The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Background/Objectives: The aim of this study was to identify and assess the independent risk factors and potential predictors for endo-periodontal lesions (EPLs) in endodontically treated teeth with periapical pathology. Methods: The study group included 90 patients (35 men, 55 women; mean age 47.96 ± 13.495 years) with 126 endodontically treated teeth. Following clinical examinations and radiologic evaluation, 50 patients were diagnosed with endo-periodontal lesions (EPLs) in 64 molars (test group); the control group included 62 endodontically treated teeth without EPLs diagnosed in 40 patients. The independent variables were assessed as risk factors for EPLs. The relationship between patients’ demographic and clinical features and endo-periodontal status was assessed using Chi-squared tests for categorical variables and Student’s t- or Mann–Whitney tests for continuous variables, depending on data distribution. The potential risk factors were characterized by calculating Odds Ratios (ORs) with 95% confidence intervals. The variables included in the multivariate logistic regression model were selected based on their clinical relevance and statistical significance in the univariate analysis. To evaluate the combined effect of the identified risk factors, a binary logistic regression model was constructed using the Enter method. Results: Out of the 126 endodontically treated molars with periapical pathology, 64 teeth (50.8%) were diagnosed with endo-periodontal lesions (EPLs). Patients aged ≥60 years were significantly more represented in the EPL group (32.8%) compared to the control group (12.9%) (p = 0.024). Probing pocket depth ≥ 4 mm was present in 85.9% of teeth with EPLs versus only 30.6% in teeth without EPLs (p < 0.001). Probing pocket depth (PPD) ≥ 4 mm was the strongest predictor (OR = 13.830) and remained significant after adjustment in multivariate analysis (OR = 6.585). PPD ≥ 3.625 mm showed a strong association in univariate analysis (OR = 12.587) and preserved significance in the multivariate model (OR = 6.163). Conclusions: This study highlights age ≥ 60 years and PPD ≥ 4 mm as the most significant independent risk factors for EPLs, emphasizing the need for early periodontal assessment in endodontically treated teeth with periapical pathology. While PPD greater than 3.625 mm is a strong indicator of the presence of EPLs, other factors such as MBL (marginal bone loss) and occlusal considerations appear to have indirect roles in EPL development in endodontically treated teeth with periapical lesions.

The aim of this study was to explore diabetes mellitus type 2 as a risk factor in the prevalence of chronic apical periodontitis (CAP) in untreated and endodontically treated teeth. The second objective was to describe the correlation between the presence of periapical lesions and blood glucose/glycated hemoglobin levels among diabetic (DM) and non-diabetic patients with endodontically treated or untreated teeth with CAP. Materials and methods: This cross-sectional study was conducted on 90 patients (55 with DM, 35 without DM), admitted to the Oral and Maxillofacial Surgery Department of “St. Spiridon” Hospital in Iași, Romania. Endodontic and perapical status was evaluated using the Periapical Index (PAI) based on clinical and radiological evaluations with blood glucose levels and HbA1c analysis. Statistical analysis included data, correlations and regression analysis, and group comparisons using appropriate parametric or non-parametric tests. DM subjects had a higher mean value of untreated teeth with CAP (2.53 vs. 2.00) compared to the control group (p = 0.010) and a lower mean number of endodontically treated teeth without CAP (1.53 vs. 2.74) compared to the control group (p < 0.001). Diabetic patients also had a higher mean number of root-filled teeth with CAP (3.33 vs. 1.94; p < 0.001). Conclusions: There was a clear association between diabetes and oral pathology, with diabetic patients having fewer teeth, more untreated teeth, and a higher prevalence of periapical lesions. Elevated blood glucose and HbA1c levels indicated that poor metabolic control negatively impacts periapical healing and overall endodontic health.

Aim of the study: This literature review analyzes research on the the role of the digital radiography and cone-beam computed tomography (CBCT) in the diagnosis of the endodontic pathology and the monitoring of post-treatment outcomes. Materials and Methods: A systematic search in scientific databases (PubMed, Web of Science), was performed to review studies from the last two decades on the relevance, benefits and drawbacks of these imaging modalities for the diagnosis of periapical lesions, root fractures, root resorption and other endodontic conditions Conclusions: CBCT is a valuable diagnostic tool in endodontics, offering superior accuracy for complex cases, post-treatment evaluation, and surgical planning; however, due to concerns regarding radiation exposure and cost, it should be used selectively, with digital radiography remaining the first-line imaging modality. While digital radiography is preferred for routine follow-ups, CBCT becomes essential in challenging scenarios—such as suspected root fractures, treatment failures, or surgical cases. Recent advancements like dose reduction protocols, enhanced imaging software, and AI-assisted processing further improve its clinical relevance.

The aim of study was to assess the periapical area and the distribution of CBCT-PAI indices in root-filled teeth with chronic periapical lesions. Materials and method. The cross-sectional study included 78 patients (gender: 24 males, 54 females; mean age 49.13  14.596 yrs.) with 181 root-filled teeth diagnosed with apical periodontitis (AP) (mean follow-up of 5.49  1.831 yrs.). Patients were selected from those treated in a private dental clinic. Clinical examination and CBCT assessment of the root and its periapical area were performed to evaluate the severity of apical periodontitis by PAI-CBCT scores. CBCT images were obtained using PaX-Uni3D (TVAPANO04, VATECH). The periapical lesions diameter was measured in coronal-apical, mesial-distal and buccal-oral sections using the Ez3D 2009 Plus software application. CBCT parameters were set for 20 second exposure time, 85 kV, 5mA. CBCT-PAI scores were assessed by statistical analysis within study group in relation to various parameters (sociodemographic, local factors, type and quality of coronal restoration and root-canal fillings). Failure of endodontic treatment was defined by CBCT-PAI scores 3-5. Results. The distribution of CBCT-PAI indices was as follows: 50,8% of teeth with CBCT-PAI 1-2, 19,3% of teeth with CBCT-PAI 3; 29,9% of teeth with CBCT-PAI 4-5. Failure of endodontic treatment (CBCT-PAI 3-5) was detected in 49,2% of the root-filled teeth. Highly significant statistical differences were found in the distribution of CBCT-PAI indices related to age groups, follow-up, dental-group, quality of coronal restoration, quality of endodontic treatment. Conclusions. CBCT-PAI scores 3-5 were detected in 49,2% of the root-filled teeth with sign of chronic periapical lesions. Highly significant statistical differences were found in the distribution of CBCT-PAI 3-5 indices related to age groups, follow-up, dental group, quality of coronal restoration and endodontic treatment. The use of CBCT-PAI scores allow accurate, reliable and reproducible evaluation of the success and failure of the endodontic treatment.

Introduction: The goal of this study was to evaluate the influence of combined artificial aging protocols on the surface roughness and Vickers microhardness of bulk-fill resin composites, compared with a nanofilled composite used as a reference. Materials and Methods: A total of 120 cylindrical specimens were prepared from three bulk-fill composites (Tetric EvoCeram Bulk Fill, Filtek One Bulk Fill, Venus Bulk Fill) and one nanofilled composite (Filtek Supreme Ultra). Specimens were allocated into three aging conditions: mechanical wear (A), mechanical wear combined with pH-cycling (B), and mechanical wear combined with thermocycling (C). Surface roughness (Ra) and Vickers microhardness (VHN) were evaluated at two time points (T1: 120,000 cycles; T2: 240,000 cycles). Non-parametric statistical tests were applied (α = 0.05). Results: Aging protocols significantly influenced both Ra and VHN (p < 0.05). Overall, higher surface roughness and lower Vickers microhardness values were observed after cumulative aging, with material-dependent variations between T1 and T2. The greatest post-aging differences were observed under combined mechanical wear and pH-cycling (subgroup B), whereas mechanical wear alone showed the lowest changes. Filtek One Bulk Fill and Filtek Supreme Ultra showed more favorable post-aging Ra and VHN values, whereas Venus Bulk Fill showed less favorable post-aging surface properties. No significant correlation was found between Ra and VHN (rho = −0.009; p = 0.958). Conclusions: Combined aging conditions significantly affected the surface roughness and Vickers microhardness of resin composites, with the greatest post-aging differences observed under acidic challenges. Bulk-fill materials exhibit variable resistance depending on composition, emphasizing the importance of material selection for long-term clinical performance. Clinical relevance: Composite restorations exposed to combined mechanical and acidic challenges may show altered surface roughness and microhardness, highlighting the need for materials with enhanced resistance in high-risk oral environments.