The association of endodontic prognostic factors with periapical lesions and cortical bone destruction: a...

Introduction This study determined the prevalence of endodontic prognostic factors and their association with periapical lesions (PL), cortical bone destruction (CBD), and buccal plate bone height (BPBH) in endodontically treated maxillary anterior teeth and premolars.Methods Analysed 203 cone-beam computed tomography scans for missed canals, obturation length, restoration type, fractured instruments, perforations, posts/screws, and PL presence. PL volume, CBD and BPBH were measured, with relationships analysed using the 'marginal model' and generalised estimating equations at p <0.05.Results Among 227 teeth, 48.9% had PLs. Significant associations with PL presence included fractured instruments, perforation, missed canals, and both overfilled and underfilled canals (p <0.01). PL volume was significantly associated with obturation length, perforation, post/screw, and restoration type (p <0.02). Perforated teeth exhibited the largest PL volumes (mean: 53.36 mm³), and composite restorations showed larger volumes than other restoration types. CBD was significantly associated with perforations (p <0.01), and BPBH was lower in teeth with perforations and crown restorations (p <0.01).Conclusions Missed canals significantly influenced PL presence, whereas perforations affected PL volume and were the only factor influencing BPBH and CBD. This highlights the importance of minimising endodontic errors and aids in patient risk stratification.