DOI QR코드

DOI QR Code

Procedural errors detected by cone beam tomography in cases with indication for retreatment: in vivo cross-sectional study

  • Henry Paul Valverde Haro (Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO)) ;
  • Carmen Rosa Garcia Rupaya (Postgraduate Program in Dentistry, Cayetano Heredia University) ;
  • Flavio R. F. Alves (Department of Dental Research, Faculty of Dentistry, Iguacu University (UNIG))
  • Received : 2024.04.24
  • Accepted : 2024.06.05
  • Published : 2024.08.31

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.

Keywords

Acknowledgement

This study was supported by grants from Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazilian Governmental Institutions.

References

  1. Toia CC, Khoury RD, Corazza BJM, Orozco EIF, Valera MC. Effectiveness of 1-visit and 2-visit endodontic retreatment of teeth with persistent/secondary endodontic infection: a randomized clinical trial with 18 months of follow-up. J Endod 2022;48:4-14. https://doi.org/10.1016/j.joen.2021.09.004
  2. Gaeta-Araujo H, Fontenele RC, Nascimento EHL, Nascimento MDCC, Freitas DQ, de Oliveira-Santos C. Association between the root canal configuration, endodontic treatment technical errors, and periapical hypodensities in molar teeth: a cone-beam computed tomographic study. J Endod 2019;45:1465-1471. https://doi.org/10.1016/j.joen.2019.08.007
  3. Alamoudi RA, Alharbi AH, Farie GA, Fahim O. The value of assessing case difficulty and its effect on endodontic iatrogenic errors: a retrospective cross-sectional study. Libyan J Med 2020;15:1688916.
  4. Yagmoor M, Bakhsh A, Mandourah O, Alsofi L. Management of a radiopaque foreign body associated with a lower first premolar: a case report. Clin Case Rep 2022;10:e05465.
  5. da Cunha LZV, Solda C, Padoin K, Rigo L. Endodontic procedural errors: analysis of images from cone beam computed tomography. Forensic Imaging 2022;28:200493. 
  6. Siqueira JF Jr, Rocas IN. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod 2008;34:1291-1301.e3. https://doi.org/10.1016/j.joen.2008.07.028
  7. Pena-Bengoa F, Caceres C, Niklander SE, Melendez P. Association between second mesiobuccal missed canals and apical periodontitis in maxillary molars of a Chilean subpopulation. J Clin Exp Dent 2023;15:e173-e176. https://doi.org/10.4317/jced.60156
  8. Ballikaya E, Koc N, Avcu N, Cehreli ZC. The quality of root canal treatment and periapical status of permanent teeth in Turkish children and teens: a retrospective CBCT study. Oral Radiol 2022;38:405-415. https://doi.org/10.1007/s11282-021-00570-2
  9. Nouroloyouni A, Salem Milani A, Etminan A, Noorolouny S, Tavakkol E, Mikaieli Xiavi H, et al. Cone-beam computed tomography assessment of quality of endodontic treatment and prevalence of procedural errors in mandibular molars. Int J Clin Pract 2023;2023:3558974.
  10. Alghamdi NS, Algarni YA, Ain TS, Alfaifi HM, AlQarni AA, Mashyakhi JQ, et al. Endodontic mishaps during root canal treatment performed by undergraduate dental students: an observational study. Medicine (Baltimore) 2021;100:e27757.
  11. Fayad MI, Nair M, Levin MD, Benavides E, Rubinstein RA, Barghan S, et al. AAE and AAOMR joint position statement: use of cone beam computed tomography in endodontics 2015 update. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;120:508-512. https://doi.org/10.1016/j.oooo.2015.07.033
  12. Costa FF, Pacheco-Yanes J, Siqueira JF Jr, Oliveira ACS, Gazzaneo I, Amorim CA, et al. Association between missed canals and apical periodontitis. Int Endod J 2019;52:400-406. https://doi.org/10.1111/iej.13022
  13. Karabucak B, Bunes A, Chehoud C, Kohli MR, Setzer F. Prevalence of apical periodontitis in endodontically treated premolars and molars with untreated canal: a cone-beam computed tomography study. J Endod 2016;42:538-541. https://doi.org/10.1016/j.joen.2015.12.026
  14. Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 1971;32:271-275. https://doi.org/10.1016/0030-4220(71)90230-1
  15. Nascimento EHL, Gaeta-Araujo H, Andrade MFS, Freitas DQ. Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis. Clin Oral Investig 2018;22:2495-2503.  https://doi.org/10.1007/s00784-018-2344-y
  16. Al Yahya RS, Al Attas MH, Javed MQ, Khan KI, Atique S, Abulhamael AM, et al. Root canal configuration and its relationship with endodontic technical errors and periapical status in premolar teeth of a Saudi sub-population: a cross-sectional observational CBCT study. Int J Environ Res Public Health 2023;20:1142.
  17. Juric R, Vidmar G, Blagus R, Jan J. Factors associated with the outcome of root canal treatment-a cohort study conducted in a private practice. Int Endod J 2024;57:377-393. https://doi.org/10.1111/iej.14022
  18. Villa-Machado PA, Restrepo-Patino DM, Calvo-Trejos JP, Restrepo-Restrepo FA, Tobon-Arroyave SI, Provenzano JC, et al. Cone-beam computed tomographic and micro-computed tomographic evaluations of the root apexes of teeth with posttreatment apical periodontitis. J Endod 2020;46:1695-1701. https://doi.org/10.1016/j.joen.2020.07.009
  19. Siqueira JF Jr, Rocas IN. Present status and future directions: microbiology of endodontic infections. Int Endod J 2022;55(Supplement 3):512-530. https://doi.org/10.1111/iej.13677
  20. Pinto JC, de Faria-Vasconcelos K, Leite AF, Pedano MS, Guerreiro-Tanomaru J, Jacobs R, et al. Effect of foraminal enlargement on microcrack formation and apical transportation: a nano-CT assessment. Sci Rep 2023;13:4881.
  21. Wu MK, Fan B, Wesselink PR. Leakage along apical root fillings in curved root canals. Part I: effects of apical transportation on seal of root fillings. J Endod 2000;26:210-216. https://doi.org/10.1097/00004770-200004000-00003
  22. Hasheminia SM, Farhad A, Sheikhi M, Soltani P, Hendi SS, Ahmadi M. Cone-beam computed tomographic analysis of canal transportation and centering ability of single-file systems. J Endod 2018;44:1788-1791. https://doi.org/10.1016/j.joen.2018.09.011
  23. Wong J, Lee A, Zhang C. Diagnosis and management of apical fenestrations associated with endodontic diseases: a literature review. Eur Endod J 2021;6:25-33.
  24. Wu L, Ha WN, Decurcio DA, Estrela C, Rossi-Fedele G. Comparison of curvature severity between sagittal and coronal planes of mesiobuccal canals in permanent maxillary first molars using multiple complexity-risk criteria: a CBCT cross-sectional study of a Brazilian subpopulation. J Endod 2023;49:1682-1689.e4. https://doi.org/10.1016/j.joen.2023.09.015
  25. Wang FM, Rudman J, Walsh RM, Jalali P. A retrospective study of initial root canal treatment failure in maxillary premolars via using cone-beam computed tomography. J Am Dent Assoc 2023;154:471-478. https://doi.org/10.1016/j.adaj.2023.02.012
  26. Ayatollahi F, Tabrizizadeh M, Razavi H, Mowji M. Diagnostic value of cone-beam computed tomography and digital periapical radiography in detection of separated instruments. Iran Endod J 2019;14:14-17.
  27. Ozer SY, Ozkan G, Cetin E, Ozkan HD. A comparative study of cone-beam computed tomography and periapical radiographs in decision-making after endodontic instrument fractures. Int J Artif Organs 2017;40:510-514. https://doi.org/10.5301/ijao.5000605