DOI QR코드

DOI QR Code

Assessing the efficacy of apicoectomy without retrograde filling in treating periapical inflammatory cysts

  • Jeong-Kui Ku (Department of Oral and Maxillofacial Surgery, School of Dentistry and Institute of Oral Bioscience, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University) ;
  • Woo-Young Jeon (Department of Oral and Maxillofacial Surgery, School of Dentistry and Institute of Oral Bioscience, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University) ;
  • Seung-O Ko (Department of Oral and Maxillofacial Surgery, School of Dentistry and Institute of Oral Bioscience, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University) ;
  • Ji-Young Yoon (Department of Conservative Dentistry, Section of Dentistry, Seoul National University Bundang Hospital)
  • Received : 2024.04.16
  • Accepted : 2024.05.12
  • Published : 2024.06.30

Abstract

Objectives: The necessity of retrograde filling after apicoectomy is controversial in cases of non-inflammatory cysts as opposed to bacteria-related periapical abscesses. This study aims to investigate whether the presence or absence of retrograde filling during apicoectomy has differential long-term prognostic implications between inflammatory and non-inflammatory cysts. Materials and Methods: This retrospective study included patients who underwent tooth apicoectomy during jaw cyst enucleation between 2013 and 2022, and who underwent follow-up cone-beam computed tomography for at least 6 months. The prognosis of the tooth was evaluated during the follow-up period according to the cyst type, the presence or absence of retrograde filling, mandible or maxilla, and location. Results: A total of 147 teeth was included in this study. All the operated teeth underwent preoperative root canal treatment by an endodontic specialist. Apicoectomy was performed for 119 inflammatory cysts and 28 non-inflammatory cysts. Retrograde filling was performed on 22 teeth with inflammatory cysts and 3 teeth with non-inflammatory cysts. All teeth survived the 3.5-year follow-up (range, 1.0-9.1 years). However, 1 tooth with an inflammatory cyst developed complications 1 year after surgery that required re-endodontic treatment. Conclusion: The prognosis of a tooth treated by apicoectomy without retrograde filling during cyst enucleation is favorable, regardless of the cyst type.

Keywords

References

  1. Ricucci D, Mannocci F, Ford TR. A study of periapical lesions correlating the presence of a radiopaque lamina with histological findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:389-94. https://doi.org/10.1016/j.tripleo.2005.08.026
  2. Rios Osorio N, Caviedes-Bucheli J, Mosquera-Guevara L, Adames-Martinez JS, Gomez-Pinto D, Jimenez-Jimenez K, et al. The paradigm of the inflammatory radicular cyst: biological aspects to be considered. Eur Endod J 2023;8:20-36. https://doi.org/10.14744/eej.2022.26918
  3. Hwang MJ, Lee YP, Lang MJ, Wu YH, Chiang CP, Chueh LH. Clinicopathological study of radicular cysts with actinomycosis. J Dent Sci 2021;16:825-30. https://doi.org/10.1016/j.jds.2021.04.008
  4. Elhakim A, Kim S, Kim E, Elshazli AH. Preserving the vitality of teeth adjacent to a large radicular cyst in periapical microsurgery: a case report with 4-year follow-up. BMC Oral Health 2021;21:382. https://doi.org/10.1186/s12903-021-01738-2
  5. Lieblich SE. Current concepts of periapical surgery: 2020 update. Oral Maxillofac Surg Clin North Am 2020;32:571-82. https://doi.org/10.1016/j.coms.2020.07.007
  6. Ng YL, Gulabivala K. Factors that influence the outcomes of surgical endodontic treatment. Int Endod J 2023;56 Suppl 2:116-39. https://doi.org/10.1111/iej.13896
  7. Huh JK, Yang DK, Jeon KJ, Shin SJ. Progression of periapical cystic lesion after incomplete endodontic treatment. Restor Dent Endod 2016;41:137-42. https://doi.org/10.5395/rde.2016.41.2.137
  8. Zhao Y, Liu B, Cheng G, Wang SP, Wang YN. Recurrent keratocystic odontogenic tumours: report of 19 cases. Dentomaxillofac Radiol 2012;41:96-102. https://doi.org/10.1259/dmfr/22891281
  9. Garcia CC, Sempere FV, Diago MP, Bowen EM. The post-endodontic periapical lesion: histologic and etiopathogenic aspects. Med Oral Patol Oral Cir Bucal 2007;12:E585-90.
  10. Angerame D, De Biasi M, Lenhardt M, Porrelli D, Bevilacqua L, Generali L, et al. Root-end resection with or without retrograde obturation after orthograde filling with two techniques: a micro-CT study. Aust Endod J 2022;48:423-30. https://doi.org/10.1111/aej.12634
  11. Jung J, Kim S, Kim E, Shin SJ. Volume of voids in retrograde filling: comparison between calcium silicate cement alone and combined with a calcium silicate-based sealer. J Endod 2020;46:97-102. https://doi.org/10.1016/j.joen.2019.10.015
  12. Villa-Machado PA, Botero-Ramirez X, Tobon-Arroyave SI. Retrospective follow-up assessment of prognostic variables associated with the outcome of periradicular surgery. Int Endod J 2013;46:1063-76. https://doi.org/10.1111/iej.12100
  13. Kim E, Song JS, Jung IY, Lee SJ, Kim S. Prospective clinical study evaluating endodontic microsurgery outcomes for cases with lesions of endodontic origin compared with cases with lesions of combined periodontal-endodontic origin. J Endod 2008;34:546-51. https://doi.org/10.1016/j.joen.2008.01.023
  14. Antunes HS, Gominho LF, Andrade-Junior CV, Dessaune-Neto N, Alves FR, Rocas IN, et al. Sealing ability of two root-end filling materials in a bacterial nutrient leakage model. Int Endod J 2016;49:960-5. https://doi.org/10.1111/iej.12543
  15. Nair PNR, Pajarola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:93-102. https://doi.org/10.1016/s1079-2104(96)80156-9
  16. Nair PNR. On the causes of persistent apical periodontitis: a review. Int Endod J 2006;39:249-81. https://doi.org/10.1111/j.1365-2591.2006.01099.x
  17. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 2006;39:921-30. https://doi.org/10.1111/j.1365-2591.2006.01180.x
  18. Cohen S, Burns RC. Pathways of the pulp. 7th ed. Mosby; 1998.
  19. Ma X, Li C, Jia L, Wang Y, Liu W, Zhou X, et al. Materials for retrograde filling in root canal therapy. Cochrane Database Syst Rev 2016;12:CD005517. https://doi.org/10.1002/14651858.cd005517.pub2
  20. Altan H, Tosun G. The setting mechanism of mineral trioxide aggregate. J Istanb Univ Fac Dent 2016;50:65-72. https://doi.org/10.17096/jiufd.50128
  21. Penarrocha-Oltra D, Soto-Penaloza D, Penarrocha-Diago M, Cervera-Ballester J, Cabanes-Gumbau G, Penarrocha-Diago M. Hemostatic agents in endodontic surgery of maxillary molars: a randomized controlled pilot study of polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze versus aluminum chloride. Med Oral Patol Oral Cir Bucal 2020;25:e634-43. https://doi.org/10.4317/medoral.23652
  22. Jang Y, Kim H, Roh BD, Kim E. Biologic response of local hemostatic agents used in endodontic microsurgery. Restor Dent Endod 2014;39:79-88. https://doi.org/10.5395/rde.2014.39.2.79
  23. Amador-Cabezali A, Pardal-Pelaez B, Quispe-Lopez N, Lobato-Carreno M, Sanz-Sanchez A, Montero J. Influence of the retrograde filling material on the success of periapical surgery. Systematic review and meta-analysis by groups. Coatings 2022;12:1140. https://doi.org/10.3390/coatings12081140
  24. Simon JH. Incidence of periapical cysts in relation to the root canal. J Endod 1980;6:845-8. https://doi.org/10.1016/s0099-2399(80)80039-2
  25. Ricucci D, Rocas IN, Hernandez S, Siqueira JF Jr. "True" versus "bay" apical cysts: clinical, radiographic, histopathologic, and histobacteriologic features. J Endod 2020;46:1217-27. https://doi.org/10.1016/j.joen.2020.05.025
  26. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 2011;37:1516-9. https://doi.org/10.1016/j.joen.2011.06.032
  27. Furusawa M, Asai Y. SEM observations of resected root canal ends following apicoectomy. Bull Tokyo Dent Coll 2002;43:7-12. https://doi.org/10.2209/tdcpublication.43.7