Periapical Status of Post-Restored Teeth: A Two-Year Follow-Up Study

Objectives: This study evaluated the prevalence of periapical lesions in endodontically treated teeth restored with cast post-and-core systems after a minimum two-year follow-up, and identified restorative and clinical factors influencing periapical health. Methods: A cross-sectional study was conducted at the dental clinic of the International University of Rabat. Of 224 contacted patients, 91 met the inclusion criteria (completed endodontic treatment and post placement > 2 years), yielding 118 post-restored teeth. Radiographs were obtained using a phosphor plate system and analyzed with DBSWIN software, applying Ørstavik’s PAI index. Statistical analysis was performed with Jamovi (v2.3.24, Australia). Quantitative data were expressed as mean and standard deviation, and qualitative data as numbers and percentages. The Chi-square test was used with a significance level of p < 0.05. Results: The study found that 31.4% of the teeth presented a radiologically detectable periapical lesion (PAI ≥ 3). Maxillary incisors and premolars were the most frequently affected. Lesion prevalence was significantly associated with post/filling gaps ≥ 2 mm (p = 0.008) and low-density root fillings (p < 0.001). Although short filling length (<4 mm) was common in teeth with periapical lesions, no significant association was observed (p = 0.550). Systemic conditions, such as diabetes, showed a trend toward higher lesion prevalence (p = 0.056). Conclusions: The findings highlight the need for a rigorous approach in restoring endodontically treated teeth. Absence of gaps between the root canal filling and post and homogeneous filling density are key protective factors for maintaining periapical health. Regular radiographic follow-up and future longitudinal studies (3D imaging and clinical parameters) remain essential to refine protocols and improve outcomes.