The Global Periapical Health Study: Treatment-Related Factors Associated With Post-Treatment Periapical Radiolucencies in Endodontically Treated Teeth.

Authors

Jorge N R Martins, “GPHS Research Group”, Marco A Versiani

Published in

Journal of endodontics. Oct 27, 2026. Epub Oct 27, 2026.

Abstract

This multinational study assessed the proportion and geographic distribution of post-treatment periapical radiolucencies in root canal-treated teeth and investigated their associations with missed root canals, root canal filling length, and coronal restoration type.
Pre-existing CBCT datasets from 54 countries across five continents were evaluated using a standardized protocol. The study included 6,688 patients, 15,981 root canal-treated teeth, and 24,368 roots. Post-treatment periapical radiolucency was assessed at patient, tooth, and root levels. Random-effects meta-analysis was used to estimate pooled frequency, and multivariable generalized estimating equations were used to evaluate treatment-related associations while accounting for clustering within patients.
Overall, 6,688 patients, 15,981 endodontically treated teeth, and 24,368 roots were evaluated. Among patients with root canal-treated teeth, 69.5% had at least one post-treatment periapical radiolucency. Radiolucencies were detected in 43.7% of treated teeth and 41.4% of evaluated roots, with substantial geographic variation, ranging from 31.4% (Oceania) to 62.3% (Africa). Missed canals were identified in 12.4% of treated teeth and were associated with nearly threefold higher odds of post-treatment periapical radiolucency (OR, 2.91; 95% CI, 2.60-3.26). Short root canal fillings showed a similarly strong association (OR, 2.83; 95% CI, 2.62-3.06), followed by overfilled (OR, 1.74; 95% CI, 1.54-1.98). Coronal restoration type showed comparatively weaker associations, with unrestored/cavitated teeth having modestly higher odds of post-treatment periapical radiolucency than teeth restored with crowns/overlays (OR, 1.21; P = .028).
Post-treatment periapical radiolucencies were common across the participating countries and varied geographically. Missed canals and inadequate root canal filling length showed the strongest associations with their presence.

PMID:
42946043
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.

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