(PR131) Pre-Operative Characteristics of Permanent Teeth Undergoing Surgical Endodontic Treatment: A Retrospective Study

Objectives: An apicoectomy’s primary purpose is to treat persistent infection at the root apex. This study examines the pre-surgical clinical and radiographic characteristics that may influence the choice of apicoectomy over nonsurgical retreatment in a more detailed approach, focusing on the clinical factors that come into the evaluation phase. We hypothesize that there are certain patterns observed through a pre-operative CBCT that may impact the decision for surgical intervention. The study aims to clarify these associations to inform clinical decision-making in surgical treatment planning.

Methods: This retrospective review analyzed 153 cases either treated or planned for surgical intervention by VCU endodontic residents. Inclusion criteria required permanent teeth scheduled for apicoectomy with a preoperative CBCT and complete electronic dental records. Data collected from CBCT and PA radiographs included: restorations, quality of prior root canal treatment, presence and size of periapical lesions (using Estrela’s PAI), posts, separated instruments, missed anatomy, root curvature, cortical plate integrity, crestal bone status, resorption, and proximity to anatomical structures.

Results: Larger periapical lesions and cases with cortical plate perforations were significantly associated with surgical intervention. Most lesions involved cortical plate destruction, with perforations on buccal, palatal, or lingual surfaces. Separated instruments were not statistically significant for persistent lesions, occurring in only 6 of 153 cases.

Conclusion: Two factors increased the likelihood of surgical treatment planning for persistent lesions: lesion size and alveolar cortical plate status. Larger lesions often required surgical intervention, and cortical plate perforations were common in cases planned for apicoectomies.