Title The Length of Obturation Affects The Prognosis of Non-Surgical Root Canal Therapy
Clinical Question In patients receiving non-surgical root canal treatment, does obturation with overfilling or underfilling affect the clinical prognosis compared to ideally placed obturation?
Clinical Bottom Line Extrusion of obturating material beyond the radiographic apex has been shown to have significantly lower success rate compared to obturation contained within the root canal space. Further, these studies have shown that the best outcome could be achieved by obturating the canal within 0-2 mm from the radiographic apex.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
14716263Kojima/2003Twenty six studies from 1956-1995 were reviewed and analyzed.Meta-Analysis
Key resultsThe success rates for root canal treatment was 70.8% (+/- 1.44%) with over extended obturation, 86.5% (+/-0.88%) with obturation within 2 mm of the radiographic apex (flush) and 85.5% (+/- 0.98%) with obturation shorter than 2 mm from radiographic apex (under extension). The difference was significant between flush and over extension (cumulative odds ratio, 2.32; 95% confidence intervals, 2.07-2.60) and between flush and under extension (cumulative odds ratio, 1.12; 95% confidence intervals, 1.00-1.27). The most favorable outcome is achieved by terminating the obturation between 0-2 mm from the radiographic apex.
15793382Schaeffer/2005Four studies including 2178 teeth were reviewed and analyzed.Meta-Analysis
Key resultsThe success rate for root canal treatment with obturation 0-1 mm short of the radiographic apex is similar to those with obturation placed 1 to 3 mm short of the apex (95% CI = -38.9%, 44.3%), p = 0.80. In addition, the success rate of root canal treatment with obturating material extruding from the apex was 26% lower than cases with obturation placed within 3mm from the radiographic foramina. (95% CI = -19.9, 72.4%), p = 0.09. The results of this meta-analysis showed that the success rate of the endodontic treatment is high with obturating the canal 0-1 mm from the radiographic apex and decreases as the obturating material extrudes.
Evidence Search Success[Title] AND rate[Title] AND endodontic[Title] AND treatment[Title] AND teeth[Title] AND vital[Title] AND nonvital[Title] AND pulps[Title] AND meta-analysis[Title] optimal[All Fields] AND obturation[All Fields] AND length[All Fields]
Comments on
The Evidence
Validity: Most of the included studies have used the radiographic apex as a reference for proper termination of the obturation length. However, it has long been appreciated that there is substantial discrepancy between the radiographic and anatomical foramina with the latter being often shorter in length. Nowadays, electronic apex locators are a proven accurate method of estimating the position of the anatomic apex and acquiring a safe working length. Although these studies have used varied obturation materials, intracanal medicaments and types/concentrations of irrigants, the results regarding the neagative impact of extrusion of obturating materials on the clinical outcome is consistent Perspective: Clinicians must employ caution while determining a safe working length and during obturation of the root canal system. The efforts should be focused on maintaining instruments, and ultimately, the obturating materials within the root canal. Therefore, termination level of root canal obturation, at best, should be at the minor constriction of the apical foramen, which can be located accurately by utilizing electronic apex locators.
Applicability The data is useful to all clinicians performing endodontic therapy as determining the working and obturation length are important factors to achieve the best root canal treatment outcome.
Specialty (Endodontics) (General Dentistry) (Restorative Dentistry)
Keywords Root canal obturation, overfilling, overextension, underfilling, working length, root canal treatment, guttpercha, gutta-percha, obturation length, endodontic treatment, endodontic therapy, non-surgical root canal treatment. root canal(s), endo(dontic) (treatment), RCT, obturation, obturate, RCT prognosis, endo prognosis
ID# 2950
Date of submission 10/16/2015
E-mail ALSHUJAA@livemail.uthscsa.edu
Author Abdulmajeed Al Shujaa, DDS
Co-author(s) e-mail
Faculty mentor Anibal Diogenes, DDS, MS, PhD
Faculty mentor e-mail DIOGENES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available