The effect of extrusion of the filling material on the periapical status

AIM. To identify the relationship between the extrusion of filling material and the periapical status when using CBCT.
MATERIALS AND METHODS. 500 CBCT scans of patients were studied, the condition of 2915 teeth and 6142 root canals were assessed. The cases of endodontic treatment, which are associated with the overfilling (extrusion) of the filling material, are analyzed. Canals with an apical level of the root seal – 0–2 mm from the X-ray apex of the root (3533 root canals) were considered as a control group. In all cases, the periapical status was assessed. Methods of medical statistics have been applied.
RESULTS. Extrusion of the filling material was determined in 10.7% of the total number of endodontically treated root canals. The material was located: 81.7% in bone tissue, 13% in the maxillary sinus, 4.7% under oral mucosa of the alveolar process, 0.6% in the mandibular canal and/or mental foramen. In the control group, the periapical status “unchanged” was noted in 89.5% of cases, pathological changes were detected in 10.5% of cases. The remaining percentage of the total number of root canals was made up of underfilled or missed root canals without taking into account the periapical status. A lower incidence of periapical changes was determined when filling material was extruded into bone tissue (7.4%), than at the optimal level of root canal filling (11.7%). The differences between the groups were found to be statistically significant. Practical recommendations have been formulated to improve the accuracy of diagnosis, proper planning and increase the effectiveness of endodontic treatment.
CONCLUSIONS. Extrusion of filling material into bone tissue is more often associated with effective endodontic treatment than optimal filling of the root canal along the apical border of the root filling. In this regard, the extrusion of the filling material into the bone tissue, in the case of a formed apical stop, can be considered a sign of successful obturation of the root canal.

1. Haji-Hassani N., Bakhshi M., Shahabi S. Frequency of iatrogenic errors through root canal treatment procedure in 1335 charts of dental patients. J Int Oral Health. 2015;7(Suppl 1):14–17.

2. Qian W.H., Hong J., Xu P.C. Analysis of the possible causes of endodontic treatment failure by inspection during apical microsurgery treatment. Shanghai Kou Qiang Yi Xue. 2015;24(2):206–209.

3. Silva J.A., de Alencar A.H., da Rocha S.S., Lopes L.G,. Estrela C. Three-dimensional image contribution for evaluation of operative procedural errors in endodontic therapy and dental implants. Braz Dent J. 2012;23(2):127–134. https://doi.org/10.1590/s0103-64402012000200007

4. Song M., Kim H.C., Lee W., Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod. 2011;37(11):1516–1519. https://doi.org/10.1016/j.joen.2011.06.032

5. Brkić A., Gürkan-Köseoğlu B., Olgac V. Surgical approach to iatrogenic complications of endodontic therapy: a report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(5):e50–53. https:// doi.org/10.1016/j.tripleo.2009.01.016

6. Mozayeni M.A., Asnaashari M., Modaresi S.J. Clinical and radiographic evaluation of procedural accidents and errors during root canal therapy. Iran Endod J. 2006;1(3):97–100.

7. Yaltirik M., Ozbas H., Erisen R. Surgical management of overfilling of the root canal: a case report. Quintessence Int. 2002;33(9):670–672.

8. Ridell K., Petersson A., Matsson L., Mejàre I. Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults. A retrospective study. Acta Odontol Scand. 2006;64(2):104–110. https:// doi.org/10.1080/00016350500367637

9. Lin L.M., Rosenberg P.A., Lin J. Do procedural errors cause endodontic treatment failure? J Am Dent Assoc. 2005;136(2):187–193. https://doi.org/10.14219/jada.archive.2005.0140

10. Chueh L.H., Chen S.C., Lee C.M., Hsu Y.Y., Pai S.F., Kuo M.L. et al. Technical quality of root canal treatment in Taiwan. Int Endod J. 2003;36(6):416–422. https://doi.org/10.1046/j.1365-2591.2003.00672.x

11. Sirak S.V., Shapovalova L.A., Kopylova L.A. The complications arising at the stage of sealing of root channels of teeth, their forecasting and preventive maintenance. Endodontics Today. 2009;(1):23–25. (In Russ.)

12. Sirak S.V., Sletov A.A., Loktionova M.V., Loktionov V.V., Sokolova E.V. Diagnostics, treatment and preventive maintenance maxillary sinus perforation after endodontic treatment. Parodontology. 2008;(3):14–18. (In Russ.)

13. Hargreaves K.M., Berman L.G. (eds). Endodontics. [Translated from English, A.V. Mitronin (ed.)]. Moscow: GEOTAR-Media; 2020. 1024 p.

14. McClanahan S.B., Crepps III J.T., Maranga M.C., Worrell D.E., Behnia A. (eds). Glossary of Endodontic Terms. 10th ed. Chicago, IL: American Association of Endodontists (AAE); 2020. 47 p. Available at: https://www.aae.org/specialty/clinical-resources/glossary-endodonticterms/ (accessed: 13.12.2024).

15. Nair P.N.R. Non-microbial etiology: foreign body reaction maintaining post-treatment apical periodontitis. Endod Topics. 2003;6(1):114–134. https://doi.org/10.1111/j.1601-1546.2003.00052.x

16. Spångberg L.S.W., Haapasalo M. Rationale and efficacy of root canal medicaments and root filling materials with emphasis on treatment outcome. Endod Topics. 2002;2(1):35–58. https://doi.org/10.1034/j.1601-1546.2002.20104.x

17. Seltzer S. Long-term radiographic and histological observations of endodontically treated teeth. J Endod. 1999;25(12):818–822. https://doi.org/10.1016/S0099-2399(99)80305-7

18. Kim J.-W., Cho K.-M., Park S.-H., Park S.-R., Lee S.-S., Lee S.-K. Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II. Restor Dent Endod. 2014;39(1):63–67. https://doi.org/10.5395/rde.2014.39.1.63

19. Maksimovskiy Yu.M., Grinin V.M. A modern view of quality valuation and effectiveness treatment of chronical periodontitis. Endodontics Today. 2004;(1-2):16–20. (In Russ.).

20. Batukov N.M., Voropanov D.A., Peradze I.R. Comparative efficiency assessment of various methods of filling the dental root canals. Dental Institute. 2014;(2):24–25. (In Russ.)

21. Da Silva D., Endal U., Reynaud A., Portenier I., Orstavik D., Haapasalo M. A comparative study of lateral condensation, heat-softened gutta-percha, and a modified master cone heat-softened backfilling technique. Int Endod J. 2002;35(12):1005–1011. https://doi.org/10.1046/j.1365-2591.2002.00610.x

22. Ketterl W.: Kriterien fur den erfolg der vitalekstirpation. Dtsch Zahnärstl Z. 1965;20:407–416.

23. Ng Y.L., Mann V., Rahbaran S., Lewsey J., Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature – Part 2. Influence of clinical factors. Int Endod J. 2008;41(1):6–31. https://doi.org/10.1111/j.1365-2591.2007.01323.x

24. Ilgüy D., Ilgüy M., Fisekçioglu E., Ersan N., Tanalp J., Dölekoglu S. Assessment of root canal treatment outcomes performed by Turkish dental students: Results after two years. J Dent Educ. 2013;77(4):502–509. https:// doi.org/10.1002/j.0022-0337.2013.77.4.tb05496.x

25. Eleftheriadis G.I., Lambrianidis T.P. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J. 2005;38(10):725–734. https://doi.org/10.1111/j.1365-2591.2005.01008.x

26. Markova K.B., Dakov K.V., Stoikova M.S. Root canal filling of endodontically treated teeth by dentistry students in clinical offices from 1996 to 1998 – radiological results. Folia Med. 2001;43(1-2):34–37.

27. Ricucci D., Siqueira Jr J.F. Endodontology. An integrated biological and clinical view. Quintessence Publishing; 2013. 425 p. https://doi.org/10.13140/2.1.4641.0886

28. Dummer P.M., McGinn J.H., Rees D.G. The position and topography of the apical canal constriction and apical foramen. Int Endod J. 1984;17(4):192–198. https://doi.org/10.1111/j.1365-2591.1984.tb00404.x

29. Rogatskin D.V., Ginali N.V. The art of dental radiography. Moscow: STBOOK; 2007. 200 p. (In Russ.)

30. Arzhantsev A.P. X-ray studies in dentistry and maxillofacial surgery. Moscow: GEOTAR-Media; 2021. 320 p. (In Russ.)

31. Vasiliev A.Yu., Ternovy S.K. (eds). Radiation diagnostics in dentistry: national manual. Moscow: GEOTAR-Media; 2010. 288 p. (In Russ.)

32. Song D., Zhang L., Zhou W., Zheng Q., Duan X., Zhou X., Huang D. Comparing cone-beam computed tomography with periapical radiography for assessing root canal obturation in vivo using microsurgical findings as validation. Dentomaxillofac Radiol. 2017;46(5):20160463. https://doi.org/10.1259/dmfr.20160463

33. Cheng L., Zhang R., Yu X., Tian Y., Wang H., Zheng G., Hu T. A comparative analysis of periapical radiography and cone-beam computerized tomography for the evaluation of endodontic obturation length. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(3):383–389. https://doi.org/10.1016/j.tripleo.2011.04.025

34. Langeland K. Root canal sealants and pastes. Dent Clin North Am. 1974;18(2):309–327.

35. Pasqualini D., Scotti N., Ambrogio P., Alovisi M., Berutti E. Atypical facial pain related to apical fenestration and overfilling. Int Endod J. 2012;45(7):670-7. https:// doi.org/10.1111/j.1365-2591.2012.02021.x

36. Alantar A., Tarragano H., Lefèvre B. Extrusion of endodontic filling material into the insertions of the mylohyoid muscle. A case report. Oral Surg Oral Med Oral Pathol. 1994;78(5):646–649. https://doi.org/10.1016/0030-4220(94)90179-1

37. Sipkin A.M., Nikitin A.A., Amhadova M.A. Diagnosis, treatment and rehabilitation of patients with complicated forms of maxillary sinusitis. Russian Journal of Dentistry. 2013;(1):40–43. (In Russ.) Available at: https://rjdentistry.com/1728-2802/article/view/39161 (accessed: 27.01.2025).

38. Guivarc’h M., Ordioni U., Catherine J.H., Campana F., Camps J., Bukiet F. Implications of endodontic-related sinus aspergillosis in a patient treated by infliximab: a case report. J Endod. 2015;41(1):125–129. https://doi.org/10.1016/j.joen.2014.09.022

39. Giardino L., Pontieri F., Savoldi E., Tallarigo F. Aspergillus mycetoma of the maxillary sinus secondary to overfilling of a root canal. J Endod. 2006;32(7):692–694. https:// doi.org/10.1016/j.joen.2005.12.001

40. Horré R., Schumacher G., Marklein G., Krömer B., Wardelmann E., Gilges S. et al. Case Report. Maxillary sinus infection due to Emericella nidulans. Mycoses. 2002;45(9-10):402–405. https://doi.org/10.1046/j.1439-0507.2002.00791.x

41. Khongkhunthian P., Reichart P.A. Aspergillosis of the maxillary sinus as a complication of overfilling root canal material into the sinus: report of two cases. J Endod. 2001;27(7):476–478. https://doi.org/10.1097/00004770-200107000-00011

42. Legent F., Billet J., Beauvillain C., Bonnet J., Miegeville M. The role of dental canal fillings in the development of Aspergillus sinusitis. A report of 85 cases. Arch Otorhinolaryngol. 1989;246(5):318–320. https://doi.org/10.1007/BF00463584

43. Willinger B., Beck-Mannagetta J., Hirschl A.M., Makristathis A., Rotter M.L. Influence of zinc oxide on Aspergillus species: a possible cause of local, non-invasive aspergillosis of the maxillary sinus. Mycoses. 1996;39(9-10):361–366. https://doi.org/10.1111/j.1439-0507.1996.tb00154.x

44. Scala R., Cucchi A., Cappellina L., Ghensi P. Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar. Indian J Dent Res. 2014;25(3):413–415. https://doi.org/10.4103/0970-9290.138362

45. González-Martín M., Torres-Lagares D., Gutiérrez-Pérez J.L., Segura-Egea J.J. Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal. J Endod. 2010;36(8):1419–1421. https:// doi.org/10.1016/j.joen.2010.03.008

46. Bastien A.V., Adnot J., Moizan H., Calenda É., Trost O. Secondary surgical decompression of the inferior alveolar nerve after overfilling of endodontic sealer into the mandibular canal: Case report and literature review. J Stomatol Oral Maxillofac Surg. 2017;118(6):389–392. https://doi.org/10.1016/j.jormas.2017.09.001

47. Köseoğlu B.G., Tanrikulu S., Sübay R.K., Sencer S. Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(6):803–806. https://doi.org/10.1016/j.tripleo.2005.07.015

48. Grötz K.A., Al-Nawas B., de Aguiar E.G., Schulz A., Wagner W. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig. 1998;2(2):73–76. https://doi.org/10.1007/s007840050048