The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis

Baseri, Milad; Radmand, Faraz; Milani, Amin Salem; Gavgani, Leili Faraji; Salehnia, Fatemeh; Dianat, Omid

doi:10.1038/s41432-023-00851-1

Cited by 7 publications

(5 citation statements)

References 93 publications

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“…Traditionally, endodontic treatment success is assessed based on the functionality and survival of treated teeth alongside healthy pulpal and periapical tissues [ 21 ]. Pre-existing periapical lesions are established risk factors for treatment outcomes [ 22 – 24 ]. Notably, in the present study, only 12 cases (15.3%) presented with such lesions.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Alsalleeh,

Albishry,

Aleyiydi

et al. 2024

BDJ Open

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Background and aim The alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA. Method Seventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI). Results Autism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries. Conclusion This study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

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Section: Discussionmentioning

confidence: 99%

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Alsalleeh,

Albishry,

Aleyiydi

et al. 2024

BDJ Open

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“…Numerous studies have demonstrated the efficacy of surgical intervention for large periapical lesions. A systematic review by Baseri et al concluded that apical surgery achieved a significantly higher rate of complete healing (92.8%) compared to non-surgical treatment (74.1%) for large periapical lesions [ 17 ]. Similarly, a meta-analysis by Ng et al reported a pooled success rate of 90.3% for apical surgery in treating large periapical lesions, significantly higher than the success rate of 74.3% for conventional RCT [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Healing and Spontaneous Realignment of Displaced Roots With Periapical Granuloma After Microsurgical Endodontic Treatment (Three Years’ Follow-up): A Case Report

Alzahrani,

Komo,

Howait

2024

Cureus

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Endodontic therapy aims to treat or prevent apical periodontitis, a condition characterized by inflammation of the periapical tissues at the apex of the tooth root. This case study demonstrates the successful nonsurgical and surgical management of a large periapical lesion involving the lower central incisors with root displacement induced by a periapical granuloma. A patient was referred from the maxillofacial department for endodontic treatment due to persistent pain and swelling in the lower anterior region started two months ago. Upon arrival, a clinical examination and radiographic assessment were performed using cone-beam computed tomography (CBCT). The CBCT scan revealed a significant radiolucent area measuring (10x8) mm extending from the lower left lateral incisor to the right central incisor. The lower left central incisor was necrotic and tender to palpation and percussion. A nonsurgical root canal was performed followed by an apicectomy using mineral trioxide aggregate (MTA) to facilitate healing of the periapical lesion. Histopathological examination of the lesion confirmed the diagnosis of periapical granuloma. At follow-up 1, 2, and 3 years' visits, the periodontal assessment was performed and found to be free of pain upon percussion or palpation. No other clinical or radiological signs or symptoms were identified except for a small radiolucent area mesially adjacent to the root of the lower left central incisor. The development of materials such as MTA has significantly improved the prognosis of cases with large periapical lesions. In this case, healing and spontaneous realignment of the root were observed after three years.

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“…Furthermore, teeth with vital pulp have a better prognosis compared to teeth with necrotic pulp and periapical radiolucency 11,15 . In addition the size of the periapical lesion affects the success rate of the endodontic treatment 9,10 .…”

Section: Discussionmentioning

confidence: 99%

“…It is the outcome of the host defence response to the bacteria and their byproducts, which leeds to local inflammation and the consequent resorption of hard tissues, destruction of periradicular tissues and formation of periapical lesions. Radiographically interpreted lesions are used to assess periapical inflammation [4][5][6][7][8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

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Single versus multiple visits endodontic therapy on healing rate of periapical lesions: A systematic review and meta-analysis

Theodoridis,

Economides

2023

Balkan J Dent Med

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The choice of one or more sessions for the endodontic treatment of teeth with pulp necrosis and apical periodontitis is controversial. The purpose of this systematic review was to compare the radiographic healing of necrotic teeth with pre-existing periapical lesions after at least 1 year of follow-up period between two therapy groups: 1. single visit endodontic treatment, 2. multiple visits endodontic treatment with calcium hydroxide as intracanal medicament. It was made a literature search of only Randomized Controlled Trials (RCTs) on PubMed database. 5 RCTs met the inclusion and exclusion criteria and were included in this review, with a total sample size of 513 cases. Complete radiographic healing was observed in 226 (83.4%) of 271 cases treated in one visit and 198 (81.8%) of 242 cases treated in more than one visit. A meta-analysis was performed, showing no significant difference in the healing rate between the two therapy groups (fixed effect model, RR: 1.025; 95% Cl: 0.950 - 1.107). Based on the results of this study, endodontic treatment of teeth with pulp necrosis and radiographic evidence of apical periodontitis in one or more appointments showed similar radiographic healing rate.

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The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis

Cited by 7 publications

References 93 publications

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study

Healing and Spontaneous Realignment of Displaced Roots With Periapical Granuloma After Microsurgical Endodontic Treatment (Three Years’ Follow-up): A Case Report

Single versus multiple visits endodontic therapy on healing rate of periapical lesions: A systematic review and meta-analysis

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