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, Rubén 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
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.