CBCT Utilization in Outcome Assessment in Endodontic Microsurgery

This retrospective study was designed to identify the potential relationship between thickness of the buccal bone at the osteotomy site of endodontic microsurgery and it’s 3-dimensional radiographical healing outcomes. CBCT were taken preoperatively and postoperatively on 143 cases of EMS. The cases were followed over 5 years with CBCT scans at each follow up. Demographics (age, gender, tooth number, medical history); Dates (surgery date and follow up dates); Pre-operative Clinical data (buccal plate thickness, marginal bone); Complexity of case (joint lesion, sinus communication, through and through lesion, re-surgery); Additional pre-operative information (permanent restoration, previously treated by investigator, quality of RCT, size of lesion); Clinical data from procedure (retrofit material, bone graft/membrane use); Post-operative clinical data (antibiotic use and flare up); and Healing data according to von Arx criteria and Fayad-Um (FU) healing criteria were collected. All cases were divided into cases with Guided Tissue Regeneration (GTR) or not. They were subdivided again into buccal bone thickness of more than 1mm or not. Average age of the patients was 55.56 years, average recall period was 20.3 months. Of the 6 healing outcome criteria only two were shown to have statistical significant in relationship with buccall plate thickness. For von Arx R index, teeth with more than 1mm buccal plate thickness heal significantly faster than teeth with 1mm or less buccal plate thickness with p = 0.001 (paired t-test, 1-tailed), and p = 0.034 (Wilcoxon sign ranks test, 1-tailed). For Fayad-Um H index, teeth with more than 1mm buccal plate thickness heal significantly faster than teeth with 1mm or less buccal plate thickness with p = 0.025 (paired t-test, 1-tailed), and p = 0.034 (Wilcoxon sign ranks test, 1-tailed). Three dimensional healing should be evaluated after EMS. Fayad-Um criteria was demonstrated to be a clinically relevant method for assessing healing rate. To improve healing rates, EMS cases with buccal plate thickness of 1mm or less should receive GTR.