Assessment of Extruded Root Canal Filling Materials in Single-Rooted Teeth Using Cone Beam Computed Tomography

Abstract views: 164 / PDF downloads: 364




endodontically-treated, root canal sealant, root canal filling material, overfilling, gutta-percha;


Objective: Overfilling a root canal has a negative influence on the prognosis of teeth with apical periodontitis. This study proposed to assess extruded sealer and gutta-percha in single-rooted teeth within a Turkish subpopulation using cone-beam computed tomography.

Methods: The study included cone-beam computed tomography scans of 2,346 endodontically treated teeth with a single root and foramen from a private dental clinic's archive. Teeth were divided into four groups: maxillary anteriors, mandibular anteriors, mandibular premolars, and maxillary second premolars. Two endodontists analyzed the scans at all planes and recorded information pertaining to tooth number, tooth type, and presence of extrusion. To examine the data, a chi-square test with a 0.05 p-value was performed.

Results: Extrusion was detected in 256 (10.91%) of the single-rooted teeth. There was significant difference among the groups (p<0.05). Extrusion was significantly higher in the maxillary anteriors than in the other tooth groups. Maxillary second premolars had lower extrusion compared to the other tooth groups. There was no statistical relationship between the maxillary anterior tooth groups and the presence of extrusion (p=0.338).

Conclusion: Maxillary anteriors had higher root canal filling material extrusion than the other tooth groups, while maxillary second premolars had lower extrusion.


Metrics Loading ...

Author Biography

Fatma Tunç, Department of Endodontics, Dental Faculty, Gaziantep University, Gaziantep, Türkiye


Sabeti MA, Nekofar M, Motahhary P, Ghandi M, Simon JH (2006) Healing of apical periodontitis after endodontic treatment with and without obturation in dogs. J Endod. 32:628-633.

Dummer PM, McGinn JH, Rees DG (1984) The position and topography of the apical canal constriction and apical foramen. Int Endod. J 17:192-198.

Ricucci D, Langeland K (1998) Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J. 31:394-409.

Ponce EH, Vilar Fernández JA (2003) The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod. 29:214-219.

Gutierrez JH, Aguayo P (1995) Apical foraminal openings in human teeth. Number and location. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 79:769-777.

Marroquín BB, El-Sayed MA, Willershausen-Zönnchen B (2004) Morphology of the physiological foramen: I. Maxillary and mandibular molars. J Endod. 30:321-328.

Siqueira JF, Jr., Rôças IN, Alves FR, Campos LC (2005) Periradicular status related to the quality of coronal restorations and root canal fillings in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 100:369-374.

Gomes AC, Nejaim Y, Silva AI, et al (2015) Influence of Endodontic Treatment and Coronal Restoration on Status of Periapical Tissues: A Cone-beam Computed Tomographic Study. J Endod. 41:1614-1618.

Ricucci D, Rôças IN, Alves FR, Loghin S, Siqueira JF, Jr (2016) Apically Extruded Sealers: Fate and Influence on Treatment Outcome. J Endod. 42:243-249.

Sjogren U, Hagglund B, Sundqvist G, Wing K (1990) Factors affecting the long-term results of endodontic treatment. J Endod. 16:498-504.

Bergenholtz G, Lekholm U, Milthon R, Heden G, Odesjö B, Engström B (1979) Retreatment of endodontic fillings. Scand J Dent Res. 87:217-224.

Halse A, Molven O (1987) Overextended gutta-percha and Kloroperka N-O root canal fillings. Radiographic findings after 10-17 years. Acta Odontol Scand. 45:171-177.

Ricucci D, Russo J, Rutberg M, Burleson JA, Spångberg LS (2011) A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 112:825-842.

Siqueira JF, Jr., Rôças IN, Ricucci D, Hülsmann M (2014) Causes and management of post-treatment apical periodontitis. Br Dent J. 216:305-312.

. Olsson B, Wennberg A (1985) Early tissue reaction to endodontic filling materials. Endod Dent Traumatol. 1:138-141.

Dalopoulou A, Economides N, Evangelidis V (2017) Extrusion of root canal sealer in periapical tissues: Report of two cases with different treatment management and literature review. Balk J Dent Med. 21:12-18.

Sjögren U, Figdor D, Persson S, Sundqvist G (1997) Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J. 30:297-306.

Fristad I, Molven O, Halse A (2004) Nonsurgically retreated root filled teeth--radiographic findings after 20-27 years. Int Endod J. 37:12-18.

Santos-Junior AO, De Castro Pinto L, Mateo-Castillo JF, Pinheiro CR (2019) Success or failure of endodontic treatments: A retrospective study. J Conserv Dent. 22:129-132.

Pogrel MA (2007) Damage to the inferior alveolar nerve as the result of root canal therapy. J Am Dent Assoc. 138:65-69.

Swartz DB, Skidmore AE, Griffin JA, Jr (1983) Twenty years of endodontic success and failure. J Endod. 9:198-202.

Pruthi PJ, Dharmani U, Roongta R, Talwar S (2015) Management of external perforating root resorption by intentional replantation followed by Biodentine restoration. Dent Res J (Isfahan). 12:488-493.

de Souza Filho FJ, Benatti O, de Almeida OP (1987) Influence of the enlargement of the apical foramen in periapical repair of contaminated teeth of dogs. Oral Surg Oral Med Oral Pathol. 64:480-484.

Vier FV, Figueiredo JA (2002) Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption. Int Endod J. 35:710-719.

ElAyouti A, Weiger R, Löst C (2001) Frequency of overinstrumentation with an acceptable radiographic working length. J Endod. 27:49-52.

Goldberg F, Cantarini C, Alfie D, Macchi RL, Arias A (2020 ) Relationship between unintentional canal overfilling and the long-term outcome of primary root canal treatments and nonsurgical retreatments: a retrospective radiographic assessment. Int Endod J. 53:19-26.

Tennert C, Jungbäck IL, Wrbas KT (2013) Comparison between two thermoplastic root canal obturation techniques regarding extrusion of root canal filling--a retrospective in vivo study. Clin Oral Investig. 17:449-454.

Khabbaz MG, Papadopoulos PD (1999) Deposition of calcified tissue around an overextended gutta-percha cone: case report. Int Endod J. 32:232-235.

Brooks JK, Kleinman JW (2013) Retrieval of extensive gutta-percha extruded into the maxillary sinus: use of 3-dimensional cone-beam computed tomography. J Endod. 39:1189-1193.

Da Silva D, Endal U, Reynaud A, Portenier I, Orstavik D, Haapasalo M (2002) A comparative study of lateral condensation, heat-softened gutta-percha, and a modified master cone heat-softened backfilling technique. Int Endod J. 35:1005-1011.

Gençoğlu N, Garip Y, Baş M, Samani S (2002) Comparison of different gutta-percha root filling techniques: Thermafil, Quick-fill, System B, and lateral condensation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 93:333-336.

Clinton K, Van Himel T (2001) Comparison of a warm gutta-percha obturation technique and lateral condensation. J Endod. 27:692-695.

De Cleen MJ, Schuurs AH, Wesselink PR, Wu MK (1993) Periapical status and prevalence of endodontic treatment in an adult Dutch population. Int Endod J. 26:112-119.

Saunders WP, Saunders EM, Sadiq J, Cruickshank E (1997) Technical standard of root canal treatment in an adult Scottish sub-population. Br Dent J. 182:382-386.

Imfeld TN (1991) Prevalence and quality of endodontic treatment in an elderly urban population of Switzerland. J Endod. 17:604-607.

Bürklein S, Schäfer E, Jöhren H-P, Donnermeyer D (2020) Quality of root canal fillings and prevalence of apical radiolucencies in a German population: a CBCT analysis. Clin Oral Investig. 24:1217-1227.

Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. Int Endod J. 44:610-625.

Ridell K, Petersson A, Matsson L, Mejàre I (2006) Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults. A retrospective study. Acta Odontol Scand. 64:104-110.

Nascimento EHL, Gaêta-Araujo H, Andrade MFS, Freitas DQ (2018) Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis. Clin Oral Investig. 22:2495-2503.

Ilgüy D, Ilgüy M, Fişekçioğlu E, Ersan N, Tanalp J, Dölekoglu S (2013) Assessment of root canal treatment outcomes performed by Turkish dental students: results after two years. J Dent Educ. 77:502-509.

Yousuf W, Khan M, Mehdi H (2015) Endodontic Procedural Errors: Frequency, Type of Error, and the Most Frequently Treated Tooth. Int J Dent. 2015:673914.

Koçak B, Önay EO, Koç C, Üngör M (2022) Examination of extruded root canal filling sealers and their relationship with various risk factors: A retrospective study [Taşkın kök kanal dolgu patları ve bunların çeşitli risk faktörleriyle ilişkilerinin incelenmesi: Retrospektif bir araştırma] Turkiye Klinikleri J Dental Sci. ([In Turkish]).

Barrieshi-Nusair KM, Al-Omari MA, Al-Hiyasat AS (2004) Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan. J Dent. 32:301-307.

Vukadinov T, Blažić L, Kantardžić I, Lainović T (2014) Technical quality of root fillings performed by undergraduate students: a radiographic study. Sci World J. 2014:751274.

Er O, Sagsen B, Maden M, Cinar S, Kahraman Y (2006) Radiographic technical quality of root fillings performed by dental students in Turkey. Int Endod J. 39:867-872.

Bürklein S, Heck R, Schäfer E (2017) Evaluation of the root canal anatomy of maxillary and mandibular premolars in a selected German population using cone-beam computed tomographic data. J Endod. 43:1448-1452.

Knowles KI, Jergenson MA, Howard JH (2003) Paresthesia associated with endodontic treatment of mandibular premolars. J Endod. 29:768-770.

Nino-Barrera JL, Gamboa-Martinez LF, Laserna-Zuluaga H, et al (2018) Factors associated to apical overfilling after a thermoplastic obturation technique - Calamus® or Guttacore®: a randomized clinical experiment. Acta Odontol Latinoam. 31:45-52. PMID: 30056466




How to Cite

Çulha, E., & Tunç, F. (2023). Assessment of Extruded Root Canal Filling Materials in Single-Rooted Teeth Using Cone Beam Computed Tomography. European Journal of Therapeutics, 29(3), 518–525.



Original Articles