{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:51:27Z","timestamp":1793137887365,"version":"4.5.0"},"reference-count":89,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova","award":["nr 26\/326\/1"],"award-info":[{"award-number":["nr 26\/326\/1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Objectives: Cone Beam Computed Tomography (CBCT) offers high-resolution, three-dimensional imaging for detecting apical periodontitis (AP) and evaluating the technical quality of endodontic treatments. This study aimed to investigate the diagnostic value of CBCT in identifying endodontic failures and periapical lesions and to explore the clinical patterns associated with these findings in a Romanian patient cohort. Materials and Methods: A retrospective study was conducted on 258 patients (with 876 root canal-treated teeth), all of whom underwent CBCT imaging between October 2024 and April 2025 at a private radiology center in Craiova, Romania. Of the 876 treated teeth, 409 were diagnosed with apical periodontitis. Patients were present for endodontic treatment at the Endodontics Clinic of the Faculty of Dentistry, University of Medicine and Pharmacy of Craiova. With the patients\u2019 consent, 3D radiological examinations were recommended for better case planning and accurate diagnosis. The periapical status and technical parameters of root canal fillings were assessed using the CBCT-PAI index and evaluated by three calibrated observers. Associations with demographic, clinical, and behavioral factors were statistically analyzed. Results: Apical periodontitis was detected in 46.69% of the teeth examined during the study period, with CBCT-PAI score 3 being the most prevalent. Poor root canal obturation quality (underfilling, overfilling, and voids) was significantly associated with periapical pathology. Chronic lesions were more common than acute ones, especially in older patients. The number of teeth with endodontic treatments and no AP, as well as the number of teeth with AP, was significantly lower for patients with acute AP, indicating the more severe impact of chronic AP on the patients\u2019 oral health status. CBCT allowed the precise localization of missed canals and assessment of lesion severity. Conclusions: Within the limits of a retrospective, referral-based cohort, CBCT aided the detection of periapical pathology in root canal-treated teeth (46.69%). These findings do not represent population-based rates but support the selective use of CBCT, in line with current ESE guidance, for complex cases or when conventional imaging is inconclusive.<\/jats:p>","DOI":"10.3390\/jcm14186364","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T08:43:54Z","timestamp":1757493834000},"page":"6364","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Retrospective Study of CBCT-Based Detection of Endodontic Failures and Periapical Lesions in a Romanian Cohort"],"prefix":"10.3390","volume":"14","author":[{"given":"Oana Andreea","family":"Diaconu","sequence":"first","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lelia Mihaela","family":"Gheorghi\u021b\u0103","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Gabriela","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6535-3152","authenticated-orcid":false,"given":"Mihaela Jana","family":"\u021auculin\u0103","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lina Alexandra","family":"Iacov","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-7583","authenticated-orcid":false,"given":"Virginia Maria","family":"R\u0103dulescu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Ionescu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina Andreea","family":"Mirea","sequence":"additional","affiliation":[{"name":"Department of Oral Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina Alexandra","family":"B\u0103nic\u0103","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104809","DOI":"10.1016\/j.jdent.2023.104809","article-title":"Outcome of Root Canal Retreatment Filled with Gutta-Percha Techniques: A Systematic Review and Meta-Analysis","volume":"142","author":"Olivieri","year":"2024","journal-title":"J. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2147\/CCIDE.S479321","article-title":"A Comparative Analysis of the Quality of Root Canal Fillings of In Vivo Studies Conducted in Saudi Arabia and Worldwide: A Systematic Review","volume":"16","author":"Alshahrani","year":"2024","journal-title":"Clin. Cosmet. Investig. Dent."},{"key":"ref_3","first-page":"CD005511","article-title":"Endodontic Procedures for Retreatment of Periapical Lesions","volume":"10","author":"Corbella","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1111\/iej.13501","article-title":"Outcome Measures to Assess the Effectiveness of Endodontic Treatment for Pulpitis and Apical Periodontitis for Use in the Development of European Society of Endodontology (ESE) S3 Level Clinical Practice Guidelines: A Protocol","volume":"54","author":"Duncan","year":"2021","journal-title":"Int. Endod. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/iej.13974","article-title":"Treatment of Pulpal and Apical Disease: The European Society of Endodontology (ESE) S3-Level Clinical Practice Guideline","volume":"56","author":"Duncan","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101805","DOI":"10.1016\/j.jebdp.2022.101805","article-title":"Dental Patient-Reported Outcomes in Endodontics\u2014A Narrative Review","volume":"23","author":"Nagendrababu","year":"2023","journal-title":"J. Evid.-Based Dent. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1038\/s41432-024-01019-1","article-title":"Root Canal Re-Treatment with Gutta Percha\u2014Which Techniques Influence Success?","volume":"25","author":"Hall","year":"2024","journal-title":"Evid.-Based Dent."},{"key":"ref_8","first-page":"871","article-title":"Introduction and interpretation of The European Society of Endodontology S3-level clinical practice guideline for treatment of pulpal and apical disease","volume":"59","author":"Huang","year":"2024","journal-title":"Zhonghua Kou Qiang Yi Xue Za Zhi."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/iej.13830","article-title":"Patient-Related Outcomes and Oral Health-Related Quality of Life in Endodontics","volume":"56","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1111\/iej.13822","article-title":"Prevalence of root canal treatment worldwide: A systematic review and meta-analysis","volume":"55","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/iej.13787","article-title":"Effectiveness of Root Canal Filling Materials and Techniques for Treatment of Apical Periodontitis: A Systematic Review","volume":"56","author":"Pirani","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1111\/iej.13739","article-title":"Present Status and Future Directions\u2014Irrigants and Irrigation Methods","volume":"55","author":"Boutsioukis","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/iej.13783","article-title":"Present Status and Future Directions: Surgical Endodontics","volume":"55","author":"Setzer","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"172","DOI":"10.12968\/denu.2008.35.3.172","article-title":"Influence of Fractured Instruments on the Success Rate of Endodontic Treatment","volume":"35","author":"Simon","year":"2008","journal-title":"Dent. Update"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chen, S., Hong, X., Ye, Z., Wu, M., Chen, L., Wu, L., Wang, Y., Chen, Y., Wu, J., and Wang, J. (2023). The Effect of Root Canal Treatment and Post-Crown Restorations on Stress Distribution in Teeth with Periapical Periodontitis: A Finite Element Analysis. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-03612-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.4103\/njcp.njcp_129_19","article-title":"Radiographic Assessment of the Relationship between Root Canal Treatment Quality, Coronal Restoration Quality, and Periapical Status","volume":"22","author":"Alkis","year":"2019","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sun, X., Yang, Z., Nie, Y., and Hou, B. (2022). Microbial communities in extraradicular and intraradicular infections associated with persistent apical periodontitis. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.798367"},{"key":"ref_18","first-page":"e1","article-title":"Cone-Beam Computed Tomography in Endodontics: From the Specific Technical Considerations of Acquisition Parameters and Interpretation to Advanced Clinical Applications","volume":"49","year":"2023","journal-title":"Restor. Dent. Endod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/iej.13736","article-title":"Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020","volume":"55","author":"Burns","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1016\/j.joen.2008.08.013","article-title":"A New Periapical Index Based on Cone Beam Computed Tomography","volume":"34","author":"Estrela","year":"2008","journal-title":"J. Endod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"European Society of Endodontology (2006). Quality Guidelines for Endodontic Treatment: Consensus Report of the European Society of Endodontology. Int. Endod. J., 39, 921\u2013930.","DOI":"10.1111\/j.1365-2591.2006.01180.x"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/iej.13397","article-title":"Clinical Decision-Making and Importance of the AAE\/AAOMR Position Statement for CBCT Examination in Endodontic Cases","volume":"54","author":"Bhatt","year":"2021","journal-title":"Int. Endod. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1007\/s11547-024-01882-z","article-title":"Diagnostic accuracy of periapical radiography and panoramic radiography in the detection of apical periodontitis: A systematic review and meta-analysis","volume":"129","author":"Stera","year":"2024","journal-title":"Radiol. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/iej.12650","article-title":"Diagnostic Accuracy of Periapical Radiography and Cone Beam Computed Tomography in Detecting Apical Periodontitis Using Histopathological Findings as a Reference Standard","volume":"50","author":"Kanagasingam","year":"2017","journal-title":"Int. Endod. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1111\/iej.13828","article-title":"Present Status and Future Directions: Imaging Techniques for the Detection of Periapical Lesions","volume":"55","author":"Cotti","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e597","DOI":"10.5114\/pjr.2023.134035","article-title":"Diagnostic performance of cone-beam computed tomography for apical periodontitis: A systematic review and meta-analysis","volume":"88","author":"Abesi","year":"2023","journal-title":"Pol. J. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.joen.2017.11.015","article-title":"Prevalence and Size of Periapical Radiolucencies Using Cone-Beam Computed Tomography in Teeth without Apparent Intraoral Radiographic Lesions: A New Periapical Index with a Clinical Recommendation","volume":"44","author":"Torabinejad","year":"2018","journal-title":"J. Endod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1111\/iej.13115","article-title":"Cone-Beam Computed Tomography in Endodontics\u2014A Review of the Literature","volume":"52","author":"Patel","year":"2019","journal-title":"Int. Endod. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104353","DOI":"10.1016\/j.jdent.2022.104353","article-title":"Influence of Cone Beam Computed Tomography on Endodontic Treatment Planning: A Systematic Review","volume":"127","author":"Tay","year":"2022","journal-title":"J. Dent."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/iej.12159","article-title":"An Evaluation of the Periapical Status of Teeth with Necrotic Pulps Using Periapical Radiography and Cone-Beam Computed Tomography","volume":"47","author":"Abella","year":"2014","journal-title":"Int. Endod. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.joen.2020.07.007","article-title":"Prevalence of apical periodontitis and conventional non-surgical root canal treatment in general adult populations: An updated systematic review and meta-analysis of cross-sectional studies published between 2012 and 2020","volume":"46","author":"Miletic","year":"2020","journal-title":"J. Endod."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kielbassa, A.M., Frank, W., and Madaus, T. (2017). Radiologic Assessment of Quality of Root Canal Fillings and Periapical Status in an Austrian Subpopulation-An Observational Study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0176724"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S476","DOI":"10.4103\/jpbs.jpbs_1433_24","article-title":"Diagnostic Accuracy of Cone-Beam Computed Tomography (CBCT) in Identifying Periapical Lesions: A Comparative Study with Conventional Radiography","volume":"17","author":"Kanneppady","year":"2025","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1365-2591.2007.01305.x","article-title":"Prevalence and technical quality of root fillings in Dakar, Senegal","volume":"41","author":"Kane","year":"2008","journal-title":"Int. Endod. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e35584","DOI":"10.1016\/j.heliyon.2024.e35584","article-title":"The prevalence of root canal treatment, periapical status, and coronal restorations in elderly patients in the Polish population","volume":"10","author":"Pietrzycka","year":"2024","journal-title":"Heliyon"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Dash, G., Mishra, L., Singh, N.R., Behera, R., Misra, S.R., Kumar, M., Sokolowski, K., Agarwal, K., Behera, S.K., and Mishra, S. (2022). Prevalence and Quality of Endodontic Treatment in Patients with Cardiovascular Disease and Associated Risk Factors. J. Clin. Med., 11.","DOI":"10.3390\/jcm11206046"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4039","DOI":"10.3390\/nursrep14040295","article-title":"Ageism and associated factors in healthcare workers: A systematic review","volume":"14","year":"2024","journal-title":"Nurs. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/ger.12231","article-title":"Influence of Increased Patient Age on Longitudinal Outcomes of Root Canal Treatment: A Systematic Review","volume":"34","author":"Shakiba","year":"2017","journal-title":"Gerodontology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1590\/1678-775720140110","article-title":"Evaluation of Technical Quality and Periapical Health of Root-Filled Teeth by Using Cone-Beam CT","volume":"22","author":"Nur","year":"2014","journal-title":"J. Appl. Oral Sci."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Park, D.M., Seok, W.-H., and Yoon, J.-Y. (2024). Factors influencing non-surgical root canal treatment outcomes in mandibular second molars: A retrospective cone-beam computed tomography analysis. J. Clin. Med., 13.","DOI":"10.20944\/preprints202405.0319.v1"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mackiewicz, E., Bonsmann, T., Kaczor-Wiankowska, K., and Nowicka, A. (2023). Volumetric assessment of apical periodontitis using cone-beam computed tomography\u2014A systematic review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20042940"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Sanz, J.L., Callado, L., Mantale, S., Nicol\u00e1s, J., Ghilotti, J., and Llena, C. (2025). Cone-Beam Computed Tomography Assessment of the Prevalence and Association of Pulp Calcification with Dental and Periodontal Pathology: A Descriptive Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041373"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Herbst, S.R., Pitchika, V., Krois, J., Krasowski, A., and Schwendicke, F. (2023). Machine learning to predict apical lesions: A cross-sectional and model development study. J. Clin. Med., 12.","DOI":"10.20944\/preprints202308.0234.v1"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Le\u00f3n-L\u00f3pez, M., Cabanillas-Balsera, D., Mart\u00edn-Gonz\u00e1lez, J., S\u00e1nchez-Dom\u00ednguez, B., Sa\u00faco-M\u00e1rquez, J.J., and Segura-Egea, J.J. (2025). Atherosclerosis and chronic apical periodontitis: A systematic review and meta-analysis. J. Clin. Med., 14.","DOI":"10.20944\/preprints202502.0059.v2"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.joen.2009.03.048","article-title":"Prevalence of Apical Periodontitis in Root Canal-Treated Teeth from an Urban French Population: Influence of the Quality of Root Canal Fillings and Coronal Restorations","volume":"35","author":"Tavares","year":"2009","journal-title":"J. Endod."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"S\u0103lceanu, M., Melian, A., Dasc\u0103lu, C., Giuroiu, C., Concita, C., Topoliceanu, C., Melian, D., Frumuzache, A., Solomon, S.M., and M\u00e2r\u021bu, M.-A. (2025). Endo-periodontal lesions in endodontically treated teeth with periapical pathology. Diagnostics, 15.","DOI":"10.3390\/diagnostics15131663"},{"key":"ref_47","first-page":"411","article-title":"Prevalence and Anatomical Particularities of the Second Mesiobuccal Canal of the Permanent Upper First Molar in the Romanian Population in a Clinical Environment Using Cone Beam Computed Tomographic Imaging-In Vivo Study","volume":"15","author":"Diaconu","year":"2023","journal-title":"Rom. J. Oral Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Jadhav, K.R., VanPutte, C.L., and Tsotsis, P. (2023). Endodontic management of three-rooted mandibular second molar with three separate orifices and three independent portals of exit: A case report. Healthcare, 11.","DOI":"10.3390\/healthcare11111528"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"491","DOI":"10.4103\/0972-0707.139851","article-title":"Mandibular Premolars with Aberrant Canal Morphology: An Endodontic Challenge","volume":"17","author":"Mittal","year":"2014","journal-title":"J. Conserv. Dent."},{"key":"ref_50","first-page":"7","article-title":"Accessory Roots and Root Canals in Maxillary Premolar Teeth: A Review of a Critical Endodontic Challenge","volume":"6","author":"Ahmed","year":"2012","journal-title":"ENDO\u2013Endod. Pract. Today"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Ozemre, M.O., Karsl\u0131o\u011flu, H., and Kamburo\u011flu, K. (2024). An evaluation of the relationship between the mesiobuccal canal configuration, the interorifice distance, and the root lengths of the permanent maxillary first molars with cone beam computed tomography. Diagnostics, 14.","DOI":"10.3390\/diagnostics14232703"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.joen.2015.12.026","article-title":"Prevalence of Apical Periodontitis in Endodontically Treated Premolars and Molars with Untreated Canal: A Cone Beam Computed Tomography Study","volume":"42","author":"Karabucak","year":"2016","journal-title":"J. Endod."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Choi, S.-K., Park, J.H., Chae, J.-M., Chang, N.-Y., and Kang, K.-H. (2023). A CBCT evaluation of the proximity of mandibular molar roots and lingual cortical bone in various vertical facial patterns and factors related to root-cortical bone contact. Appl. Sci., 13.","DOI":"10.3390\/app13063444"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Kazimierczak, W., Kazimierczak, N., Issa, J., Wajer, R., Wajer, A., Kalka, S., and Serafin, Z. (2024). Endodontic Treatment Outcomes in Cone Beam Computed Tomography Images\u2014Assessment of the Diagnostic Accuracy of AI. J. Clin. Med., 13.","DOI":"10.3390\/jcm13144116"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"AlEraky, D.M., Rahoma, A.M., Abuohashish, H.M., AlQasser, A., AlHamali, A., AlHussain, H.M., AlShoalah, H.M., AlSaghah, Z., Khattar, A., and Rifaat, S. (2023). Assessment of Bacterial Sealing Ability of Two Different Bio-Ceramic Sealers in Single-Rooted Teeth Using Single Cone Obturation Technique: An In Vitro Study. Appl. Sci., 13.","DOI":"10.3390\/app13052906"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Jankowska, A., Fr\u0105ckiewicz, W., Kus-Bartoszek, A., Wdowiak-Szymanik, A., and Jarz\u0105bek, A. (2025). Effectiveness of treatment of periapical lesions in mature and immature permanent teeth depending on the treatment method used: A critical narrative review guided by systematic principles. J. Clin. Med., 14.","DOI":"10.3390\/jcm14145083"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Vishwanathaiah, S., Maganur, P.C., Khanagar, S.B., Chohan, H., Testarelli, L., Mazzoni, A., A Gupta, A., Raj, A.T., Bhandi, S., and Mehta, D. (2021). The incidence and intensity of postendodontic pain and flareup in single and multiple visit root canal treatments: A systematic review and meta-analysis. Appl. Sci., 11.","DOI":"10.3390\/app11083358"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"S\u0103lceanu, M., Dasc\u0103lu, C., Melian, A., Giuroiu, C., Antohi, C., Concita, C., Hamburda, T., Topoliceanu, C., and M\u00e2r\u0163u, M.-A. (2024). Assessment of periodontitis risk factors in endodontically treated teeth: A cross-sectional study. Diagnostics, 14.","DOI":"10.3390\/diagnostics14171972"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Al Yahya, R.S., Al Attas, M.H., Javed, M.Q., Khan, K.I., Atique, S., Abulhamael, A.M., and Bahammam, H.A. (2023). Root Canal Configuration and Its Relationship with Endodontic Technical Errors and Periapical Status in Premolar Teeth of a Saudi Sub-Population: A Cross-Sectional Observational CBCT Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021142"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e391","DOI":"10.5114\/pjr\/190412","article-title":"Assessment of endodontic treatment and prevalence of apical periodontitis using cone-beam computed tomography: A cross-sectional study","volume":"89","author":"Kubala","year":"2024","journal-title":"Pol. J. Radiol."},{"key":"ref_61","first-page":"176","article-title":"Statusul Periapical al Din\u021bilor cu Tratament Endodontic\u2014Prevalen\u021ba Leziunilor Periapicale \u0219i Factorii de Risc","volume":"57","author":"Cotrui","year":"2011","journal-title":"Rev. Rom. Stomatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"331","DOI":"10.22543\/2392-7674.1562","article-title":"Primary endodontic infections\u2014Key issue in pathogenesis of chronic apical periodontitis","volume":"11","author":"Iliescu","year":"2024","journal-title":"J. Mind Med. Sci."},{"key":"ref_63","first-page":"150","article-title":"Prevalence of Untreated Canals and Their Association with Periapical Periodontitis Using Cone-Beam Computed Tomography","volume":"19","author":"Ebrahimi","year":"2024","journal-title":"Iran. Endod. J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.sdentj.2021.05.005","article-title":"Endodontic Postoperative Flare-Up: An Update","volume":"33","author":"Bassam","year":"2021","journal-title":"Saudi Dent. J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"136","DOI":"10.4103\/ejd.ejd_320_17","article-title":"Cone-Beam Computed Tomography in the Assessment of Periapical Lesions in Endodontically Treated Teeth","volume":"12","author":"Gambarini","year":"2018","journal-title":"Eur. J. Dent."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.joen.2025.03.004","article-title":"CBCT-Assessed Outcomes and Prognostic Factors of Primary Endodontic Treatment and Retreatment: A Systematic Review and Meta-Analysis","volume":"51","author":"Georgiou","year":"2025","journal-title":"J. Endod."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Pestana de Vasconcelos, N., Martins, I.S., Afonso, A.S., Braga, A.C., and Pina-Vaz, I. (2024). Osteoporosis and apical periodontitis prevalence: A systematic review. Dent. J., 12.","DOI":"10.3390\/dj12080272"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"673","DOI":"10.4103\/1119-3077.188697","article-title":"Assessment of Periapical Health, Quality of Root Canal Filling, and Coronal Restoration by Using Cone-Beam Computed Tomography","volume":"19","author":"Cakici","year":"2016","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Bieszczad, D., Wichlinski, J., and Kaczmarzyk, T. (2023). Treatment-Related Factors Affecting the Success of Endodontic Microsurgery and the Influence of GTR on Radiographic Healing\u2014A Cone-Beam Computed Tomography Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196382"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1002\/jemt.23935","article-title":"Marginal Gaps and Voids of Three Root-End Filling Materials: A Microcomputed Tomographic Study","volume":"85","author":"Barbosa","year":"2022","journal-title":"Microsc. Res. Tech."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.joen.2023.08.011","article-title":"Clinical Outcome and Predictors of Endodontic Microsurgery Using Cone-beam Computed Tomography: A Retrospective Cohort Study","volume":"49","author":"Zhang","year":"2023","journal-title":"J. Endod."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/0103-6440202104096","article-title":"Marginal Gaps and Internal Voids After Root-End Filling Using Three Calcium Silicate-Based Materials: A Micro-CT Analysis","volume":"32","author":"Jardine","year":"2021","journal-title":"Braz. Dent. J."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Karkle, A., Slaidina, A., Zolovs, M., Vaskevica, A., Meistere, D., Bokvalde, Z., and Neimane, L. (2024). Comparative Analysis of Examination Methods for Periapical Lesion Diagnostics: Assessing Cone-Beam Computer Tomography, Ultrasound, and Periapical Radiography. Diagnostics, 14.","DOI":"10.3390\/diagnostics14070766"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Kazimierczak, W., Wajer, R., Wajer, A., Kiian, V., Kloska, A., Kazimierczak, N., Janiszewska-Olszowska, J., and Serafin, Z. (2024). Periapical Lesions in Panoramic Radiography and CBCT Imaging-Assessment of AI\u2019s Diagnostic Accuracy. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092709"},{"key":"ref_75","first-page":"17","article-title":"Periapical Status and Quality of Root Fillings and Coronal Restorations in an Adult Turkish Subpopulation","volume":"14","author":"Gencoglu","year":"2010","journal-title":"Eur. J. Dent."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Alshomrani, F. (2024). Cone-Beam Computed Tomography (CBCT)-Based Diagnosis of Dental Bone Defects. Diagnostics, 14.","DOI":"10.3390\/diagnostics14131404"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2147\/CCIDE.S236747","article-title":"The Effect of Smoking Habit on Apical Status of Adequate Endodontically Treated Teeth with and Without Periodontal Involvement","volume":"11","author":"Mahmood","year":"2019","journal-title":"Clin. Cosmet. Investig. Dent."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1038\/s41432-023-00954-9","article-title":"Dose-Response Association of Smoking with Delayed Healing of Apical Periodontitis After Endodontic Treatment","volume":"24","author":"Majid","year":"2023","journal-title":"Evid.-Based Dent."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Alhilou, A.M., Al-Moraissi, E.A., Bakhsh, A., Christidis, N., and N\u00e4sman, P. (2023). Pain After Emergency Treatments of Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis in the Permanent Dentition: A Systematic Review of Randomized Clinical Trials. Front. Oral Health, 4.","DOI":"10.3389\/froh.2023.1147884"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"El Ouarti, I., Chala, S., Sakout, M., and Abdallaoui, F. (2021). Prevalence and risk factors of apical periodontitis in endodontically treated teeth: Cross-sectional study in an adult Moroccan subpopulation. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01491-6"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"45","DOI":"10.17656\/sdj-10115","article-title":"Prevalence of Apical Periodontitis by Cone Beam Computed Tomography: A Cross Sectional Study","volume":"7","author":"Baban","year":"2020","journal-title":"Sulaimani Dent. J."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1111\/iej.13467","article-title":"The global prevalence of apical periodontitis: A systematic review and meta-analysis","volume":"54","author":"Michelon","year":"2021","journal-title":"Int. Endod. J."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"80179163","DOI":"10.1259\/dmfr\/80179163","article-title":"Prevalence of apical periodontitis detected in cone beam CT images of a Brazilian subpopulation","volume":"42","year":"2013","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.5395\/rde.2024.49.e16","article-title":"Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: A cross-sectional study","volume":"49","author":"Alhailaa","year":"2024","journal-title":"Restor. Dent. Endod."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"4439890","DOI":"10.1155\/2023\/4439890","article-title":"Cone-Beam Computed Tomography Assessment of Prevalence of Procedural Errors in Maxillary Posterior Teeth","volume":"2023","author":"Nouroloyouni","year":"2023","journal-title":"Biomed. Res. Int."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Zargar, N., Khosravi, K., Zadsirjan, S., Safi, Y., Vatankhah, M., Baghban, A.A., and Varzaneh, F.A. (2024). The association of endodontic prognostic factors with the presence of periapical lesion, its volume, and bone characteristics in endodontically treated molars: A cross-sectional study. BMC Oral Health, 24.","DOI":"10.1186\/s12903-023-03818-x"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Le\u00f3n-L\u00f3pez, M., Montero-Miralles, P., Cabanillas-Balsera, D., Sa\u00faco-M\u00e1rquez, J.J., Mart\u00edn-Gonz\u00e1lez, J., and Segura-Egea, J.J. (2025). Association Between the Presence of Missed Canals, Detected Using CBCT, and Post-Treatment Apical Periodontitis in Root-Filled Teeth: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.20944\/preprints202502.0059.v2"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e940533","DOI":"10.12659\/MSM.940533","article-title":"Periapical Lesions and Missed Canals in Endodontically Treated Teeth: A Cone-Beam Computed Tomographic Study of a Chinese Subpopulation","volume":"29","author":"Hao","year":"2023","journal-title":"Med. Sci. Monit."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/aej.12638","article-title":"Evaluation of endodontically treated teeth and related apical periodontitis using periapical and endodontic status scale: Retrospective cone-beam computed tomography study","volume":"48","year":"2022","journal-title":"Aust. Endod. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6364\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:42:44Z","timestamp":1760035364000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":89,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186364"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186364","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}