Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Case Selection
- -
- Inclusion criteria: Endodontically treated mandibular molar with its root growth completed, which had to be fully included in CBCT’s imaging range, with clear and complete images available.
- -
- Exclusion criteria: Presence of periodontitis at least in a moderate stage. Diagnosis of conditions other than pulpal or periapical lesions (such as fibro-osseous lesions, benign neoplasms, oral cancer, etc.). Difficulty in radiographic interpretation due to metal artifacts associated with the tooth.
2.2. CBCT Analysis
2.2.1. An Anatomical Factor: Root Canal Morphology Classification
2.2.2. Treatment Factors: Intra- and Post-Operative Factors
Factor | Description | |
---|---|---|
Obturation density [1] | Good | Homogeneous radiopaque material and no visible space. No more than 2 small voids (<1 mm) |
Poor | Non-uniform radiodensity, with the canal space visible laterally and apically. Isthmus area that had not been treated (Figure 3a) | |
Missed canals [18] | Unfilled canals appearing from cemento-enamel junction to apex including canals splitting from a main canal at coronal, mid, or apical third (Figure 3b) | |
Obturation level [1] | Obturation level of a filling material was measured in millimeters relative to the radiographic apex | |
Normal | Fillings within 2 mm short of the radiographic apex | |
Abnormal | Fillings more than 2 mm short of the radiographic apex. Excess root filling. Sealer extrusion | |
Iatrogenic problems | File separation. Perforation (present/absent) (Figure 3c,d) | |
Coronal restoration [18] | Adequate | Any permanent restoration that appeared intact radiographically and had no comment on the clinical examination record |
Inadequate | Any permanent restoration with detectable radiographic signs of overhangs, open margins, or recurrent caries or comments such as “ill-fitting margin” or “secondary dental caries” on the clinical examination record |
2.3. Statistical Analysis
3. Results
3.1. An Anatomical Factor: The Root Canal Morphology
3.2. Intra- and Post-Operative Treatment Factors: Missed Canals, Obturation Length, Obturation Density, Iatrogenic Problems, and Coronal Restoration
3.3. The Correlation between an Anatomical Factor and Treatment Factors
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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C-Shaped N = 77 (100%) | Non C-Shaped N = 73 (100%) | Total N = 150 | |
---|---|---|---|
Success | 20 (26%) | 30 (41.1%) | 50 |
Failure | 57 (74%) | 43 (58.9%) | 100 |
x2(p) | 3.856 (p = 0.05) |
Treatment Factor | N | Endodontic Outcome | |
---|---|---|---|
Success (N = 50) | Failure (N = 100) | ||
Missed canal | |||
Present | 46 | 8 (17.4%) | 38 (82.6%) |
Absent | 104 | 42 (40.4%) | 62 (59.6%) |
Obturation length | |||
Adequate | 107 | 44 (41.1%) | 63 (58.9%) |
Inadequate | 42 | 6 (14.3%) | 36 (85.7%) |
Obturation density | |||
Poor | 80 | 18 (22.5%) | 62 (77.5%) |
Good | 70 | 32 (45.7%) | 38 (54.3%) |
Iatrogenic problem | |||
Present | 9 | 3 (33.3%) | 6 (66.7%) |
Absent | 141 | 47 (33.3%) | 94 (66.7%) |
Coronal restoration | |||
Adequate | 75 | 35 (46.7%) | 40 (53.3%) |
Inadequate | 71 | 15 (21.1%) | 56 (78.9%) |
Endodontic Failure | |||||
---|---|---|---|---|---|
B | S.E. | Wald | p | Exp (B) | |
C configuration | 0.115 | 0.504 | 0.053 | 0.819 | 1.122 |
Missed canal | 1.132 | 0.478 | 5.606 | 0.018 * | 3.103 |
Obturation length | 1.068 | 0.533 | 4.019 | 0.045 * | 2.909 |
Obturation density | 0.572 | 0.508 | 1.267 | 0.260 | 1.772 |
Iatrogenic events | −0.110 | 0.819 | 0.018 | 0.893 | 0.896 |
Coronal leakage | 1.117 | 0.405 | 7.619 | 0.006 * | 3.057 |
C-Shaped | Non C-Shaped | X2 | p-Value | |
---|---|---|---|---|
Missed canal (N = 46) | 25 (54.3%) | 21 (45.7%) | 0.241 | 0.623 |
Inadequate obturation length (N = 42) | 26 (61.9%) | 16 (38.1%) | 2.450 | 0.118 |
Poor obturation density (N = 80) | 65 (81.3%) | 15 (18.7%) | 61.416 | <0.001 * |
Iatrogenic problem (N = 9) | 3 (33.3%) | 6 (66.7%) | 0.318 † |
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Park, D.-M.; Seok, W.-H.; Yoon, J.-Y. Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis. J. Clin. Med. 2024, 13, 2931. https://doi.org/10.3390/jcm13102931
Park D-M, Seok W-H, Yoon J-Y. Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis. Journal of Clinical Medicine. 2024; 13(10):2931. https://doi.org/10.3390/jcm13102931
Chicago/Turabian StylePark, Da-Min, Woo-Hyun Seok, and Ji-Young Yoon. 2024. "Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis" Journal of Clinical Medicine 13, no. 10: 2931. https://doi.org/10.3390/jcm13102931
APA StylePark, D. -M., Seok, W. -H., & Yoon, J. -Y. (2024). Factors Influencing Non-Surgical Root Canal Treatment Outcomes in Mandibular Second Molars: A Retrospective Cone-Beam Computed Tomography Analysis. Journal of Clinical Medicine, 13(10), 2931. https://doi.org/10.3390/jcm13102931