A Comparison of 2- and 3-dimensional Healing Assessment after Endodontic Surgery Using Cone-beam Computed Tomographic Volumes or Periapical Radiographs

Tom Schloss; David Sonntag; Meetu R Kohli; Frank C Setzer

doi:10.1016/j.joen.2017.02.007

A Comparison of 2- and 3-dimensional Healing Assessment after Endodontic Surgery Using Cone-beam Computed Tomographic Volumes or Periapical Radiographs

J Endod. 2017 Jul;43(7):1072-1079. doi: 10.1016/j.joen.2017.02.007. Epub 2017 May 17.

Authors

Tom Schloss¹, David Sonntag², Meetu R Kohli³, Frank C Setzer⁴

Affiliations

¹ Private Practice, Nuremberg, Germany; Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² Poliklinik fuer Zahnerhaltung, Parodontologie und Endodontologie, Heinrich-Heine-Universitaet Duesseldorf, Duesseldorf, Germany.
³ Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: fsetzer@upenn.edu.

PMID: 28527841
DOI: 10.1016/j.joen.2017.02.007

Abstract

Introduction: The aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging.

Methods: The healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software).

Results: There was a significant difference between the mean preoperative lesion volumes of 95.34 mm³ (n = 51, standard deviation [SD] ±196.28 mm³) versus 6.48 mm³ (n = 51, SD ±17.70 mm³) at follow-up (P < .05). The mean volume reduction was 83.7%. Preoperatively, mean lesion areas on periapical films were 13.55 mm² (n = 51, SD ±18.80 mm²) and 1.83 mm² (n = 51, SD ±.68 mm²) at follow-up (P < .05). According to Molven's criteria, 40 teeth were classified as complete healing, 7 as incomplete healing, and 4 as uncertain healing. Based on the modified PENN 3D criteria, 33 teeth were classified as complete healing, 14 as limited healing, 1 as uncertain healing, and 3 as unsatisfactory healing. The variation in the distribution of the 2D and 3D healing classifications was significantly different (P < .05). Periapical healing statuses incomplete healing or uncertain healing according to Molven's criteria could be clearly classified using 3D criteria.

Conclusions: CBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery.

Keywords: Apicoectomy; cone-beam computed tomography; endodontic; healing; microsurgery; outcome; root-end surgery; success.

Publication types

Comparative Study

MeSH terms

Cone-Beam Computed Tomography
Dental Pulp
Endodontics
Female
Humans
Imaging, Three-Dimensional
Male
Microsurgery
Middle Aged
Root Canal Therapy* / adverse effects
Root Canal Therapy* / methods
Surgical Wound / diagnostic imaging*
Wound Healing