Influence of root width and dentin wall thickness evaluated by endoscopy upon the outcome of periapical surgery. A cohort study

Abstract

Background: An analysis was made of the correlation between root width, the thickness of the remaining dentinal wall as determined by endoscopy, and the outcome of periapical surgery. Material and Methods: A retrospective cohort study was carried out involving patients subjected to periapical surgery between 2017 and 2019 at the University of Valencia (Valencia, Spain). One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section of the treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimum root width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, and the position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) were further correlated to periapical surgery outcome. Results: A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13 +/- 0.84 mm), minimum root width (2.46 +/- 0.72 mm), peripheral dentin thickness (0.77 +/- 0.2 mm) and minimum dentin thickness (0.4 +/- 0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58 +/- 0.25 mm) ( p<0.003) than incisor roots. No significant association was found between the different measurements and the healing rate at one year, though the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. The position and type of tooth did not influence healing outcome. Conclusions: The root width and thickness of the remaining dentin wall did not significantly influence healing. However, the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly.