Evaluation of extruded root canal filling materials: A retrospective study

The aim of this study was to evaluate the presence of apically extruded root canal filling materials in endodontically treated teeth at the Endodontics Clinic of Tokat Gaziosmanpaşa University between 2021 and 2023. Additionally, the study aimed to analyze associated clinical factors and assess the periapical healing process and fate of extruded materials using the Periapical Index (PAI) scoring system. In this retrospective study, a total of 10,956 teeth and 18,560 roots treated with either primary root canal treatment or retreatment were radiographically examined, and extruded filling material was detected in 3,244 roots. Radiographic evaluations were conducted using 27-inch medical monitors, and images were analyzed via the SisoView medical imaging software. In cases with detected extrusion, clinical parameters such as tooth group, root type, jaw location, treatment type, presence of periapical lesions, and operator experience level were recorded. In 220 roots with periapical lesions where extrusion was observed and a minimum of six months of follow-up was available, healing was assessed using the Periapical Index (PAI) scoring system. Furthermore, in a total of 306 roots—regardless of the presence of lesions—the resorption of extruded filling material was evaluated. The relationship between material resorption and periapical healing was also evaluated. All data were analyzed statistically, with a significance level set at p<0,05. The overall rate of apical extrusion was found to be 17.5%, with 5.8% representing gutta-percha and 12.5% sealer materials. Extrusion was significantly more common in anterior teeth compared to premolars and molars (p<0,001). Both the presence of periapical lesions and retreatment procedures significantly increased the extrusion rate. While no association was found between gutta-percha extrusion and treatment type, sealer extrusion was more frequent in retreatment cases. Gutta-percha extrusion was more prevalent among interns, whereas sealer extrusion was significantly viii higher among residents and specialists (p<0,001). Among the 220 roots with follow-up, 76.8% showed periapical healing. Notably, mandibular incisors exhibited significantly higher healing rates compared to other root types (p<0,05). Furthermore, follow-ups exceeding 24 months were associated with a significantly greater healing rate (p=0,001). Material resorption was significantly associated only with follow-up duration (p=0,005), with no meaningful correlation observed with other variables such as root type, jaw localization, or operator type. Similarly, no significant relationship was found between the fate of extruded materials and treatment outcomes.