Influence of Endodontic Treatment and Coronal Restoration on Status of Periapical Tissues: A Cone-beam Computed Tomographic Study Aline C. Gomes, DDS, MSc,* Yuri Nejaim, DDS, MSc, † Amaro I.V. Silva, DDS, MSc, PhD, † Francisco Haiter-Neto, DDS, MSc, PhD, † Nestor Cohenca, DDS, ‡ Alexandre A. Zaia, DDS, MSc, PhD,* and Emmanuel Jo~ ao Nogueira Leal Silva, DDS, MSc, PhD § Abstract Introduction: This cross-sectional study determined the prevalence of apical radiolucency in 1290 root ca- nal–treated teeth and the correlation between endodon- tic treatment quality and the presence of coronal restorations with apical radiolucency using cone-beam computed tomographic imaging. Methods: Cone- beam computed tomographic scans were analyzed, and teeth were classified as healthy or diseased accord- ing to the periapical status. Other factors were also eval- uated for their association with the apical diagnosis including sex, quality of endodontic treatment, presence of coronal restorations and posts, and apical level of filling. Results: Of the treated teeth, 48.83% were clas- sified as healthy. Only 55.11% of the teeth had end- odontic treatment rated as adequate. The quality of endodontic treatment and the presence of coronal resto- ration were statistically correlated with the presence or absence of an apical radiolucency (P < .0001). Com- bined data revealed that teeth with both adequate end- odontic treatment and the presence of coronal restoration showed significantly better apical status than the other combinations (P < .001). Canals filled up to 0–2 mm short of the apex had a significantly higher number of teeth rated as healthy compared with overfilled or underfilled cases (P = .001). The pres- ence of a post was not found to be a statistical signifi- cant factor (P = .81). Conclusions: Data showed a relatively high prevalence of apical radiolucencies in root canal–treated teeth. The quality of the endodontic treatment, the presence of coronal restoration, and api- cal extent of the root canal filling were significantly associated with healthy apical tissues. (J Endod 2015;-:1–5) Key Words Apical radiolucency, cone-beam computed tomography, coronal restoration, cross- sectional studies, root canal therapy C ross-sectional studies performed in several countries revealed the prevalence of apical radiolucency in root endodontically treated teeth to be relatively high, ranging from 35%–60% (1–12). Ray and Trope (13) examined the radiographs of 1010 endodontically treated teeth and observed the presence of periapical pathology in 39.97% of the cases, showing a strong correlation among the technical quality of end- odontic treatment and coronal restoration and apical radiolucency. These statistics are in contrast to the outcome of endodontic treatment obtained in follow-up clinical studies (ie, 90%–95%) (14–16). Most cross-sectional studies evaluating the apical status of endodontically treated teeth have been performed using 2-dimensional (2D) periapical radiographs (2–9) or panoramic radiographs (10–12). However, current literature has shown the limited diagnostic value of 2D periapical radiographs, especially for determination of the quality of treatment as well as its limitation in the detection of apical radiolucency (17). Cone-beam computed tomographic (CBCT) imaging has the potential to circum- vent most of the limitations of 2D radiographs, and its high sensitivity for the detection of bone changes has comparatively disclosed a higher prevalence of apical radiolucency than radiographs (18, 19). A recent clinical study showed a 14 times increase in the periapical radiolucency rate when teeth were assessed with CBCT imaging when compared with periapical radiographs (20). To the best of our knowledge, there are no studies evaluating the correlation be- tween qualities of endodontic treatment with apical radiolucency using CBCT scanning. The aim of the present study was to assess the prevalence of apical radiolucency in endodontically treated teeth and its correlation to several clinical variables. Materials and Methods Study Population The sample for this cross-sectional prospective study consisted of 434 adult patients who were referred to the oral and maxillofacial radiology department in 2008 requiring 3-dimensional CBCT scanning as part of their dental examination, diagnosis, and treat- From the *Department of Restorative Dentistry, Endodontic Division and † Department of Oral Diagnosis, Dental Radiology Division, Piracicaba Dental School, State University of Campinas, Piracicaba, S~ ao Paulo, Brazil; ‡ Department of Pediatric Dentistry, University of Washington, Seattle, Washington; and § Department of Endodon- tics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil. Address requests for reprints to Dr Emmanuel Jo~ ao Nogueira Leal Silva, Rua Herotides de Oliveira, 61/902, Icara  ı, Niter oi, RJ, Brazil. E-mail address: nogueiraemmanuel@hotmail.com 0099-2399/$ - see front matter Copyright ª 2015 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2015.07.008 Clinical Research JOE — Volume -, Number -, - 2015 Status of Periapical Tissues 1