Study Finds Higher Prevalence of Periapical Radiolucent Lesions in Endodontically Treated Teeth with Intraradicular Posts

"Although factors such as the type of IRP and the remaining gutta-percha length did not show a significant impact, the presence of IRPs increased the risk of PRL formation by over three times (OR, 3.670). The study emphasizes the importance of carefully weighing the benefits and risks of using IRPs in ETT restorations," the researchers wrote.

Periapical radiolucent lesions are areas of bone loss surrounding the root apex, often indicating inflammation or infection. These lesions can complicate the treatment of root canal-treated teeth, leading to potential failures in the restoration process. The literature presents conflicting findings on the relationship between intraradicular posts and the prevalence of periapical radiolucent lesions in endodontically treated teeth.

Against the above background, Badi Alotaibi, Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraidah, Qassim, Saudi Arabia, and colleagues aimed to examine the relationship between the presence of intraradicular posts (IRPs) and the prevalence of periapical radiolucent lesions (PRLs).

For this purpose, the researchers conducted a cross-sectional study to compare the prevalence of PRLs in ETT with and without IRPs. CBCT images were used, focusing on teeth with at least 2 mm of remaining gutta-percha apical to the post-end. Two calibrated assessors evaluated the presence of PRLs. A stepwise backward binomial logistic regression was employed to assess the impact of age, post-presence, gender, tooth position (anterior/posterior), and arch location (maxillary/mandibular) on the likelihood of PRL occurrence. The null hypothesis posited that the presence of IRPs does not affect PRL prevalence.

The study revealed the following findings:

• Teeth with intraradicular posts (IRPs) exhibited a significantly higher prevalence of periapical radiolucent lesions (PRLs).
• No significant differences in PRL prevalence were found based on the type of IRP or the remaining gutta-percha length.
• The regression model, including all five predictors, showed a significant fit, explaining 14.5% of the variance in PRL presence (Nagelkerke R²).
• The Hosmer-Lemeshow test indicated no lack of fit, supporting the model’s adequacy.
• The model correctly classified 67.3% of cases, with a sensitivity of 54.5%, specificity of 75.4%, positive predictive value (PPV) of 58.3%, and negative predictive value (NPV) of 72.4%.
• Among the predictors, the presence of posts was the only statistically significant variable (B = 1.300, OR = 3.670).

The study observed a higher prevalence of periapical radiolucent lesions in endodontically treated teeth with intraradicular posts.

"Given the study's limitations, we recommend that clinicians carefully assess the risks and benefits of using IRPs during ETT restorations," the researchers concluded.

Reference:

Alotaibi, B., Javed, M.Q., Alsallomi, A. et al. Prevalence of periapical radiolucent lesions in endodontically-treated teeth with intraradicular posts: a cross-sectional CBCT study. BMC Oral Health 25, 33 (2025). https://doi.org/10.1186/s12903-024-05394-0