25 February 2020

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Untreated root canals and failure in endodontics

Simona Chirico

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An untreated root canal is one of the main causes of failure in endodontics. Absence of disinfection and shaping of a root canal can determine the presence of a reservoir of bacteria, which may lead to a persistent apical periodontitis and may have an impact on the treatment outcome. An untreated canal in an endodontically treated tooth could be a result of an operator’s limited knowledge of tooth anatomy, complexities in canal configuration, or procedural errors (such as inadequate access cavity design). 

So which is the influence between an untreated canal and its association with the presence of periapical lesions that causes endodontics faiulre? Baruwa et. al try to answer to this question, in their study published on the Journal of Endodontics in January 2020. 

Materials and Methods
1160 preexisting cone-beam computed tomographic scans from 8 different health centers were assessed between January 2018 and December 2018 by 5 independently calibrated observers. 2305 endodontically treated teeth were identified in a sample of 20,836 teeth (27,046 roots). All endodontically treated teeth were evaluated for the presence or absence of missed root canals and periapical lesions.
The z test for proportions was used to analyze differences between groups, and an odds ratio was calculated in order to analyze the association between missed canals and lesions. P<.05 was considered statistically significant. 

Results
The prevalence of missed canals was 12.0%. Teeth with periapical pathology due to untreated canals were 82.6% of the cases.
Mesiobuccal root of the maxillary first molar was the most untreated canal in the 62.8% of cases and in these situation 75,2% of cases show an association with periapical lesions in 75.2% of cases. Maxillary molar mesiobuccal roots presenting with a missed canal were 3.1 times more likely to be associated with periapical pathology than maxillary molars with all canals identified and treated. 

Conclusions
Considering this study, there’s an high prevalence of periapical lesions when we have missed and untreated canals that causes endodontics failure. This influences the prognosis of an endodontically treated teeth. For this reason is so important to have knowledge about teeth anatomy, root canal configurations and possible variations, before starting an endodontic treatment

For additional informations: The Influence of Missed Canals on the Prevalence of Periapical Lesions in Endodontically Treated Teeth: A Cross-sectional Study