Endodontic and surgical treatment of chronic apical periodontitis: a randomized clinical study

Abstract

AbstractThe development of regenerative endodontic therapy offers new opportunities for faster tooth recovery in chronic apical periodontitis. This study aimed to use three different surgical protocols to compare the results (filling the apical lesion with bone tissue over 6 months) of treatment in patients with chronic apical periodontitis. This study included 23 patients and 30 teeth with chronic apical periodontitis. The patients were divided into three groups: (1) Endodontic treatment and apical osteotomy without filling; (2) Endodontic treatment and apical osteotomy with the placement of blood concentrate according to the advanced platelet-rich fibrin A-PRF + protocol; (3) Endodontic treatment and apical osteotomy with the placement of blood concentrate according to the ‘sticky bone’ and A-PRF + protocols with allograft. The results were reported after 6 months using cone-beam computed tomography. The results showed a statistically significant difference (Mann–Whitney U test) in the filling of the bone defect in the healing process between the first group (average rank 31.490) and the second group (average rank 96.015), as well as between the first group (average rank 31.490) and the third group (average rank 91.765). No significant difference was found in the filling of the bone defects between the second and third groups. We show that placement of A-PRF + blood concentrate alone or combined with alloplastic graft after classical apical osteotomy of teeth with chronic apical periodontitis leads to a size reduction of the bone defect with 95.25% for group 2 and 90.80% for group 3 after 6 months.

Keywords

• Chronic apical periodontitis
• regenerative endodontic therapy
• platelet-rich fibrin
• cone-beam computed tomography
• apical surgery
• treatment outcomes