 40.6 ± 12.27 were included. Among those, 139 teeth presented PL with a mean volume of 18.68 mm3. CBD was prevalent in 137 teeth and the mean BPBH appeared to be 9.45 mm. The presence of a missed canal (OR = 10.022, P < .05), underfilled canal (OR = 3.725, P < .05), overfilled canal (OR = 15.859, P = .018), and perforation (OR = 15.261, P = .013) was significantly associated with PLs. None of the prognostic factors could considerably contribute to the CBD (P > .05). The presence of a missed canal was positively associated with the PL volume (P < .05). Similarly, missed canals (P < .05), perforation (P < .05), and separated instruments (P = .004) were associated with a significantly reduced BPBH. CONCLUSIONS Overfillings, perforations, missed canals, and underfillings were identified as remarkable predictors of PL, arranged in descending order of their respective impact. The only factor capable of significantly increasing the PL volume was the missed canal. In brief, obturation length errors, perforations, missed canals, and separated instruments were robustly correlated with endodontic failure, which highlights the importance of mitigating the potential for errors by following the fundamentals of endodontics.
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Affiliation(s)
- Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Khosravi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeede Zadsirjan
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Vatankhah
- School of Dentistry, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nouroloyouni A, Nazi Y, Mikaieli Xiavi H, Noorolouny S, Kuzekanani M, Plotino G, Walsh JL, Sheikhfaal B, Alyali R, Tavakkol E. Cone-Beam Computed Tomography Assessment of Prevalence of Procedural Errors in Maxillary Posterior Teeth. BIOMED RESEARCH INTERNATIONAL 2023; 2023:4439890. [PMID: 38116330 PMCID: PMC10730252 DOI: 10.1155/2023/4439890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
A range of procedural errors can occur when performing endodontic treatment on posterior teeth. These errors may decrease the success rate in endodontic practice. This study assessed the prevalence of procedural errors and the quality of endodontic treatments in maxillary molars and premolars using cone-beam computed tomography (CBCT). CBCT scans from two private radiology centers were assessed retrospectively to ensure the same calculated sample size of 327 teeth for each of the four maxillary posterior tooth types (a total of 1,308 endodontically treated teeth). Image sets were evaluated for procedural errors categorized as follows: obturation length (overfilling or underfilling by >2 mm short of the root apex), missed canals, perforations, strip perforations (with extrusion of material into the furcation area), separated instruments in the root canal space, and root fracture. Data were analyzed with SPSS version 20 (SPSS Inc., Chicago, IL, USA), and frequency data was assessed using the Monte Carlo test at the 0.05 level of significance. The procedural errors most commonly reported in the present study were from most frequent to least frequent: underfilled canals (50.0%), missed canals (27.5%), overfilled canals (12.5%), apical perforations (5.0%), separated instruments (3.1%), and root fractures (1.9%). No strip perforations (with extrusion of material into the furcation area) were seen in the study (0%). Underfilled and missed root canals were the most frequent procedural errors identified in the present study. These findings underline the importance of more consideration of critical working length management during all stages of root canal treatment, greater awareness of root canal anatomy, and the use of imaging and diagnostic devices that enhance the ability to identify and treat root canals both safely and effectively.
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Affiliation(s)
- Ahmad Nouroloyouni
- Department of Endodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | - Yousef Nazi
- Department of Endodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | | | - Sara Noorolouny
- Department of Pediatric Dentistry, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | - Maryam Kuzekanani
- Endodontology Research Center, Department Of Endodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Gianluca Plotino
- Private Practice, Grande Plotino & Torsello Studio di Odontoiatria, 00187 Rome, Italy
| | - James Laurence Walsh
- UQ Oral Health Centre, School of Dentistry, The University of Queensland, Brisbane, Australia
| | - Behzad Sheikhfaal
- Department of Endodontics, School of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Rashin Alyali
- Department of Radiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Tavakkol
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
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Nouroloyouni A, Moradi N, Salem Milani A, Noorolouny S, Ghoreishi Amin N. Prevalence and Morphology of C-Shaped Canals in Mandibular First and Second Molars of an Iranian Population: A Cone-Beam Computed Tomography Assessment. SCANNING 2023; 2023:5628707. [PMID: 37822804 PMCID: PMC10564578 DOI: 10.1155/2023/5628707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
Objectives The complex anatomy of C-shaped canals poses challenges for clinicians compared to teeth with normal root canal anatomy. This study is aimed at evaluating the frequency and morphology of C-shaped canals in the mandibular first and second molars among an Iranian population using cone-beam computed tomography (CBCT). Materials and Methods This cross-sectional study evaluated 369 CBCT scans from the archives of a radiology clinic in Ardabil, Iran. The sample included 248 mandibular first molars and 478 mandibular second molars. The presence of C-shaped canals and their classification, according to Fan et al., were evaluated at four levels: orifice, coronal, middle, and apical. Prevalence based on gender and tooth type was also assessed. Results A total of 199 (53.9%) males and 170 (46.1%) females were evaluated. C-shaped canals were found in 11 (8 males/3 females) out of 248 (4.4%) first molars and in 20 (11 males/9 females) out of 478 (3.7%) second molars. The C2 configuration was most prevalent in the orifice, coronal, and middle levels of both molar types, while C3 and C4 morphologies were most commonly found apically in the second and first molars, respectively. A significant difference in configuration was found only at the coronal level between molar types. A significant association between gender and configuration was observed only at the orifice level of the second molars. No other significant differences were found (P > 0.05). Conclusion C-shaped canal configurations should be expected in 4.4% of mandibular first molars and 3.7% of the second molars in this Iranian population, with a predominance of the C2 configuration in the orifice, coronal, and middle levels.
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Affiliation(s)
- Ahmad Nouroloyouni
- Department of Endodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | - Neda Moradi
- Department of Endodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran
| | - Amin Salem Milani
- Department of Endodontics, School of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Sara Noorolouny
- Department of Pediatric Dentistry, Ardabil University of Medical Science, Ardabil, Iran
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