Impact of Three Radiographic Methods in the Outcome of Nonsurgical Endodontic Treatment: A Five-Year Follow-up

Introduction: The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR,, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success. Methods: A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores >= 2 for PFR and DPR and >= 1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multi-variate analyses. Statistical significance was defined at a P level <.05. Results: CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P <= 001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P <.05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration. Conclusions: The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PER, 92.3%/DPR, and 81.3%/CBCT.