Skip to main content

Advertisement

SpringerLink
Log in

The influence of apical extent of root canal obturation on endodontic therapy outcome: a systematic review

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This systematic review (SR) aimed to investigate the influence of obturation extent on the final outcome of root canal treatment (RCT), by answering the question “among patients requiring RCT on fully formed permanent teeth, is there an association between obturation extent and the final treatment outcome?”

Materials and methods

Five electronic databases and three gray literature searches were performed. Observational studies investigating the association between obturation extent and RCT outcome in fully formed permanent teeth with a minimum follow-up of 12 months were included. We evaluated the risk of bias (RoB) in with MAStARI for cohort studies. The overall quality of the evidence was assessed with the GRADE-tool.

Results

Twenty-two studies were included, 2 had high RoB, 7 moderate RoB, and 13 low RoB. Underextended obturation demonstrated increased odds of an unfavorable outcome in seven studies, in which the odds varied between 6.94 (95%CI 2.20–21.87) and 1.73 (95%CI 1.02–2.95). Overextended obturation also demonstrated this association in four studies, with odds varying from 1.90 (95%CI 1.23–2.94) to 23.00 (95%CI 5.58–94.75). Due to heterogeneity and the very low level of evidence found in the GRADE analysis, the results from this SR should be interpreted with caution.

Conclusions

Obturation extent seems to influence RCT outcome; overextended and underextended obturations showed higher chance of association with less favorable outcomes than adequate obturation; however, this association was not categorically supported.

Clinical relevance

This SR provides information about obturation extent influence on RCT outcome and guides clinicians to make evidence-based decisions during endodontic practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. European Society of Endodontology (2006) Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 39:921–930

    Article  Google Scholar 

  2. Stoll R, Betke K, Stachniss V (2005) The influence of different factors on the survival of root canal fillings: a 10-year retrospective study. J Endod 31:783–790

    Article  PubMed  Google Scholar 

  3. Sjögren U, Hägglund B, Sundqvist G, Wing K (1990) Factors affecting the long-term results of endodontic treatment. J Endod 16:498–504

    Article  PubMed  Google Scholar 

  4. Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K (2008) Outcome of primary root canal treatment: systematic review of the literature—part 2. Influence of clinical factors. Int Endod J 41:6–31

    Article  PubMed  Google Scholar 

  5. Eliyas S, Briggs PFA, Harris IR, Newton JT, Gallagher JE (2017) Development of quality measurement instruments for root canal treatment. Int Endod J 50:652–666

    Article  PubMed  Google Scholar 

  6. Ribeiro DM, Reus JC, Felippe WT et al (2017) Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta-analysis. Int Endod J 53:269–283

    Google Scholar 

  7. Eleftheriadis GI, Lambrianidis TP (2005) Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J 38:725–734

    Article  PubMed  Google Scholar 

  8. Martins JN, Marques D, Mata A, Carames J (2014) Clinical efficacy of electronic apex locators: systematic review. J Endod 40:759–777

    Article  PubMed  Google Scholar 

  9. American Association of Endodontists (2015) Glossary of endodontic terms. American Association of Endodontists, Chicago

    Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  Google Scholar 

  11. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647

    Article  PubMed  Google Scholar 

  12. Booth A, Clarke M, Ghersi D, Moher D, Petticrew M, Stewart L (2011) An international registry of systematic-review protocols. Lancet 377:108–109

    Article  PubMed  Google Scholar 

  13. Joanna Briggs Institute (2014) The meta-analysis of statistics assessment and review instrument. Joanna Briggs Institute, Adelaide

    Google Scholar 

  14. McMaster University,2015 (developed by Evidence Prime I. GRADEpro GDT: GRADEpro Guideline Development Tool [Software]

  15. Barbakow FH, Cleaton-Jones P, Friedman D (1980) An evaluation of 566 cases of root canal therapy in general dental practice 2. Postoperative observations. J Endod 6:485–489

    Article  PubMed  Google Scholar 

  16. Chugal NM, Clive JM, Spångberg LSW (2003) Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96:81–90

    Article  PubMed  Google Scholar 

  17. Farzaneh M, Abitbol S, Lawrence HP, Friedman S (2004) Treatment outcome in endodontics—the Toronto study. Phase II: initial treatment. J Endod 30:302–309

    Article  PubMed  Google Scholar 

  18. Friedman S, Abitbol S, Lawrence HP (2003) Treatment outcome in endodontics: the Toronto study. Phase 1: initial treatment. J Endod 29:787–793

    Article  PubMed  Google Scholar 

  19. Halse A, Molven O (1987) Overextended gutta-percha and Kloroperka N-O root canal fillings. Radiographic findings after 10-17 years. Acta Odontol Scand 45:171–177

    Article  PubMed  Google Scholar 

  20. Harty FJ, Parkins BJ, Wengraf AM (1970) Success rate in root canal therapy. A retrospective study of conventional cases. Brit Dent J 128:65–70

    Article  PubMed  Google Scholar 

  21. Heling I, Bialla-Shenkman S, Turetzky A, Horwitz J, Sela J (2001) The outcome of teeth with periapical periodontitis treated with nonsurgical endodontic treatment: a computerized morphometric study. Quintessence Int 32:397–400

    PubMed  Google Scholar 

  22. Hellwig E, Klimek J, Ahrens G (1982) 3-year follow-up of the success of root canal treatments done in student demonstrations. Dtsch Zahnarztl Z 37:949–953

    PubMed  Google Scholar 

  23. İlgüy D, İlgüy M, Fişekçioğlu E, Ersan N, Tanalp J, Dölekoğlu S (2013) Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years. J Dent Educ 77:502–509

    PubMed  Google Scholar 

  24. Kane AW, Sarr M, Faye B, Wadji N (1998) Long term evaluation of results of endodontic treatments of dental pulp necrosis (74 cases obturated by the monoconal technique). Dakar Med 43:216–219

    PubMed  Google Scholar 

  25. Lee AHC, Cheung GSP, Wong MCM (2012) Long-term outcome of primary non-surgical root canal treatment. Clin Oral Investig 16:1607–1617

    Article  PubMed  Google Scholar 

  26. Liang YH, Li G, Wesselink PR, Wu MK (2011) Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans. J Endod 37:326–331

    Article  PubMed  Google Scholar 

  27. Matsumoto T, Nagai T, Ida K, Ito M, Kawai Y, Horiba N, Sato R, Nakamura H (1987) Factors affecting successful prognosis of root canal treatment. J Endod 13:239–242

    Article  PubMed  Google Scholar 

  28. Peak JD, Hayes SJ, Bryant ST, Dummer PMH (2001) The outcome of root canal treatment. A retrospective study within the armed forces (Royal Air Force). Brit Dent J 190:140–144

    Article  PubMed  Google Scholar 

  29. Pirani C, Chersoni S, Montebugnoli L, Prati C (2015) Long-term outcome of non-surgical root canal treatment: a retrospective analysis. Odontology 103:185–193

  30. Ricucci D, Russo J, Rutberg M, Burleson JA, Spngberg LSW (2011) A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:825–842

    Article  PubMed  Google Scholar 

  31. Ridell K, Petersson A, Matsson L, Mejàre I (2006) Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults: a retrospective study. Acta Odontol Scand 64:104–110

    Article  PubMed  Google Scholar 

  32. Santos SMC, Soares JA, Costa GM, Brito-Júnior M, Moreira AN, de Magalhães CS (2010) Radiographic parameters of quality of root canal fillings and periapical status: a retrospective cohort study. J Endod 36:1932–1937

    Article  PubMed  Google Scholar 

  33. Smith CS, Setchell DJ, Harty FJ (1993) Factors influencing the success of conventional root canal therapy—a five-year retrospective study. Int Endod J 26:321–333

    Article  PubMed  Google Scholar 

  34. Tamarut T, Kovacevic M, Glavičič S (2006) Influence of the length of instrumentation and canal obturation on the success of endodontic therapy. A 10-year clinical follow-up. Am J Dent 19:211–216

    PubMed  Google Scholar 

  35. Tani-Ishii N, Teranaka T (2003) Clinical and radiographic evaluation of root-canal obturation with obtura II. J Endod 29:739–742

    Article  PubMed  Google Scholar 

  36. Chavez de Paz LE (2007) Redefining the persistent infection in root canals: possible role of biofilm communities. J Endod 33:652–662

    Article  PubMed  Google Scholar 

  37. Noiri Y, Ehara A, Kawahara T, Takemura N, Ebisu S (2002) Participation of bacterial biofilms in refractory and chronic periapical periodontitis. J Endod 28:679–683

    Article  PubMed  Google Scholar 

  38. Willershausen I, Callaway A, Briseno B, Willershausen B (2011) In vitro analysis of the cytotoxicity and the antimicrobial effect of four endodontic sealers. Head Face Med 7:15

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ricucci D, Langeland K (1998) Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J 31:394–409

    Article  PubMed  Google Scholar 

  40. Wu MK, Wesselink PR, Walton RE (2000) Apical terminus location of root canal treatment procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:99–103

    Article  PubMed  Google Scholar 

  41. Ricucci D, Siqueira JF (2010) Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. J Endod 36:1277–1288

    Article  PubMed  Google Scholar 

  42. Subramanian K, Mickel AK (2009) Molecular analysis of persistent periradicular lesions and root ends reveals a diverse microbial profile. J Endod 35:950–957

    Article  PubMed  Google Scholar 

  43. Borlina SC, de Souza V, Holland R, Murata SS, Gomes-Filho JE, Dezan Junior E, Marion JJC, Neto DA (2010) Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs’ teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:932–940

    Article  PubMed  Google Scholar 

  44. de Souza Filho FJ, Benatti O, de Almeida OP (1987) Influence of the enlargement of the apical foramen in periapical repair of contaminated teeth of dog. Oral Surg Oral Med Oral Pathol 64:480–484

    Article  PubMed  Google Scholar 

  45. Peters OA, Paque F (2010) Current developments in rotary root canal instrument technology and clinical use: a review. Quintessence Int 41:479–488

    PubMed  Google Scholar 

  46. Hülsmann M, Schäfer E (2009) Apical patency: fact and fiction—a myth or a must? A contribution to the discussion. Endod Pract Today 3

  47. Pereira TC, da Silva Munhoz Vasconcelos LR, Graeff MSZ et al (2018) Intratubular decontamination ability and physicochemical properties of calcium hydroxide pastes. Clin Oral Investig https://doi.org/10.1007/s00784-018-2549-0

  48. Guneser MB, Arslan D, Usumez A (2015) Tissue dissolution ability of sodium hypochlorite activated by photon-initiated photoacoustic streaming technique. J Endod 41:729–732

    Article  PubMed  Google Scholar 

  49. Hulsmann M, Hahn W (2000) Complications during root canal irrigation—literature review and case reports. Int Endod J 33:186–193

    Article  PubMed  Google Scholar 

  50. Mohammed N, Noushad MC, Balan B, Dhanesh N, Jayasheelan N, Revankar VD (2016) Apical extrusion of intracanal bacteria following use of two engine-driven instrumentation techniques: an in vitro study. J Contemp Dent Pract 17:939–942

    Article  PubMed  Google Scholar 

  51. Ounsi HF, Nassif W, Grandini S, Salameh Z, Neelakantan P, Anil S (2017) Evolution of nickel-titanium alloys in endodontics. J Contemp Dent Pract 18:1090–1096

    Article  PubMed  Google Scholar 

  52. Moinzadeh AT, Shemesh H, Neirynck NA, Aubert C, Wesselink PR (2013) Bisphosphonates and their clinical implications in endodontic therapy. Int Endod J 46:391–398

    Article  PubMed  Google Scholar 

  53. Capar ID, Arslan H (2016_ A review of instrumentation kinematics of engine-driven nickel-titanium instruments. Int Endod J 49:119–135, 2016

  54. Imura N, Pinheiro ET, Gomes BP et al (2007) The outcome of endodontic treatment: a retrospective study of 2000 cases performed by a specialist. J Endod 33:1278–1282

    Article  PubMed  Google Scholar 

  55. Alves FR, Coutinho MS, Goncalves LS (2014) Endodontic-related facial paresthesia: systematic review. J Can Dent Assoc:80:e13

  56. Gluskin AH (2005) Mishaps and serious complications in endodontic obturation. Endod Top 12:52–70

    Article  Google Scholar 

  57. Gonzalez-Martin M, Torres-Lagares D, Gutierrez-Perez JL, Segura-Egea JJ (2010) Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal. J Endod 36:1419–1421

    Article  PubMed  Google Scholar 

  58. Koseoglu BG, Tanrikulu S, Subay RK, Sencer S (2006) Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:803–806

    Article  PubMed  Google Scholar 

  59. Orstavik D, Kerekes K, Eriksen HM (1986) The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 2:20–34

    Article  PubMed  Google Scholar 

  60. Plascencia H, Cruz A, Palafox-Sanchez CA et al (2017) Micro-CT study of the root canal anatomy of maxillary canines. J Clin Exp Dent 9:e1230–e1236

    Article  PubMed  PubMed Central  Google Scholar 

  61. Marceliano-Alves M, Alves FR, Mendes DM, Provenzano JC (2016) Micro-computed tomography analysis of the root canal morphology of palatal roots of maxillary first molars. J Endod 42:280–283

    Article  PubMed  Google Scholar 

  62. ElAyouti A, Hulber JM, Judenhofer MS et al (2014) Apical constriction: location and dimensions in molars—a micro-computed tomography study. J Endod 40:1095–1099

    Article  PubMed  Google Scholar 

  63. Tomaszewska IM, Leszczynski B, Wrobel A, Gladysz T, Duncan HF (2018) A micro-computed tomographic (micro-CT) analysis of the root canal morphology of maxillary third molar teeth. Ann Anat 215:83–92

    Article  PubMed  Google Scholar 

  64. Salineiro FCS, Kobayashi-Velasco S, Braga MM, Cavalcanti MGP (2017) Radiographic diagnosis of root fractures: a systematic review, meta-analyses and sources of heterogeneity. Dentomaxillofac Radiol 46:20170400. https://doi.org/10.1259/dmfr.20170400

    Article  PubMed  PubMed Central  Google Scholar 

  65. Leonardi Dutra K, Haas L, Porporatti AL, Flores-Mir C, Nascimento Santos J, Mezzomo LA, Corrêa M, de Luca Canto G (2016) Diagnostic accuracy of cone-beam computed tomography and conventional radiography on apical periodontitis: a systematic review and meta-analysis. J Endod 42:356–364

    Article  PubMed  Google Scholar 

  66. SEDENTEXCT (2012) Radiation protection: cone beam ct for dental and maxillofacial radiology. Evidence based guidelines. http://www.sedentexct.eu/files/radiation_protection_172.pdf. Accessed 22 January 2018

Download references

Funding

This study was financed in part by the Coordenação deAperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. FWM is supported by the Fundação de Amparo à Pesquisa e Invovação do Estado de Santa Catarina (FAPESC) [grant number 88887.200724/2018-00]

Author information

Authors and Affiliations

  1. Postgraduate program in Dentistry, Federal University of Santa Catarina—Florianópolis, Florianópolis, Santa Catarina, Brazil

    Fernanda Weber Mello & Andressa Fernanda Paza Miguel

  2. Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil

    Dayane Machado Ribeiro, André Luís Porporatti, Lucas da Fonseca Roberti Garcia & Kamile Leonardi Dutra-Horstmann

  3. Department of Endodontics, Island’s Dentistry Studies Center, Florianópolis, Brazil

    Bráulio Pasternak Jr

  4. School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Carlos Flores-Mir

  5. Department of Clinical Dentistry/Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI, USA

    Ana Cristina Andrada

Authors
  1. Fernanda Weber Mello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andressa Fernanda Paza Miguel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dayane Machado Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bráulio Pasternak Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. André Luís Porporatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Flores-Mir
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ana Cristina Andrada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lucas da Fonseca Roberti Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kamile Leonardi Dutra-Horstmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernanda Weber Mello.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This work does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 22 kb)

ESM 2

(DOCX 58 kb)

ESM 3

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mello, F.W., Miguel, A.F.P., Ribeiro, D.M. et al. The influence of apical extent of root canal obturation on endodontic therapy outcome: a systematic review. Clin Oral Invest 23, 2005–2019 (2019). https://doi.org/10.1007/s00784-019-02897-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-019-02897-x

Keywords

Search

Navigation