Influence of intraoperative factors on the outcome of root canal treatment (Part 2): A retrospective clinical study


  • Gazala Ehtiba Department of Conservative and Endodontic, dental school, Sirte University, Sirte, Libya
  • Ali Ahtiba Department of Dentistry, Sirte Polyclinic center, Sirte, Libya.


Intraoperative factors, Success rate, Primary root canal treatment, Endodontic outcome, European Society of Endodontology


Aim: to assess how intraoperative prognostic variables (Treatment session, apical preparation size, Root canal filling length, Obstruction, Type of irrigant, Acute flare up) affect the outcome of the initial endodontic therapy. Methodology: Out of 109 treated patients, 91 had completed medical and dental data. A total of 146 received endodontic treatment with 408 Canals. All procedures were carried out in 2018 and 2019, in a private dental clinic in Sirte, Libya. The criteria of the European Society of Endodontology were used to assess the treatment outcome. The level of significance was set at p-value < 0.05%. Results: three factors, namely, the Apical preparation size (Chi-square = 49.7, p-value = 0.0001), the type of irrigant (Chi-square = 18.7, p-value = 0.001) and the root filling extension (Chi-square = 15.6, p-value = 0.016) were found to have a significant effect on the success rate at < 0.05 level of significance. Conclusion: Quantitative results lead to the conclusion that three intraoperative factors, namely, the apical preparation size, the type of irrigant and the length of root filling were found to have a significant effect on the success rate of root canal treatment.


Bender IB, S.S., Soltanoff W, Endodontic success – a reappraisal of criteria. 1. Oral Surgery, Oral Medicine, and Oral Pathology, 1966a. 22: p. 780-9.

Bystro¨m A, H.R., Sjo¨gren U, Sundqvist G, Healing of periapical lesion of pulpless teeth after endodontic treatment with controlled asepsis. Endodontics and Dental Traumatology 1987. 3: p. 58-63.

Dugas NN, L.H., Teplitsky P, Friedman S Quality of life and satisfaction outcomes of endodontic treatment. Journal of Endodontics. 2002. 28: p. 819-27.

Friedman S, M.C., The success of endodontic therapy – healing and functionality. Canadian Dental Association Journal, 2004. 32: p. 496-503.

Ng Y-L, M.V., Rahbaran S, Lewsey J, Gulabivala K Outcome of primary root canal treatment: systematic review of the literature – part 2. Influence of clinical factors. International Endodontic Journal, 2008a. 41: p. 6-31.

Ng YL, M.V., Gulabivala K, A prospective study of the factors affecting outcomes of non-surgical root cana treatment: part 2: tooth survival. International Endodontic Journal, 2011. 44(7): p. 610-25.

PV, A., Recognition and prevention of failures in clinical dentistry, endodontics. Annals of the Royal Australasian College of Dental Surgeons, 1991. 11: p. 150-66.

I., B., A histological and roentgenological study of the periapical region of human upper incisors. Odontol Revy, 1967. 18(11): p. 1-176.

M. K. Wu, P.W., and H. Shemesh,, “New terms for categorizing the outcome of root canal treatment. International Endodontic Journal, 2011. 44(11): p. 1079-80.

HAAPASALO M, S.Y., RICUCCI D, Reasons for persistent and emerging post-treatment endodontic disease. Endodontic topic, 2008. 18(1): p. 31-50.

Ørstavik D, K.K., Eriksen H, The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endodontics and Dental Traumatology, 1986. 2: p. 20-34.

Bergenholtz G, S.L., Controversies in Endodontics. Crit Rev Oral Biol Med 2004; 15: 99–114., 2004. 15: p. 99-114.

Figini L, L.G., Gorni F, Gagliani M. , Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod 2008 (Sep). 34(9): p. 1041–7.

Manfredi, M.F., L.; Gagliani, M.; Lodi, G. , Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst. Rev. , 2016.

KM, H., Single-visit more effective than multiple-visit root canal treatment? Evid Based Dent, 2006. 7: p. 13-14.

Fleming, C.H.L., M.S.; Alley, L.W.; Eleazer, P.D., Comparison of Classic Endodontic Techniques versus Contemporary Techniques on Endodontic Treatment Success. Endod. J., 2010. 36: p. 414-418.

Friedman, S.A., S.; Lawrence, H.P., Treatment outcome in endodontics: The Toronto study. Phase 1: Initial treatment. Endod. J., 2003. 29: p. 787-793.

Paredes-Vieyra, J.E., F.J.J., Success Rate of Single- versus Two-visit Root Canal Treatment of Teeth with Apical Periodontitis: A Randomized Controlled Trial. Endod. J., 2012. 38: p. 1164-1169.

Moreira, M.S.A.A., N.S.; Tedesco, T.K.; dos Santos, M.; Morimoto, S., Endodontic Treatment in Single and Multiple Visits: An Overview of Systematic Reviews. Endod. J., 2017. 43: p. 864-870.

Chugal, N.M.C., J.M.; Spångberg, L.S.W., A prognostic model for assessment of the outcome of endodontic treatment: Effect of biologic and diagnostic variables. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol., 2001. 91: p. 342-352.

Fernández, R.C., J.A.; Cadavid, D.; Álvarez, L.G.; Restrepo, F.A., Survival of Endodontically Treated Roots/Teeth Based on Periapical Health and Retention: A 10-year Retrospective Cohort Study. Endod. J. , 2017. 43: p. 2001-2008.

Marquis, V.L.D., T.; Farzaneh, M.; Abitbol, S.; Friedman, S. , Treatment Outcome in Endodontics: The Toronto Study. Phase III: Initial Treatment. Endod. J., 2006. 32: p. 299-306.

Ng, Y.-L.M., V.; Gulabivala, K. , A prospective study of the factors affecting outcomes of non-surgical root canal treatment: Part 2: Tooth survival. Int. Endod. J., 2011. 44: p. 610-625.

Iqbal, A., The Factors Responsible for Endodontic Treatment Failure in the Permanent Dentitions of the Patients Reported to the College of Dentistry, the University of Aljouf, Kingdom of Saudi Arabia. J. Clin. Diagn. Res., 2016. 10: p. ZC146.

Ricucci, D.R., J.; Rutberg, M.; Burleson, J.A.; Spångberg, L.S. , A prospective cohort study of endodontic treatments of 1369 root canals: Results after 5 years. . Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, 2011. 112: p. 825-842.

Craveiro, M.A.F., C.E.; de Martin, A.S.; Bueno, C.E.D.S., Influence of Coronal Restoration and Root Canal Filling Quality on Periapical Status: Clinical and Radiographic Evaluation. Endod. J., 2015. 41: p. 836-840.

H., Y., The significance of the presence of foreign material periapically as a cause of failure of root treatment. Oral Surgery, Oral Medicine, and Oral Patholology, 1982. 54: p. 566-574.

Nair PN, S.g.U., Krey G, Sundqvist G, Therapyresistant foreign body giant cell granuloma at the periapex of a root-filled human tooth. Journal of Endodontics 16, 589–95., 1990. 16: p. 589-595.

Koppang HS, K.R., Stolen SO, Identification of common foreign material in postendodontic granulomas and cysts. The Journal of the Dental Association of South Africa, 1992. 47: p. 210-216.

Sjo¨gren U, S.G., Nair PNR, Tissue reaction to gutta-percha of various sizes when implanted subcutaneously in guinea pigs. European Journal of Oral Sciences, 1995. 103: p. 313-321.

Shuping GB, Ø.D., Sigurdsson A, Trope M., Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications. Journal of Endodontic, 2000. 26: p. 751-755.

Card SJ, S.A., Ørstavik D, Trope M., The effectiveness of increased apical enlargement in reducing intracanal bacteria. Journal of Endodontics, 2002. 28: p. 779-783.

Dalton BC, Ø.D., Phillips C, Pettiette M, Trope M, Bacterial reduction with nickel-titanium rotary instrumentation. Journal of Endodontics, 1998. 24: p. 763-767.

Sj€ogren U, F.D., Spangberg L, Sundqvist G., The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. International Endodontic Journal, 1991. 24: p. 119-125.

Rollison S, B.F., Stevens RH., Efficacy of bacterial removal from instrumented root canals in vitro related to instrumentation technique and size. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodology, 2002. 94: p. 366-371.

Mc Gurkin-Smith R, T.M., Caplan D, Sigurdsson A. , Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaOCl, EDTA, and Ca(OH)2. Journal of Endodontic, 2005. 31: p. 359-363.

TW., C., Mechanical effectiveness of root canal irrigation. J Endod 1983;9:475–9. Journal of Endodontic, 1983. 9: p. 475-479.

Khademi A, Y.M., Feizianfard M. , Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems. Journal of Endodontics, 2006. 32: p. 417-420.

Albrecht LJ, B.J., Marshall JG., Evaluation of apical debris removal using various sizes and tapers of ProFile GT files. Journal of Endodontics, 2004. 30: p. 425-428.

Ørstavik D, K.K., Molven O. , Effects of extensive apical reaming and calcium hydroxide dressing on bacterial infection during treatment of apical periodontitis: a pilot study. International Endodontic Journal, 1991. 24: p. 1-7.

Yared GM, D.F., Influence of apical enlargement on bacterial infection during treatment of apical periodontitis. Journal of endodontiv 1994: p. 535-537.

LZ., S., The dependence of the results of pulp therapy on certain factors—ananalytical study based on radiographic and clinical follow-up examinations. Acta Odontol Scand, 1956. 14: p. 1-175.

Kerekes K, T.L., Long-term results of endodontic treatment performed with a standardized technique. Journal of Endodontics, 1979. 5: p. 83–90.

Hoskinson SE, N.Y., Hoskinson AE, Moles DR, Gulabivala K. , A retrospective comparison of outcome of root canal treatment using two different protocols. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodogy, 2002. 93: p. 705–15.

Saini HR, T.S., Sangwan P, Duhan J, Gupta A., Effect of Different Apical Preparation Sizes on Outcome of Primary Endodontic Treatment: A Randomized Controlled Trial. Journal of Endodontic, 2012. 38: p. 1309-1315.

Zehnder, M., Root canal irrigants. Journal of Endodontic, 2006. 32: p. 389-398.

Ruksakiet, K.H., L.; Farkas, N.; Hegyi, P.; Sadaeng, W.; Czumbel, L.M.; Sang-Ngoen, T.; Garami, A.; Mikó, A.; Varga, G.; et al. , Antimicrobial efficacy of chlorhexidine and sodium hypochlorite in root canal disinfection: A systematic review and meta-analysis of randomized controlled trials. Journal of Endodontic, 2020. 46: p. 1032-1041.

Byström A, S.G., Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res., 1981. 89: p. 321-8.

Byström A, S.G., Bacteriologic evaluation of the effect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral Surgery Oral Medicine Oral Pathology., 1983. 55: p. 307-12.

Cvek M, H.L., Nord C-E Treatment of non-vital permanent incisors with calcium hydroxide. Odontologisk Revy, 1976. 27: p. 93-108.

Gulabivala K, P.B., Evans G, Ng Y-L., Effects of mechanical and chemical procedures on root canal surfaces. Endodontic Topics, 2005. 10: p. 103-122.

Bystrom A, S.G., The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. International Endodontic Journal, 1985. 18: p. 35-40.

A., B., Evaluation of endodontic treatment of teeth with apical periodontitis, in Endodontics and Oral Microbiology. 1986, University of Umeå.

Clarkson RM, P.H., Moule AJ., Influence of ethylenediaminetetraacetic acid on the active chlorine content of sodium hypochlorite solutions when mixed in various proportions. Journal of Endodontic, 2011. 37: p. 538-43.

Grawehr M, S.B., Waltimo T, et al., Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. International Endodontic Journal, 2003. 36: p. 411-7.