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

Abstract

Endodontic technical errors are the foremost cause of treatment failure. A thorough understanding of root canal configuration (RCC) is essential to prevent these iatrogenic errors. This study used CBCT images to determine the association between root canal configuration, endodontic technical errors, and periapical status. CBCT images of 101 patients, including total of 212 obturated premolars (256 canals) were assessed. RCCs were classified according to the Vertucci system. The presence of endodontic errors and periapical lesions associated with each RCC was noted. Presence or absence of coronal restoration and its association with periapical radiolucency was recorded. The most frequent RCC was Type I (199 cases; 77.73%), followed by Type II (26 cases; 10.15%), Type IV (22 cases; 8.59%), Type V (4 cases; 1.56%), Type III (4 cases; 1.56%), and Type VI (1 case; 0.39%). Under-filling and non-homogeneous filling were the most common technical errors. Prevalence of periapical radiolucency was 81% in the presence of technical errors. The absence of coronal restoration caused apical lesions in 93% of cases. The frequency of endodontic technical errors increased as the root canal configurations became more complex. Periapical lesions occurred more often in teeth with endodontic errors and/or absent coronal restoration.

Keywords: cone-beam computed tomography; endodontic errors; endodontics; oral diseases; oral health; oral radiology; root canal configuration.

Figure 1

Sections of CBCT showing root canal treatment of two premolars with Type II canal configuration: (A) Sagittal section showing root canal treatment of a type II premolar without technical endodontic error; (B) sagittal section showing defective root canal treatment of a Type II premolar with a missed untreated canal (red arrow); and (C) cross-sectional view of the same premolar tooth showing missed untreated canal (red arrow).

Figure 2

Sections of CBCT showing cases of different RCC of premolar teeth with different technical endodontic errors: (A) Sagittal section of treated premolar tooth with extruded overfilled material; (B) coronal section of treated premolar tooth with short root canal obturation; (C) sagittal section of treated premolar tooth showing deviation from the original path; (D) coronal section of treated premolar tooth showing non-homogeneous root canal obturation; (E) coronal section of treated premolar tooth with defective coronal seal.