Department of Endodontics
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Publication Long-term Clinical and Radiographic Healing of Endodontic Microsurgery with Collagen-Based Bone-Filling Material: Comparison of 2D and 3D Healing(2024-08-30) Szu Hua Chiang, DMDABSTRACT Aim: (1) To evaluate the long-term clinical and radiographic periapical and cor:cal bone healing of endodon:c lesions with four-wall defects following endodon:c microsurgery (EMS) using collagen-based bone-filling material, (2) to study collagen-based filling material’s clinical significance and (3) to compare 2D- and 3D- outcome assessments. Methodology: The long-term clinical and radiographic evalua:ons of 58 surgical cases was reported in ‘Periapical Healing Following Endodon:c Microsurgery with Collagen-Based Bone- Filling Material: A Randomized Controlled Clinical Trial by Albagle et al. IEJ 2023 (1). In the preliminary methodology of this study, EMS was performed by calibrated postgraduate endodon:c residents. Before flap closure placement of a collagen-based bone-filling material was randomly assigned to osteotomies as the treatment group, whereas no material was placed in the control group. If necessary, separate osteotomies were created for mul:-rooted teeth. Samples were included only if two osteotomy sites were separated by bone. Each individual osteotomy was considered a sample and randomized. Proceeding with the asymptoma:c 66 endodon:c-origin lesions collected and assessed at the 1-year follow-up evaluated by double blinded endodon:sts examined using periapical (PA) radiographs according to Molven’s criteria 20 for 2D healing, cone beam computed tomography (CBCT) scans in conformity with Penn 3D criteria for 3D periapical healing and RAC/B index for cor:cal plate healing. For follow-up, pa:ents (n = 58) were contacted ini:ally for phone interviews, to determine if symptoms or it needed an extrac:on or re-surgery. Subjects returned for the long-term follow-up appointment. Teeth were assessed for sensi:vity to palpa:on and percussion, mobility, probing depths and symptom as such as presence of intraoral swelling or sinus tract. PA radiographs and CBCT scans of the asymptoma:c teeth were evaluated similarly by three evaluators following Molven and Penn3D evalua:on methods. Results: A total of 39 cases were evaluated radiographically a9er excluding extrac:ons, lost pa:ents, declining to clinical examina:on and one symptoma:c case due to fracture. The follow- up period ranged from 2.78 years to 4.75 years; 17 and 22 cases are in the control and treatment groups, respec:vely. Both control and treatment groups obtained higher success rates according to Molven’s criteria (95.5% and above) than PENN 3D criteria and C-score system. At the 3 year follow-up, the success rates were determined similar between PENN 3D and C-score ranging from 82.4% to 86.4% in both treatment and control groups. Compared to the control group, the Founda:on group obtained higher percentage of healing at year 1 according to Molven’s criteria, PENN 3D, and C-score system. In contrast, the control group had an overall higher improvement in healing rate from year 1 to year 3. The long-term follow-up rate for the study was 75.9%. Conclusions: The long-term evalua:on of the cor:cal plate healing is equal in the control and treatment groups as the observa:on period reached close to 4 years or above. The cri:cal healing 21 period was between 1 year to 3 years, where placement of collagen-based bone-filling material is suggested to accelerate the radiographic healing in two- and three- dimensions.