The Prevalence of Missed Canals and their Association with Apical Periodontitis in Medina Population: A CBCT Study

Abstract

Background: The study examines the critical role of thorough root canal treatment (RCT) in preventing endodontic failure, often resulting from undetected canals. Missed canals can harbor persistent infections, leading to apical periodontitis—an inflammatory condition affecting the tissues surrounding the root. This research underscores the limitations of traditional radiographs in identifying these missed canals and emphasizes the advantages of cone beam computed tomography (CBCT), which offers a more precise, three-dimensional perspective of the root canal system. The study aims to evaluate the prevalence of missed canals and their association with apical periodontitis within the Medina population using CBCT. Methods: The materials and methods section of the study describes a cross-sectional analysis conducted on cone beam computed tomography (CBCT) scans collected retrospectively from multiple hospitals in Medina between 2018 and 2023. The study included CBCT scans that featured at least one endodontically treated tooth, excluding those with no evidence of previous treatment, or with poor quality images. The scans were independently reviewed by two dentists to identify missed canals and the presence of apical periodontitis, with a third expert consulted in cases of uncertainty. Data collected included tooth number, the presence or absence of missed canals, the number of orifices, and the presence or absence of periapical radiolucency. The data were analyzed using SPSS software, with results presented as frequencies and percentages, and significance set at a p-value of less than 0.05. Results: The results of the study showed that the maxillary first molars (U6) had the highest prevalence of missed canals, accounting for 40.12% of the total missed canals, followed by the mandibular first molars (L6) at 18.83%. The second mesiobuccal (MB2) canals were the most commonly missed, comprising 35.8% of all missed canals. Additionally, 54% of the teeth with missed canals were associated with periapical lesions, indicating a strong link between missed canals and apical periodontitis. Teeth with multiple orifices had a significantly higher likelihood of missed canals, with 15.7% of such teeth showing missed canals, compared to 3.2% in teeth with single orifices. The study highlights the importance of thorough canal identification and advanced imaging techniques in preventing treatment failures in endodontics. Conclusion: In conclusion, this study reveals a notable prevalence of missed canals in endodontically treated teeth, particularly in maxillary and mandibular first molars among the Medina population. The findings show a strong link between missed canals and the occurrence of apical periodontitis, highlighting the crucial need for comprehensive canal identification during root canal procedures. Advanced imaging methods, such as CBCT, play an essential role in enhancing the detection of missed canals, thereby improving treatment outcomes and minimizing the risk of post-treatment complications. The study also underscores the importance of continuous education and specialized training for dental professionals to better manage complex canal anatomies and reduce the occurrence of missed canals. Future research should extend these findings to larger populations and examine additional factors, such as clinician experience, to further enhance endodontic success rates.