The Global Periapical Health Study: A Big Data CBCT Analysis of Periapical Pathology across 54 Countries
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Source: Journal of Endodontics
Authors: Jorge N.R. Martins, Jorge N.R. Martins, 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, Sheila Michel Burdiez Gonzalez, Juan Carlos Izquierdo Camacho, Moataz-Bellah A.M. Alkhawas, Tiago Pimentel, Alina Eglit, Wajih Jinnah, Tea Natsvlishvili, Antonis Chaniotis, Gergely Benyőcs, Magnús F. Ragnarsson, Jojo Kottoor, Mohammad Nekoofar, Nuno Gonçalves, Avi Shemesh, Raffaella Castagnola, Sriteja Tummala, Masashi Yamada, Mohammad Hammo, Marzhan Ongarova, Arina Maksimova, Hani Ounsi, Marija Šubina, Alexandre Khairallah, Abhishek Parolia, Ruben Rosas Aguilar, Imran Cassim, Olabisi H. Oderinu, Muhammad Rizwan Nazeer, Carlos Heilborn, Christian Nole, Bartlomiej Karaś, Sergiu Nicola, Elena Lipatova, Hussam Alfawaz, Hussein C. Seedat, Seok Woo Chang, Jose Antonio Gonzalez, Thomas Gerhard Wolf, Alaa Kabtoleh, Raweewan Arayasantiparb, Ali Keles, Iliana Modyeievsky, Adam Monroe, Sevara Rizaeva, Carlos Boveda, Erick Souza, Emmanuel J.N.L. Silva, Michael Solomonov, Marco A. Versiani, Marco A. Versiani
Institutions: University of Lisbon, Centro de Estudos de Medicina Baseada na Evidência, Azerbaijan Medical University, The University of Melbourne, Faculdade São Leopoldo Mandic, Universidad Diego Portales, Al-Azhar University, University College London, Helse Førde, Tokyo Dental College, Lebanese University, University of Siena, Riga Stradiņš University, IMU University, Universidad Nacional Autónoma de México, King Saud University, Kyung Hee University, Kyung Hee University Dental Hospital, Universidad Nacional Pedro Henríquez Ureña, Damascus University, Hebrew University of Jerusalem
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
Funders: University of Iowa, University of Bern, Università degli Studi di Siena, University College London, University of Melbourne, King Saud University, Kyung Hee University, Johannes Gutenberg-Universität Mainz, Université Libanaise, Mahidol University, Tehran University of Medical Sciences and Health Services, Universidad Nacional Autónoma de México, Soochow University, Universidad Nacional Mayor de San Marcos, International Medical University, Pontificia Universidad Javeriana, Universidad Central de Venezuela, Al-Azhar University, Damascus University, Universidade Federal do Maranhão, College of Dentistry, University of Tennessee, Department of Quantitative Theory and Methods, Department of Radiology, Baylor College of Medicine
OpenAlex ID: W7128522822