Root Canal Treatment Failures in Maxillary Premolars

Multiple factors are associated with primary root canal treatment failures in maxillary premolars. Variations in canal morphology appear to be underappreciated in maxillary second premolars.

Researchers have found in a new research that primary root canal treatment failures in maxillary second premolars are linked to complicated canal configurations. Therefore, besides adequate filling, clinicians should give extra attention to anatomic variability in second premolars owing to higher failure incidence.

Study Publication

The new study has been published in The Journal of the American Dental Association.

In the research, the researchers retrospectively searched records using Current Dental Terminology codes to identify maxillary first and second premolars with endodontic failure. Periapical and cone-beam computed tomographic images were examined to determine Vertucci classifications and suspected factors related to treatment failure.

Study Findings

In this retrospective study designed to describe the anatomy of maxillary premolars that failed root canal treatment using cone-beam CT, the Vertucci classification for canal configurations was assigned and the number of roots was recorded. Second premolars demonstrated a higher rate of endodontic failures than first premolars, and failures were more common among female participants than among male participants.

The four most common clinical factors for failure were:

• Inadequate filling
• Restorative failures
• Vertical root fracture
• Missed canals

Missed canals were significantly more common in maxillary second premolars than in maxillary first premolars. More treatment failures were noticed in maxillary second premolars than first premolars and in females than in males. The four most common factors related to failure were inadequate filling, restorative failure, vertical root fracture, and missed canals. Missed canals were more frequently identified in maxillary second premolars (21.8%) than first premolars (11.4%) (P = .044).

Conclusion

The researchers concluded that multiple factors are associated with primary root canal treatment failures in maxillary premolars. Variations in canal morphology appear to be underappreciated in maxillary second premolars.

Reference

Feng-Ming Wang, Jessica Rudman, Ryan M. Walsh, Poorya Jalali. A retrospective study of initial root canal treatment failure in maxillary premolars via using cone-beam computed tomography. The Journal of the American Dental Association. Published: April 13, 2023

DOI: https://doi.org/10.1016/j.adaj.2023.02.012

Keywords

Primary, root, canal, treatment, failures, maxillary, second, premolars, linked, complicated, canal configurations, The Journal of the American Dental Association, Feng-Ming Wang, Jessica Rudman, Ryan M. Walsh, Poorya Jalali.