Prognostic Evaluation of Subjects Undergoing Root-end Surgeries for Persisting PeriRadicular Pathologies Following Ineffective Endodontic Retreatment: A Comparative Clinical Study

Gaurav Jain1 , R. S. Bedi2 , Balakrishnan Rajkumar3 , Lalit C. Boruah4 1Associate Professor, Department of Conservative Dentistry and Endodontics, Saraswati Dental College, Lucknow – 227105 , Uttar Pradesh, India, 2 Principal, Professor and Head of Department, Department of Oral and Maxillofacial Surgery, Saraswati Dental College, Lucknow- 227105, Uttar Pradesh, India, 3 Principal, Professor & Head of Department, 4 Professor, Department of Conservative Dentistry and Endodontics, BBD College of Dental Sciences, Lucknow – 227105, Uttar Pradesh, India.

ABSTRACT Introduction: Surgical endodontics is concerned with the diagnosis and treatment of periapical lesions of endodontic origin that cannot be treated or do not respond to conventional endodontic therapy. The objective of periapical surgery is to seal the root canal system, enabling healing by forming a barrier between the irritants within the confines of affected root and periapical tissue thus by surgical intervention maintain a tooth in oral cavity that primarily has an endodontic lesion that cannot be resolved by conventional endodontic re-treatment. So for the success, it becomes of clinical relevance to perform a thorough clinical and radiographic examination of the tooth before endodontic surgery. Materials and Method: An elaborated clinical study was conducted at our Dental College & Hospital, Lucknow. A total of 34 patients with chronic periapical lesions were treated by periapical surgeries using rotary burs and ultrasonics under 3.5x magnifying loupes to prepare root-end cavities, and retrograde filling with MTA. The study was pre-approved by the ethics committee, and an informed consent was obtained from each patient. The study was conducted by the Department of Endodontics in collaboration with the Department of Oral & Maxillofacial Surgery. The patients were analysed (follow-up) for the period of atleast 12 months after treatment. The patients so analysed were from an age group of 18 years to 50 years of age. Patients so selected for the analysis and treatment had buccal bone defect (minimal bone overlying the root structure), which had occurred due to the failure of the root canal treatment or re-root canal treatment. The data were collected using a set protocol for each patient and later statistically analysed. Results: A total of 34 patients were analysed, out of which 12 patients underwent root canal treatment for first time and remaining 22 patients were re-root canal treatment cases. Out of 22 patients of reroot canal cases, 11 patients showed positive clinical and radiographic parameters with bony defect correction visible within 12months of the periapical surgery as per von Arx and Kurt B et al.(1998), Mikkonen et al.(1983)and Rud et al.(1972) criteria. In this same group 2 patients showed minimal visible changes even after 12 months of the surgery. Conclusion: Root-end endodontic surgery is considered as a predictable treatment option to save a tooth with apical pathology that might not be managed by conventional, non-surgical endodontics.