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

Jorge N.R. MartinsDepartment of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal. Electronic address: [email protected]Jorge N.R. MartinsDepartment of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal. Electronic address: [email protected]Jorge N.R. MartinsDepartment of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal. Electronic address: [email protected]Jorge N.R. MartinsDepartment of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal. Electronic address: [email protected]Pablo EnsinasMSc -Private Practice , Salta , ArgentinaNarine Hovhannisyan-Private Practice , Yerevan , ArmeniaFrancis Chan-Prosthodontic dentistry department , Azerbaijan Medical University , Baku , AzerbaijanNarin Babayeva-Private Practice , Yerevan , ArmeniaLuiza Berti- The University of Melbourne , Melbourne , AustraliaMarcia AntúnezMSc -Universidad Diego Portales , Faculty of Health and Dentistry , SantiagoYongchun GuMSc -Universidad Diego Portales , Faculty of Health and Dentistry , SantiagoCatalina Mendez de la EspriellaMSc -Universidad Diego Portales , Faculty of Health and Dentistry , SantiagoSheila Michel Burdiez GonzalezJuan Carlos Izquierdo CamachoMoataz-Bellah A.M. AlkhawasQuito , EcuadorTiago Pimentel- Department of Endodontics , Al-Azhar University Faculty of Dental Medicine , Cairo , EgyptAlina Eglit-Private Practice , Tallinn , EstoniaWajih Jinnah-Private Practice , Tallinn , EstoniaTea NatsvlishviliMSc -Private Practice , Lappeenranta , FinlandA. Chaniotis- Albius International Periochool , Tbilisi , GeorgiaGergely Benyőcs-Private Practice , Budapest , HungaryMagnús F. RagnarssonMarine and Freshwater Research InstituteJojo KottoorMarine and Freshwater Research InstituteMohammad NekoofarNuno GonçalvesMSc -Private Practice , Dublin , IrelandAvi ShemeshMSc -Private Practice , Dublin , IrelandRaffaella CastagnolaSriteja TummalaUniversity of Technology, JamaicaMasashi YamadaUniversity of Technology, JamaicaMohammad Hammo- Department of Endodontics , Tokyo Dental College , Tokyo , JapanMarzhan OngarovaArina MaksimovaPrivate Practice , Bishkek , KyrgyzstanHani OunsiPrivate Practice , Bishkek , KyrgyzstanMarija ŠubinaDDS -Rīga Stradiņš University , Riga , LatviaAlexandre KhairallahDDS -Rīga Stradiņš University , Riga , LatviaAbhishek Parolia- Department of Imaging , Lebanese University , Beirut , LebanonRubén Rosas AguilarPhD -International Medical University School of Dentistry , Kuala Lumpur , Malaysia - College of Dentistry and Dental Clinics ,Imran Cassim- National Autonomus University of Mexico , León , MexicoOlabisi H. OderinuMuhammad Rizwan NazeerCarlos Heilborn-Private Practice , Asunción , ParaguayChristian Nole-Private Practice , Asunción , ParaguayBartlomiej KaraśSergiu NicolaBartlomiej Karaś , DDS -Private Practice , Wroclaw , PolandElena Lipatova-Private Practice , Yekaterinburg , RussiaHussam Alfawaz- King Saud University , College of Dentistry , Riyadh , Saudi ArabiaHussein C. SeedatDurban , South AfricaSeok Woo Chang- Department of Conservative Dentistry , School of Dentistry , Kyung Hee University , Seoul , South KoreaJose Antonio Gonzalez-Private Practice , Astana , KazakhstanThomas Gerhard WolfAlaa KabtolehPhD -Department of Endodontics , Damascus University , Damascus , SyriaRaweewan ArayasantiparbAli KelesMSc -Private Practice , Montevideo , UruguayIliana ModyeievskyMSc -Private Practice , Montevideo , UruguayAdam Monroe-Private Practice , Vista , USAS.M. Rizaeva-Private Practice , Vista , USACarlos Bóveda-Private Practice , Vista , USAErick Souza- Tashkent State Dental Institute , Tashkent , UzbekistanE. J. N. L. SilvaMichael Solomonov-Faculty of Dental Medicine , Hebrew University of Jerusalem , Jerusalem , IsraelMarco A. VersianiDental Specialty Center, Brazilian Military Police, Belo Horizonte, Minas Gerais, BrazilMarco A. VersianiDental Specialty Center, Brazilian Military Police, Belo Horizonte, Minas Gerais, Brazil

2026en

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Annotatsiya

INTRODUCTION: 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). METHODS: 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. RESULTS: 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. CONCLUSION: Periapical pathology is highly prevalent worldwide, with notable regional and age-related differences. Endodontically treated teeth showed a disproportionately high prevalence of periapical pathology.

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DOI: 10.1016/j.joen.2026.01.021

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