Advertisement

Clinician-centered Outcomes Assessment of Retreatment and Endodontic Microsurgery Using Cone-beam Computed Tomographic Volumetric Analysis

      Abstract

      Introduction

      Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases.

      Methods

      For 68 retreatment and 57 EMS cases, preoperative and recall clinical data, periapical (PA) radiographs, and CBCT imaging were retrospectively obtained. Specialized software was used by 2 board-certified endodontists for volumetric analysis of PARLs. For EMS and retreatment, clinical outcomes were determined by combining clinical data with CBCT-generated volumetric analysis (PA radiographs not used). Additionally, comparisons of percent volume reduction for EMS and retreatment were performed. Examiner interpretations of outcomes assessment using PA radiography and CBCT imaging were compared.

      Results

      In teeth with or without a preoperative PARL, EMS resulted in a statistically significant difference in complete healing (49/57 [86.0%]) versus retreatment (28/68 [41.2%], P < .0001). EMS resulted in a statistically significant difference in combined complete healing and reductive healing (54/57 [94.7%]) versus retreatment (56/68 [82.4%], P < .05). Of 46 recalls in which CBCT imaging detected a PARL, PA radiography detected 30 (a 35% false-negative rate). Of the 79 recall studies in which CBCT imaging did not detect a PARL, PA radiography did detect PARL in 13 (a 16.5% false-positive rate).

      Conclusions

      In this CBCT and clinical data-based outcomes assessment, EMS resulted in a greater mean volumetric reduction and a higher healing rate compared with retreatment. Postoperative CBCT imaging is more sensitive and specific than PA radiography in assessing PARL and has demonstrable usefulness in outcomes assessment.

      Key Words

      To read this article in full you will need to make a payment

      References

        • Kakehashi S.
        • Stanley H.R.
        • Fitzgerald R.J.
        The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats.
        Oral Surg Oral Med Oral Pathol. 1965; 20: 340-349
        • Moller A.J.
        • Fabricius L.
        • Dahlen G.
        • et al.
        Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys.
        Scand J Dent Res. 1981; 89: 475-484
        • Lin L.M.
        • Di Fiore P.M.
        • Lin J.
        • Rosenberg P.A.
        Histological study of periradicular tissue responses to uninfected and infected devitalized pulps in dogs.
        J Endod. 2006; 32: 34-38
        • Bender I.B.
        • Seltzer S.
        Roentgenographic and direct observation of experimental lesions in bone: I. 1961.
        J Endod. 2003; 29: 702-706
        • Bender I.B.
        • Seltzer S.
        • Soltanoff W.
        Endodontic success–a reappraisal of criteria. 1.
        Oral Surg Oral Med Oral Pathol. 1966; 22: 780-789
        • Schwartz S.F.
        • Foster J.K.
        Roentgenographic interpretation of experimentally produced bony lesions. I.
        Oral Surg Oral Med Oral Pathol. 1971; 32: 606-612
        • Orstavik D.
        Time-course and risk analyses of the development and healing of chronic apical periodontitis in man.
        Int Endod J. 1996; 29: 150-155
        • Rud J.
        • Andreasen J.O.
        • Jensen J.E.
        A follow-up study of 1,000 cases treated by endodontic surgery.
        Int J Oral Surg. 1972; 1: 215-228
        • Rud J.
        • Andreasen J.O.
        • Jensen J.E.
        Radiographic criteria for the assessment of healing after endodontic surgery.
        Int J Oral Surg. 1972; 1: 195-214
        • Saidi A.
        • Naaman A.
        • Zogheib C.
        Accuracy of cone-beam computed tomography and periapical radiography in endodontically treated teeth evaluation: a five-year retrospective study.
        J Int Oral Health. 2015; 7: 15-19
        • Venskutonis T.
        • Daugela P.
        • Strazdas M.
        • Juodzbalys G.
        Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically treated teeth.
        J Oral Maxillofac Res. 2014; 5: e1
        • Patel S.
        • Dawood A.
        • Mannocci F.
        • et al.
        Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography.
        Int Endod J. 2009; 42: 507-515
        • Liang Y.H.
        • Jiang L.
        • Gao X.J.
        • et al.
        Detection and measurement of artificial periapical lesions by cone-beam computed tomography.
        Int Endod J. 2014; 47: 332-338
        • Al-Nuaimi N.
        • Patel S.
        • Foschi F.
        • Mannocci F.
        The detection of simulated periapical lesions in human dry mandibles with cone-beam computed tomography: a dose reduction study.
        Int Endod J. 2016; 49: 1095-1104
        • Lofthag-Hansen S.
        • Huumonen S.
        • Gröndahl K.
        • Gröndahl H.G.
        Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 114-119
        • Tsai P.
        • Torabinejad M.
        • Rice D.
        • Azevedo B.
        Accuracy of cone-beam computed tomography and periapical radiography in detecting small periapical lesions.
        J Endod. 2012; 38: 965-970
        • Mota de Almeida F.J.
        • Knutsson K.
        • Flygare L.
        The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics.
        Dentomaxillofac Radiol. 2014; 43: 20130137
        • Ee J.
        • Fayad M.I.
        • Johnson B.R.
        Comparison of endodontic diagnosis and treatment planning decisions using cone-beam volumetric tomography versus periapical radiography.
        J Endod. 2014; 40: 910-916
        • Rodríguez G.
        • Abella F.
        • Durán-Sindreu F.
        • et al.
        Influence of cone-beam computed tomography in clinical decision making among specialists.
        J Endod. 2017; 43: 194-199
        • Rosen E.
        • Taschieri S.
        • Del Fabbro M.
        • et al.
        The diagnostic efficacy of cone-beam computed tomography in endodontics: a systematic review and analysis by a hierarchical model of efficacy.
        J Endod. 2015; 41: 1008-1014
        • Kruse C.
        • Spin-Neto R.
        • Wenzel A.
        • Kirkevang L.L.
        Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model.
        Int Endod J. 2015; 48: 815-828
        • Patel S.
        • Wilson R.
        • Dawood A.
        • et al.
        The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography - part 2: a 1-year post-treatment follow-up.
        Int Endod J. 2012; 45: 711-723
        • Davies A.
        • Patel S.
        • Foschi F.
        • et al.
        The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.
        Int Endod J. 2016; 49: 623-635
        • von Arx T.
        • Janner S.F.
        • Hänni S.
        • Bornstein M.M.
        Agreement between 2D and 3D radiographic outcome assessment one year after periapical surgery.
        Int Endod J. 2016; 49: 915-925
        • Becconsall-Ryan K.
        • Tong D.
        • Love R.M.
        Radiolucent inflammatory jaw lesions: a twenty-year analysis.
        Int Endod J. 2010; 43: 859-865
        • Çalışkan M.K.
        • Kaval M.E.
        • Tekin U.
        • Ünal T.
        Radiographic and histological evaluation of persistent periapical lesions associated with endodontic failures after apical microsurgery.
        Int Endod J. 2016; 49: 1011-1019