Research on clinical characteristics and clinical healing assessment after endodontic surgery using ultrasonic tip and root -end filling material by MTA
Authors:   Department of Dentistry, 175 Military Hospital, Ho Chi Minh City, Vietnam, Bui Chi Thi Loan , Ly Nguyen Thi Bich ,   Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, Huynh Huu Thuc Hien ,   Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City
Published: September 2023

Background: Endodontic surgery is one of the tooth-conserving interventions indicated when conventional endodontic treatment fails for teeth with periapical lesions with the conventional classical method using handpiece with drill for osteotomy, apectomy, sinus creation and retrograde filling with Amalgam. Today, many studies have shown that when applying improvements in surgery such as the use of ultrasonic instruments for osteotomy, apectomy, sinus creation and retrograde filling with biomaterial Mineral Trioxide Aggregate (MTA) helps to reduce pain and swelling, to increases the clinical healing rate after surgery, thereby contributing to increase the success after intervention. Objectives: To investigate the clinical outcomes and evaluate clinical healing after endodontic surgery using ultrasound instruments and retrograde fillings with MTA materials. Materials and methods: This quasi experimental study carried out on 24 pernament teeth, one maxillary root in 16 patients (8 males and 8 females), whose periapical lesions of teeth with indication for endodontic surgery, who came for examinaton and treatment at Department of Dentistry, 175 Military Hospital from 10 /2021 to 10 /2022. Before surgery, patients were recorded with clinically relevant features. Endodontic surgery was performed according to the standard procedure of the Department of Oral Surgery, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, using ultrasonic instruments and root -end filling with MTA material. Pain and swelling at 1, 3, 7 days after surgery were assessed according to the variable VAS scale of Pasqualini et al (2005). Clinical healing assessment according to the criteria of Gutmann (1994). Results: Before surgery, most of the damaged teeth were not endodontic treatment (66,7%), pain (70,8%), swelling (87,5%), no pus fistula in the gums (70,8%), no fixed prosthesis (33,3%), discolored (58,3%), . At 1, 3, 7 days after surgery, most of the studied cases had mild pain, mild swelling; this level of pain, swelling gradually decreases over time; the difference in the rate of pain and swelling rates was evident at the 1st and 7th day after surgery and was statistically significant (with p < 0,001). The average pain score was 0,792 ± 0,588; 0,458 ± 0,509 and 0,083 ± 0,282 with the difference in mean pain score at 1, 3, 7 days after surgery was statistically significant ( p < 0,001). The mean swelling score was 1,375 ± 0,647; 0,833 ± 0,637 and 0,125 ± 0,338 with the difference in mean swelling score at 1, 3, 7 days after surgery was statistically significant (p < 0,001). At 3, 6 month after surgery, most of the teeth had a high clinical healing rate (including complete healing and incomplete healing) with the rate of 87,5% (3 months) and 91,7% (6 months), respectively. There was no difference in clinical healing rates between 3 and 6 months postoperatively. Conclusion: Endodontic surgery using ultrasonic instruments and retrograde filling with MTA has mild postoperative pain and swelling; achieve a high clinical healing rate. This technique contributes significantly to the success of surgery, helps improve treatment efficiency, and improves oral health for patients.