Risk factors for abscess formation during or following endodontic treatment in an outpatient setting

Abstract

This retrospective matched case-control study aimed to identify potential risk factors associated with the development of dental abscesses during or after endodontic treatment. The study analyzed data from 133 patients (74 males, 58 females; mean age 43.1 ± 16.5 years) with abscess formation of endodontic origin and compared them with a 1:1 matched control group without abscess. Matching was performed based on age and the specifically treated tooth. Collected variables included preoperative symptoms, radiographic findings, type and stage of endodontic intervention, and systemic medical conditions. Statistical analysis used chi-square or Fisher exact tests to compare between groups. STROBE and PROBE guidelines were followed. Among 2637 maxillofacial infections of odontogenic origin, 526 cases (19.9%) were related to endodontic treatment. No statistically significant associations were found regarding age, sex, or underlying systemic diseases (p > 0.05). Teeth exhibiting apical radiolucency were at significantly higher risk for abscess development (p < 0.001). Teeth that had undergone definitive root canal filling were significantly less likely to develop abscesses compared to those left without temporary filling after trepanation (p < 0.001) or treated with intracanal medication and temporary filling (p = 0.009). The highest incidence of abscess formation was observed within the first four days post-treatment (p < 0.001). Within the limitations of this retrospective study, abscess formation during or after endodontic treatment was linked to local procedural and radiographic factors, whereas systemic diseases did not demonstrate a measurable influence. The absence of temporary sealing and the presence of apical radiolucency were identified as significant risk indicators and may warrant increased clinical attention, particularly in the early postoperative period. Given the retrospective design and limited sample size, these findings should be interpreted with caution and require confirmation in prospective studies.