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Abstract

Background: Missed root canals are common and can cause persistent periapical disease, making the assessment of their prevalence essential for improving diagnostic accuracy and treatment outcomes. This study aimed to investigate the prevalence of missed canals and evaluate their association with periapical lesions in root canal–treated teeth in the Makkah population.

Methods: This retrospective cross-sectional study analysed 815 cone-beam computed tomography scans obtained from Umm Al-Qura University between 2019 and 2024. Missed canals and their association with periapical lesions were assessed by two independent observers. Statistical analysis was performed using the chi-square test.

Results: Missed canals were detected in 21% of maxillary and 14.2% of mandibular root canal–treated teeth. A highly significant association was observed among maxillary teeth (p < 0.001), whereas no statistically significant association was found for mandibular teeth (p = 0.25). Periapical lesions were present in 77.9% of maxillary teeth and 69.2% of mandibular teeth with missed canals.

Conclusions: Missed canals are common in root canal–treated teeth in the Makkah diverse population and are strongly associated with a high prevalence of periapical lesions. Meticulous canal detection and consideration of population-specific anatomical variations are essential to reduce missed canals, prevent periapical pathology, and enhance endodontic treatment outcomes.

References

  1. Clarke P, Jones ADC, Jarad F, Albadri S. Technical outcome of root canal treatment on permanent teeth in children: a retrospective study. Eur Arch Paediatr Dent. 2015;16:409–15.
  2. Witherspoon DE, Small JC, Regan JD. Missed canal systems are the most likely basis for endodontic retreatment of molars. Tex Dent J. 2013;130(2):127–39.
  3. Estrela C, Bueno MR, Couto GS, Rabelo LEG, Alencar AHG, Silva RG, et al. Study of root canal anatomy in human permanent teeth in a subpopulation of Brazil's center region using cone-beam computed tomography-part 1. Braz Dent J. 2015;26(5):530–6.
  4. Tronstad L, Asbjørnsen K, Døving L, Pedersen I, Eriksen H. Influence of coronal restorations on the periapical health of endodontically treated teeth. Dent Traumatol. 2000;16(5):218–21.
  5. Marending M, Peters OA, Zehnder M. Factors affecting the outcome of orthograde root canal therapy in a general dentistry hospital practice. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(1):119–24.
  6. Cantatore G, Berutti E, Castellucci A. Missed anatomy: frequency and clinical impact. Endod Topics. 2009;15(1):3–31.
  7. Rouhani A, Aboutorabzadeh SM, Reyhani M, Kheirabadi N, Mortazavi S, Navabi S. Prevalence of missed canals in endodontically treated teeth: A cone-beam computed tomography study. J Clin Exp Dent. 2023;15(8):e605–11.
  8. Alghamdi F, Shakir M. The influence of Enterococcus faecalis as a dental root canal pathogen on endodontic treatment: a systematic review. Cureus. 2020;12(3):e7257.
  9. Nair PNR. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006;39(4):249–81.
  10. Ping Y, Wang J, Liang J. Pyrosequencing analysis of apical microbiota of teeth with persistent apical periodontitis. J Dent Sci. 2015;10(4):365–71.
  11. Zargar N, Khosravi K, Zadsirjan S, Safi Y, Vatankhah M, Baghban AA, et al. 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.
  12. Peña-Bengoa F, Cáceres C, Niklander SE, Meléndez P. Association between second mesiobuccal missed canals and apical periodontitis in maxillary molars of a Chilean subpopulation. J Clin Exp Dent. 2023;15(3):e173–6.
  13. Baruwa AO, Martins JN, Meirinhos J, Pereira B, Gouveia J, Quaresma SA, et al. The influence of missed canals on the prevalence of periapical lesions in endodontically treated teeth: a cross-sectional study. J Endod. 2020;46(1):34–9.e1.
  14. Costa FFNP, Pacheco‐Yanes J, Siqueira JF, Oliveira ACS, Gazzaneo I, Amorim CA, et al. Association between missed canals and apical periodontitis. Int Endod J. 2019;52(4):400–6.
  15. Ebrahimi R, Khajeh S, Paik H, Moradi M, Khosravi MR. Prevalence of untreated canals and their association with periapical periodontitis using cone-beam computed tomography. Iran Endod J. 2024;19(3):208–15.
  16. Ureyen Kaya B, Kececi AD, Guldas HE, Orhan H. A retrospective radiographic study of coronal-periapical status and root canal filling quality in a selected adult Turkish population. Med Princ Pract. 2013;22(4):334–9.
  17. Tsuneishi M, Yamamoto T, Yamanaka R, Tamaki N, Sakamoto T, Tsuji K,, et al. Radiographic evaluation of periapical status and prevalence of endodontic treatment in an adult Japanese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(5):631–5.
  18. Karobari MI, Batul R, Khan M, Patil SR, Basheer SN, Rezallah NNF, Luke AM, et al. Micro computed tomography (Micro-CT) characterization of root and root canal morphology of mandibular first premolars: a systematic review and meta-analysis. BMC Oral Health. 2024;24(1):1.
  19. de Paula-Silva FWG, Wu MK, Leonardo MR, da Silva LAB, Wesselink PR. Accuracy of periapical radiography and cone beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard. J Endod. 2009;35(7):1009–12.
  20. Patel S, Wilson R, Dawood A, Mannocci F. The detection of periapical pathosis using periapical radiography and cone beam computed tomography—part 1: pre-operative status. Int Endod J. 2012;45(8):702–10.
  21. Fadhil NH, Ali AH, Al Hashimi RA, Al-Qathi OS, Foschi F. Assessment of Treatment Quality Risk Factors Influencing the Radiographic Detection of Apical Periodontitis in Root-Filled Teeth: A Retrospective CBCT Analysis. Eur Endod J. 2024;9(3):252–9.
  22. Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod. 2008;34(3):273–9.
  23. Song M, Kim H-C, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod. 2011;37(11):1516–9.
  24. Huumonen S, Kvist T, Gröndahl K, Molander A. Diagnostic value of computed tomography in re-treatment of root fillings in maxillary molars. Int Endod J. 2006;39(10):827–33.
  25. do Carmo WD, Verner FS, Aguiar LM, Visconti MA, Ferreira MD, Lacerda MFLS, et al. Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography. Clin Oral Investig. 2021;25(4):2317–23.
  26. Hoen MM, Pink FE. Contemporary endodontic retreatments: an analysis based on clinical treatment findings. J Endod. 2002;28(12):834–6.
  27. Alotaibi BB, Khan KI, Javed MQ, Dutta SD, Shaikh SS, Almutairi NM. Relationship between apical periodontitis and missed canals in mesio-buccal roots of maxillary molars: CBCT study. J Taibah Univ Med Sci. 2024;19(1):18–27.
  28. Mashyakhy M, Hadi FA, Alhazmi HA, Alfaifi RA, Alabsi FS, Bajawi H, et al. Prevalence of missed canals and their association with apical periodontitis in posterior endodontically treated teeth: A CBCT study. Int J Dent. 2020;2021(1):9962429.
  29. Bürklein S, Schäfer E, Jöhren HP, Donnermeyer D. Quality of root canal fillings and prevalence of apical radiolucencies in a German population: a CBCT analysis. Clin Oral Investig. 2020;24(3):1217–27.
  30. Matherne RP, Angelopoulos C, Kulild JC, Tira D. Use of cone-beam computed tomography to identify root canal systems in vitro. J Endod. 2008;34(1):87–9.
  31. Muzaffar MA, Ahmed A, Ulfat H, Bhatti U, Muhammad, Khan K. An assessment of morphological patterns and number of canals in mesiobuccal root of maxillary second molars in our patients: Analyzed by cone beam computed tomography. Isra Med J. 2022;14(1):7–11.
  32. Buchanan GD, Gamieldien MY, Fabris-Rotelli I, van Schoor A, Uys A. A study of mandibular premolar root and canal morphology in a black South African population using cone-beam computed tomography and two classification systems. J Oral Sci. 2022;64(4):300–6.
  33. Karabucak A, Bunes C, 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(4):538–41.
  34. Kartal N, Yanikoğlu FC. Root canal morphology of mandibular incisors. J Endod. 1992;18(11):562–4.
  35. Ahmed HM, Hashem AA. Accessory roots and root canals in human anterior teeth: a review and clinical considerations. Int Endod J. 2016;49(8):724–6.
  36. Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J. 1995;28(1):12–8.
  37. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1984;58(5):589–99.
  38. Calişkan MK, Pehlivan Y, Sepetçioğlu F, Türkün M, Tuncer SS. Root canal morphology of human permanent teeth in a Turkish population. J Endod. 1995;21(4):200–4.
  39. 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(3):405–15.
  40. Ridell K, Petersson A, Matsson L, Mejàre I. Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults. A retrospective study. Acta Odontol Scand. 2006;64(2):104–10.
  41. Sert S, Bayirli GS. Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population. J Endod. 2004;30(6):391–8.
  42. Kim SY, Kim BS, Kim Y. Mandibular second molar root canal morphology and variants in a Korean subpopulation. Int Endod J. 2016;49(2):136–44.
  43. Mohara NT, Coelho MS, De Queiroz NV, et al. Root anatomy and canal configuration of maxillary molars in a Brazilian subpopulation: a 125-μm cone-beam computed tomographic study. Eur J Dent. 2019;13(1):82–7.
  44. Al-Shehri S, Al-Nazhan S, Shoukry S, Al-Shwaimi E, Al-Sadhan R, Al-Shemmery B. Root and canal configuration of the maxillary first molar in a Saudi subpopulation: a cone beam computed tomography study. Saudi Endod J. 2017;7:69–76.

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