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Endodontic microsurgery is a predictable and successful procedure when using techniques that have been developed over the past several years. One of the steps during surgery involves curettage of the entire lesion. However, there are cases in which the lesion has advanced to invade anatomic structures like the nasal fossa, maxillary sinus, mandibular canal, neighboring vital teeth, or through and through to the palate. These lesions make endodontic microsurgery difficult for the operator to execute and have inherent risks to the patient. Selective curettage is a conservative approach to treat such cases by removing approximately 50%-70% of the granulomatous tissue while avoiding complications and damage to the neighboring structures. Three-dimensional cone-beam computed tomographic imaging, 2-dimensional periapical radiographs, and clinical follow-ups of the selective curettage lesions showed complete or incomplete (scar tissue) healing in all cases with no untoward results., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Cone-beam computed tomographic (CBCT) imaging is an emerging technology for clinical endodontic practice. The aim of this study was to investigate the acceptance, accessibility, and usage of CBCT imaging among American Association of Endodontists members in the United States by means of an online survey., Methods: An invitation to participate in a web-based survey was sent to 3076 members of the American Association of Endodontists. The survey consisted of 8 questions on demographics, access to CBCT machines, field of view (FOV), frequency of use for particular applications, and reasons in case CBCT was not used., Results: A total of 1083 participants completed the survey, giving an overall completed response rate of 35.2%; 80.30% of the participants had access to a CBCT scan, of which 50.69% (n = 443) were on-site and 49.31% (n = 431) were off-site, and 19.30% of all respondents denied having access to CBCT imaging. Limited FOV was used by 55.26% participants, 22.37% used larger FOV formats, and the remaining 22.37% were not sure about the format. There was a significantly greater usage of CBCT technology in residency programs (n = 78/84 [92.86%]) compared with practitioners who had finished an endodontic specialty program (n = 796/999 [79.68%]) (χ 2 = 10.30, P = .02). Practitioners used CBCT imaging "frequent" or "always" for internal or external resorptions (47.28%), preoperatively for surgical retreatment or intentional replantation (45.34%), missing canals (25.39%), preoperatively for nonsurgical retreatments (24.91%), differential diagnosis (21.16%), identifying periradicular lesions (18.26%), calcified cases (13.54%), immature teeth (4.71%), and to assess healing (3.87%). There was a significant difference in on-site and off-site CBCT imaging use for any of these applications (P < .001). Prevalent reasons for not using CBCT technology were cost (53.79%) and lack of installation space (8.29%). General concerns were expressed about resolution limitations, radiation exposure, and cost to the patient., Conclusions: There is a widespread application of CBCT technology in endodontic practice; however, results from the survey also confirmed that the benefit versus risk ratio should always be in favor of the patient if CBCT scans are taken., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate two‐ and three‐dimensionally the effect of resorbable collagen‐based bone‐filling material on periapical healing of endodontic lesions with four‐wall defects following endodontic microsurgery (EMS). Methodology: This parallel, randomized controlled superiority clinical trial involved 86 lesions with the strictly endodontic origin and four‐wall defect morphology. EMS procedures were performed by calibrated postgraduate residents. Before flap closure, osteotomies were randomized to the control or treatment group. In the control group, the flap was repositioned with no material added. In the treatment group, a collagen‐based bone‐filling augmentation material was placed into the osteotomy. Clinical and radiographic examinations were completed after 12 months. Periapical healing was evaluated by blinded evaluators using periapical (PA) radiographs according to Molven's criteria and cone beam computed tomography (CBCT) scans according to PENN's 3D criteria. Cortical plate healing was scored according to the RAC/B index. The data were analysed using Fisher's exact test, Logistic regression models and Chi‐squared test. The significance level was predetermined at p <.05. Results: Sixty‐six cases were evaluated at the 12‐month follow‐up, with 30 and 36 cases in the control and treatment groups, respectively. Only the asymptomatic cases (control = 26, treatment = 32) were included in the radiographic evaluation. Twenty‐three cases (88.5%) in the control and 28 (87.5%) cases in the treatment group demonstrated complete healing on PA radiographs (p = 1.000). On CBCT, 10 (38.4%) and 21 (65.6%) cases had completely healed in the control and treatment groups, respectively (p =.095). The re‐establishment of the buccal cortical plate was detected in 12 (46.2%) and 22 (68.8%) cases in the control and treatment groups, respectively (p =.243). Conclusion: Within the limitations of the present study, the use of collagen‐based bone‐filling material had no statistically significant effect on the periapical healing of endodontic lesions with four‐wall defect following EMS at the 12‐month follow‐up when evaluated by PA radiographs or CBCT scans. However, the observed higher percentage of a re‐established cortical plate in the treatment group could suggest a clinical benefit that is of interest after surgical endodontic treatment. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging. Methods The healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software). Results There was a significant difference between the mean preoperative lesion volumes of 95.34 mm 3 ( n = 51, standard deviation [SD] ±196.28 mm 3 ) versus 6.48 mm 3 ( n = 51, SD ±17.70 mm 3 ) at follow-up ( P < .05). The mean volume reduction was 83.7%. Preoperatively, mean lesion areas on periapical films were 13.55 mm 2 ( n = 51, SD ±18.80 mm 2 ) and 1.83 mm 2 ( n = 51, SD ±.68 mm 2 ) at follow-up ( P < .05). According to Molven's criteria, 40 teeth were classified as complete healing, 7 as incomplete healing, and 4 as uncertain healing. Based on the modified PENN 3D criteria, 33 teeth were classified as complete healing, 14 as limited healing, 1 as uncertain healing, and 3 as unsatisfactory healing. The variation in the distribution of the 2D and 3D healing classifications was significantly different ( P < .05). Periapical healing statuses incomplete healing or uncertain healing according to Molven's criteria could be clearly classified using 3D criteria. Conclusions CBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery. [ABSTRACT FROM AUTHOR]