A Cone-Beam Computed Tomography Outcome Evaluation of Maxillary Posteriors after Endodontic Microsurgery

Introduction: The purpose of this study was to determine the outcome of endodontic microsurgery with or without sinus perforation during surgery and to evaluate the effect of a maxillary sinus perforation during surgery on healing time and overall healing. Methods: CBCT scans were previously taken for 33 surgical patients comprising 42 roots at a local endodontic specialty practice between January 1, 2011 and July 15, 2015. All scans were obtained using a Kodak 9000 3D extra-oral imaging system (Kodak Dental Systems, Atlanta, GA) with a limited field of view and a 76 micron voxel size. All included scans must have a pre-operative scan of maxillary posterior teeth taken for the purposes of performing endodontic microsurgery with a post-operative recall scan taken at least 6 months after surgery. The pre-operative scan must show an endodontically treated tooth with a periapical radiolucency and/or symptoms requiring endodontic microsurgery. Non-diagnostic CBCT scans and cases without a 6-month or greater recall scan were excluded. Pre-operative and recall scans were evaluated by a board-certified endodontist and two second-year endodontic residents using the CBCT PAI scale. The age group and gender of the patient were recorded for each case, as were the tooth number, type, and root. Results: The average recall time was 13.8 months. Age, sex and use of a bone graft did not have a significant effect on healing. 36.8% of roots with a sinus perforation were healing at recall versus 4.3% of roots without a sinus perforation which was significant. When the healed and healing categories were combined, 84.4% roots with a sinus perforation were improving on recall versus 69.6% of roots without a sinus perforation. This difference was not significant. Conclusions: A sinus perforation during endodontic microsurgery does not affect the overall outcome of the surgical procedure.