The dynamics of periapical lesions in endodontically treated teeth that are left without intervention

By Tsesis I, Goldberger T, Taschieri S, Seifan M, Tamse A, Rosen E.

Date: 10/2014
Journal: JOE

Purpose: to retrospectively evaluate the long-term dynamics of periapical lesions that were left without intervention in endodontically treated coronally restored teeth and the effects of possible influencing factors.

N= 74 patients with 200 teeth with PA lesions

Inclusion: teeth with root canal treatment (RCT) and coronal restoration that had been completed at least 1 year before the first survey and with a periapical lesion of PAI ≥ 2 present at the first survey.

Exclusion criteria:  endodontically retreated, or with coronal restoration replaced before the second survey. Teeth with a radiographic lesion not located in the periapical area and/or with root perforation or a vertical root fracture


•2 consecutive periapical radiographs of at least 4 year interval were evaluated for each patient and Periapical score index (PAI) was determined. •The dynamics in the periapical status between the 2 consecutive status surveys was defined as ‘‘improved’’ when the PAI score decreased, ‘‘unchanged’’ when the PAI score remained unchanged, or ‘‘worse’’ when the PAI score increased.

•Data for the following variables were collected: age, systemic disease, follow up period, quality of  the obturation and quality of the coronal restorations. and the influence of these variables on the difference between the consecutive PA was examined.

Most highlighted Results: 

•Of the 200 PA evaluated:

-28.5% lesions remained unchanged

-51.5% lesions worsened (PAI score increased)

-20% lesions improved (PAI score decreased)

•Poor root canal filling, or poor restoration adversely affected the dynamics of the periapical status (P  < .05).

•Age, sex, tooth location, and post presence had no statistically  significant influence on the dynamics of the periapical status

Clinical significance:

The quality of the obturation and the coronal restorations are significant factors that can affect the outcome of RCT.