Two- and tridimensional analysis of periapical repair after endodontic surgery.

By Tanomaru-Filho M1, Jorge EG, Guerreiro-Tanomaru JM, Reis JM, Spin-Neto R, Gonçalves M.

Date: 04/2015
Journal: Clin Oral Investig

Purpose: to evaluate the periapical repair of teeth after endodontic surgery using two- (conventional and digital radiography) and tridimensional (CBCT) imaging methods.

N = 11 patients


•Maxillary anterior single-rooted teeth, with the presence of radiographically visible periapical bone rarefaction and indication for endodontic surgical treatment. •Conventional and digital periapical radiographs and CBCT of the region of interest were taken before endodontic surgery.

•The i-CAT classic unit was used. Recent guidelines state that for the diagnosis of periapical pathology, the smallest available field of view should be used.

•Endodontic surgery was performed.

•Computerized tomography performed and conventional and digital radiographs were taken after periods of 48 h, 4 months and 8 months. •Conventional radiographs were digitized and calibrated. The ImageJ software was used to delimit the outline of the periapical lesions on a computer monitor and 3 evaluators took the measurements. 

•For the CBCT image analysis the values of volume (cubic millimeters) and area (square millimeters), measured in the different time intervals of evaluation, were converted into percentage values, which allowed the comparison of bone repair progression. 

Most highlighted Results: 

•Baseline ( 48 h) showed a larger lesion volume (192.54 mm3) than 4-month (79.79 mm3) and   8-month (47.51 mm3) periods.

•No differences were found in the percentage of repair in the first 4 months and after 8 months.

•The volumetric analysis showed a higher percentage of repair when the first and last 4 months were compared.

•No differences were found in the percentage of repair by area in the CBCTs.

•Repair of 73 % was obtained after 8 months. Similar results were observed by the Bland-Altman agreement analyses.

Clinical significance:

CBCT is more accurate than PA in determining bone healing. Could be used in cases with slow PA healing for follow up.