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The Global Periapical Health Study: A Big Data CBCT Analysis of Periapical Pathology across 54 Countries
Journal article   Open access   Peer reviewed

The Global Periapical Health Study: A Big Data CBCT Analysis of Periapical Pathology across 54 Countries

Jorge N.R. Martins, Jorge N.R. Martins, Pablo Ensinas, Narine Hovhannisyan, Francis Chan, Narin Babayeva, Luiza Berti, Marcia Antúnez, Yongchun Gu, Catalina Mendez de la Espriella, …
Journal of endodontics
02/10/2026
DOI: 10.1016/j.joen.2026.01.021
PMID: 41679428
url
https://doi.org/10.1016/j.joen.2026.01.021View
Published (Version of record) Open Access

Abstract

Periapical pathology, a common outcome of pulpal infection or failed endodontic therapy, remains underexplored globally. Most studies are small-scale and based on two-dimensional radiographs. This study aimed to provide a standardized worldwide estimate of its prevalence using cone-beam computed tomography (CBCT). A cross-sectional, multicenter study was conducted across 54 countries, each represented by one calibrated examiner. Examiners consecutively assessed 3,500 roots from pre-existing CBCT scans, yielding data from 189,000 roots (138,536 teeth) of 6,688 patients. A standardized protocol was applied using the CBCT periapical index to record lesion presence, tooth type, previous root canal treatment, and demographic variables. Only scans with voxel size ≤200 μm were included. Data were analyzed through meta-analysis and logistic regression model to evaluate factors associated with periapical pathology, with meta-regression assessing voxel size and field-of-view effects. At the patient level, periapical pathology affected 58.6% of individuals worldwide. Secondary tooth-level analysis showed a prevalence of 7.3%, ranging from 2.5% in Oceania to 9.6% in Africa. Maxillary teeth (9.3%) were more frequently affected than mandibular teeth (5.3%), with maxillary first molars showing the highest prevalence (18.6%). Prevalence increased with age, from 2.9% (≤20 years) to 10.5% (≥61 years). Endodontically treated teeth showed markedly higher prevalence of post-treatment periapical radiolucencies (44.3%) than untreated teeth (2.6%) (odds ratio = 21.6; confidence interval 19.1-23.1; P < .001). Voxel size and field-of-view did not influence outcomes. Periapical pathology is highly prevalent worldwide, with notable regional and age-related differences. Endodontically treated teeth showed a disproportionately high prevalence of periapical pathology.
 Epidemiology Cone-beam computed tomography endodontics periapical pathology prevalence root canal treatment

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