Clinical Research| Volume 41, ISSUE 7, P1020-1025, July 2015

Management of Apical Periodontitis: Healing of Post-treatment Periapical Lesions Present 1 Year after Endodontic Treatment

Published:March 30, 2015DOI:



      Post-treatment periapical lesions present 1 year after treatment may heal during the second year or later. The aim of this study was to assess second-year volumetric changes in post-treatment periapical radiolucencies detected 1 year after treatment.


      Post-treatment periapical radiolucencies were detected on cone-beam computed tomographic (CBCT) scans obtained from 93 single-rooted teeth 1 year after endodontic treatment. The outcome of these teeth was evaluated 2 years after treatment. Two examiners independently measured the volume of the radiolucencies on CBCT images twice. A Wilcoxon signed rank test was used to assess the 1- and 2-year post-treatment volumes.


      The intraclass correlation coefficients for the CBCT volumetric measurements were 0.971 and 0.998 for the 2 examiners, and the interexaminer correlation coefficient was 0.998. Of the 93 teeth with post-treatment radiolucencies at 1 year, 61were examined at the second-year evaluation. The overall size of the radiolucencies significantly decreased during the second year (P = .01); the volume decreased in 38 teeth (63%), remained unchanged in 20 (33%), and increased in 2 (3%).


      The volume of post-treatment periapical radiolucencies detected 1 year after treatment was significantly reduced after the second year in 63% of teeth.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ørstavik D.
        Time-course and risk analyses of the development and healing of chronic apical periodontitis in man.
        Int Endod J. 1996; 29: 150-155
        • Patel S.
        • Dawood A.
        • Mannocci F.
        • et al.
        Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography.
        Int Endod J. 2009; 42: 507-515
        • Liang Y.H.
        • Jiang L.
        • Gao X.J.
        • et al.
        Detection and measurement of artificial periapical lesions by cone-beam computed tomography.
        Int Endod J. 2014; 47: 332-338
        • Metska M.E.
        • Parsa A.
        • Aartman I.H.
        • et al.
        Volumetric changes in apical radiolucencies of endodontically treated teeth assessed by cone-beam computed tomography 1 year after orthograde retreatment.
        J Endod. 2013; 39: 1504-1509
        • Patel S.
        • Wilson R.
        • Dawood A.
        • et al.
        The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography—part 2: a 1-year post-treatment follow-up.
        Int Endod J. 2012; 45: 711-723
        • Liang Y.H.
        • Jiang L.M.
        • Jiang L.
        • et al.
        Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant: a randomized controlled trial.
        J Endod. 2013; 39: 1218-1225
        • van der Borden W.G.
        • Wang X.
        • Wu M.K.
        • Shemesh H.
        Area and 3-dimensional volumetric changes of periapical lesions after root canal treatments.
        J Endod. 2013; 39: 1245-1249
        • Bornstein M.M.
        • Lauber R.
        • Sendi P.
        • von Arrx T.
        Comparison of periapical and limited cone-beam computed tomography in mandibular molars for analysis of anatomical landmarks before apical surgery.
        J Endod. 2011; 37: 151-157
        • Chang P.C.
        • Liang K.
        • Lim J.C.
        • et al.
        A comparison of the thresholding strategies of micro-CT for periodontal bone loss: a pilot study.
        Dentomaxillofac Radiol. 2013; 42: 1-12
        • Kamburoğlu K.
        • Kiliç C.
        • Özen T.
        • Horasan S.
        Accuracy of chemically created periapical lesion measurements using limited cone beam computed tomography.
        Dentomaxillofac Radiol. 2010; 39: 95-99
        • Farman A.G.
        ALARA still applies.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100: 395-397
        • Paula-Silva F.W.
        • Wu M.K.
        • Leonardo M.R.
        • et al.
        Accuracy of periapical radiography and cone-beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard.
        J Endod. 2009; 35: 1009-1012
        • Wu M.K.
        • Shemesh H.
        • Wesselink P.R.
        Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment.
        Int Endod J. 2009; 42: 656-666
        • Ng Y.L.
        • Mann V.
        • Rahbaran S.
        • et al.
        Outcome of primary root canal treatment: systematic review of the literature—part 1. Effects of study characteristics on probability of success.
        Int Endod J. 2007; 40: 921-939
        • Haapasalo M.
        • Udnaes T.
        • Endal U.
        Persistent, recurrent, and acquired infection of the root canal system post-treatment.
        Endod Topics. 2003; 6: 29-56
        • Velvart P.
        • Hecker H.
        • Tillinger G.
        Detection of the apical lesion and mandibular canal in conventional radiography and computed tomography.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 92: 682-688
        • Bhaskar S.N.
        Periapical lesions: types, incidence, and clinical features.
        Oral Surg Oral Med Oral Pathol. 1966; 21: 657-671
        • Love R.M.
        • Firth N.
        Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin.
        Int Endod J. 2009; 42: 198-202
        • Haapasalo M.
        • Shen Y.
        • Ricucci D.
        Reasons for persistent and emerging post-treatment endodontic disease.
        Endod Topics. 2011; 18: 31-50
        • Wang J.
        • Chen W.
        • Jiang Y.
        • Liang J.
        Imaging of extraradicular biofilm using combined scanning electron microscopy and stereomicroscopy.
        Microsc Res Tech. 2013; 76: 979-983
        • Nair P.N.
        • Henry S.
        • Cano V.
        • Vera J.
        Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after ‘one-visit’ endodontic treatment.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99: 231-252
        • Molander A.
        • Reit C.
        • Dahlén G.
        • Kvist T.
        Microbiological status of root-filled teeth with apical periodontitis.
        Int Endod J. 1998; 31: 1-7
        • Chávez de Paz L.
        Redefining the persistent infection in root canals: possible role of biofilm communities.
        J Endod. 2007; 33: 652-662
        • Wu M.K.
        • Wesselink P.
        • Shemesh H.
        New terms for categorizing the outcome of root canal treatment.
        Int Endod J. 2011; 44: 1079-1080
        • Gorni F.G.
        • Gagliani M.M.
        The outcome of endodontic retreatment: a 2-yr follow-up.
        J Endod. 2004; 30: 1-4
        • Ørstavik D.
        • Qvist V.
        • Stoltze K.
        A multivariate analysis of the outcome of endodontic treatment.
        Eur J Oral Sci. 2004; 112: 224-230
        • Ng Y.L.
        • Mann V.
        • Rahbaran S.
        • et al.
        Outcome of primary root canal treatment: systematic review of the literature—part 2. Influence of clinical factors.
        Int Endod J. 2008; 41: 6-31
        • Liang Y.H.
        • Li G.
        • Shemesh H.
        • et al.
        The association between complete absence of post-treatment periapical lesion and quality of root canal filling.
        Clin Oral Investig. 2012; 16: 1619-1626