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- Title
Outcome of nonsurgical management of large cyst-like periapical lesions using a modified apical negative pressure irrigation system: a case series study.
- Authors
Ling, Danhua; Chen, Yun; Chen, Gongpei; Zhang, Yanzhen; Wang, Yanhong; Wang, Ying; He, Fuming
- Abstract
Objective: To assess the effectiveness of a self-constructed modified apical negative pressure irrigation (ANPI) system employing commonly used clinical instruments in nonsurgical root canal therapy (NSRCT) for large cyst-like periapical lesions (LCPLs). Methods: From 2017 to 2022, 35 patients diagnosed with LCPLs (5-15 mm) via preoperative clinical and radiographic evaluations of endodontic origin underwent NSRCT combined with ANPI. These patients were subjected to postoperative clinical and radiographic follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years, with a CBCT scan specifically conducted at 6-month follow-up. Through the reconstruction of three-dimensional cone beam computed tomography (CBCT) data, an early prognosis was facilitated by monitoring changes in lesion volume. Various treatment predictors—including sex, type of treatment, lesion size, preoperative pain, jaw, type of teeth involved, sealer extrusion, and the number of root canals—were meticulously analyzed. The evaluation of post-treatment outcomes leveraged both clinical observations and radiographic data collected during the follow-up periods. The Kruskal‒Wallis test and one-way ANOVA were also conducted to determine the independent factors influencing treatment outcomes. A significance level of 5% was established. Results: Thirty-five teeth from 35 patients with a median age of 28 years (range 24–34) were treated; the median follow-up duration was 19 months (range 12–26). The overall success rate was 91.4%, with a median lesion reduction of 77.0% (range 54.2–96.4%) at 6 months. Patients under 30 years of age exhibited a significantly greater success rate than older patients did (100.0% vs. 80.0%, p = 0.037). Other factors, such as sex, jaw, treatment type, preoperative pain, cyst size, tooth location, sealer extrusion, and the number of roots, did not significantly impact treatment outcomes. Conclusions: Despite limitations related to the observational case-series study design and relatively small sample size, our findings suggest that utilizing the ANPI in the NSRCT for LCPLs may hold promise. The notably higher success rate in patients younger than 30 years is worth noting. Clinical significance: The modified ANPI system offers a viable treatment modality for managing outcomes in patients with LCPLs. Strengths and limitations of this study: This is the first study to explore the outcomes of apical negative pressure irrigation in nonsurgical root canal therapy for large cyst-like periapical lesions. A modified apical negative pressure irrigation system is designed to overcome limitations such as high costs, complex operation, the risk of injury due to improper usage, and limited availability in certain dental practices. The imaging examinations in this study were consistently scheduled for the 6-month follow-up period, which is more significant than what has been observed in other studies with inconsistent follow-up times. The limitations of this study include its retrospective case series design and the limited number of included patients.
- Subjects
ENDODONTICS; POSTOPERATIVE care; DENTAL radiography; PERIAPICAL diseases; COMPUTED tomography; KRUSKAL-Wallis Test; CYSTS (Pathology); TREATMENT effectiveness; NEGATIVE-pressure wound therapy; ROOT canal treatment; ONE-way analysis of variance; IRRIGATION (Medicine); CASE studies
- Publication
BMC Oral Health, 2024, Vol 24, Issue 1, p1
- ISSN
1472-6831
- Publication type
Article
- DOI
10.1186/s12903-024-04110-2