Two- and three-dimensional healing assessment after endodontic microsurgery in through-and-through periapical lesions: 5-year follow-up from a randomized controlled trial

IF 5.4 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

International endodontic journal Pub Date : 2024-05-17 DOI:10.1111/iej.14084

Ritika Dhamija, Sanjay Tewari, Ambika Gupta

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引用次数: 0

Abstract

Aim

To evaluate clinical and radiographic outcome of endodontic microsurgery in through-and-through periapical lesions at 1-year and 5-year follow-up with adjunct use of platelet-rich plasma (PRP).

Methodology

Thirty-two patients with large through-and-through periapical lesions were randomized in platelet-rich plasma (PRP) group and control group. Two-dimensional (2D) healing was evaluated with Molven's criteria and three-dimensional (3D) healing with modified PENN 3D criteria. Healing at resection plane (R), apical area (A), buccal cortex (BC), palatal cortex (PC) and overall bone healing (B) was assessed using CBCT scans. The volume of lesion was measured using ITK-Snap software. The analysis included comparison of 1- to 5-year intragroup (Friedman test/McNemar test) and intergroup scoring (Chi-square/ Mann–Whitney test). Logistic regression analysis was performed to determine the effect of various factors on healing at 5 years.

Results

Out of 32 patients/59 teeth evaluated after 1-year of endodontic microsurgery, 24 patients/44 teeth reported at 5 - year follow-up. Healing assessment with modified PENN 3D criteria revealed improvement in overall success rate of 66.7% at 1 year to 83.3% at 5 years, with no deterioration in any healing category. PRP group exhibited significantly better 3D healing than control group; both at 1 year (84.6% vs. 45.5%) and 5 years (100% vs. 63.6%). A significantly higher number of completely healed teeth were observed in PRP group than the control group at 5 years with respect to R, BC and B parameters. A volume reduction of 88% (91.4% PRP, 84% control) was depicted at 1 year and 94% (97.1% PRP, 91.1% control) at 5 years. None of the recorded factors including age, gender, size of lesion, preoperative swelling and sinus, histology of lesion, use of PRP, tooth location, preoperative buccal bone had significant effect on 3D healing at 5 years.

Conclusions

This 5-year study suggested improvement in 3D radiographic healing of large through-and-through periapical lesions from 1 to 5 years with no deterioration in any healing parameter in both control and PRP groups. The additional use of PRP led to significantly better healing in such lesions. RACB index using CBCT allows better estimation of healing at resected, apical and cortical plane over modified PENN 3D or Molven's criteria.

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牙髓显微外科手术后对贯通性根尖周病变的二维和三维愈合评估：一项随机对照试验的 5 年随访。

目的：评估牙髓显微外科手术治疗贯通性根尖周病变1年和5年随访时辅助使用富血小板血浆（PRP）的临床和影像学效果：将 32 例大型贯通性根尖周病变患者随机分为富血小板血浆 (PRP) 组和对照组。二维（2D）愈合采用 Molven 标准进行评估，三维（3D）愈合采用修改后的 PENN 3D 标准进行评估。使用 CBCT 扫描评估切除面（R）、根尖区（A）、颊皮层（BC）、腭皮层（PC）和整体骨愈合（B）。使用 ITK-Snap 软件测量病变体积。分析包括 1 至 5 年的组内比较（Friedman 检验/McNemar 检验）和组间评分（Chi-square 检验/Mann-Whitney 检验）。为确定各种因素对 5 年愈合的影响，进行了逻辑回归分析：在牙髓显微手术 1 年后进行评估的 32 名患者/59 颗牙齿中，有 24 名患者/44 颗牙齿在 5 年随访时报告了愈合情况。根据修改后的 PENN 3D 标准进行的愈合评估显示，总体成功率从 1 年时 66.7% 提高到 5 年时 83.3%，且所有愈合类别均无恶化。PRP 组的 3D 愈合效果明显优于对照组；1 年时（84.6% 对 45.5%）和 5 年时（100% 对 63.6%）均是如此。就 R、BC 和 B 参数而言，PRP 组 5 年后完全愈合的牙齿数量明显高于对照组。1 年时，体积缩小了 88%（PRP 为 91.4%，对照组为 84%），5 年时缩小了 94%（PRP 为 97.1%，对照组为 91.1%）。记录的因素包括年龄、性别、病变大小、术前肿胀和窦道、病变组织学、PRP 的使用、牙齿位置、术前颊骨，这些因素对 5 年后的三维愈合均无显著影响：这项为期 5 年的研究表明，大型贯通性根尖周病变在 1 至 5 年的三维影像学愈合情况有所改善，对照组和 PRP 组的任何愈合参数都没有恶化。额外使用 PRP 可明显改善此类病变的愈合。与修改后的 PENN 3D 或 Molven 标准相比，使用 CBCT 的 RACB 指数能更好地估计切除面、根尖面和皮质面的愈合情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International endodontic journal 医学-牙科与口腔外科

CiteScore

10.20

自引率

28.00%

发文量

195

审稿时长

4-8 weeks

期刊介绍： The International Endodontic Journal is published monthly and strives to publish original articles of the highest quality to disseminate scientific and clinical knowledge; all manuscripts are subjected to peer review. Original scientific articles are published in the areas of biomedical science, applied materials science, bioengineering, epidemiology and social science relevant to endodontic disease and its management, and to the restoration of root-treated teeth. In addition, review articles, reports of clinical cases, book reviews, summaries and abstracts of scientific meetings and news items are accepted. The International Endodontic Journal is essential reading for general dental practitioners, specialist endodontists, research, scientists and dental teachers.