Influence of Size and Volume of Periapical Lesions on the Outcome of Endodontic Microsurgery: 3-Dimensional Analysis Using Cone-beam Computed Tomography

Introduction: The purpose of this study was to examine the size, volume, and other parameters of preoperative periapical lesions measured from cone-beam computed tomographic (CBCT) images as potential prognostic factors in endodontic microsurgery. Methods: A clinical database was searched for patients who had received endodontic microsurgery with preoperative CBCT examination between March 2010 and December 2014. The CBCT images were analyzed with the OnDemand3D software program (Cybermed, Seoul, South Korea). The mesiodistal (L-x), apicocoronal (L-y), and buccolingual (L-z) diameter and the volume (V) of the periapical lesions, destruction of the cortical bone, and height of the buccal bone plate (L-b) were measured independently by 2 examiners. The outcome was classified as a success or failure based on the clinical and radiographic evaluation at least 1 year after the operation. Univariate analyses using the chi-square or Fisher exact test were performed to show the correlation of the outcomes with variables to identify the potential predisposing factors. Multivariate analysis using a logistic regression model was performed with the associated variables. Results: Ninety-five cases were evaluated after a period of at least 1 year, and 2 were extracted before the 1-year follow-up. The interexaminer agreements were excellent for the linear and volume measurement of the preoperative periapical lesion. A lesion volume above 50 mm(3) was found to be a significant negative predictor in the univariate analysis (P = .028) and the logistic regression model (P = .038). Conclusions: Within the limitations of this study, the volume of the preoperative periapical lesion had a significant effect on the outcome of endodontic microsurgery. It is suggested that further studies on endodontic microsurgery should be performed and that quantitative measurements using CBCT imaging may be useful for the analyses.