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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 8  »  Comparison between a conventional technique and two bone regeneration techniques in periradicular surgery
Comparison between a conventional technique and two bone regeneration techniques in periradicular surgery
Results.



Of the 28 patients registered for the study, three had to be removed from the study for different reasons: one patient (group C) needed further surgery 2months after the initial operation for a subperiosteal abscess in the lingual aspect originating from a neighboring tooth. Another patient, with two surgical sites (groups A and C) did not return for reviews. One patient from group B was removed because of a vertical root fracture. At the end of the study, 25 patients with 26 surgical sites were examined. Of these, one patient from group A refused further surgery for the histological sample. One patient from group B refused to allow a tissue sample to be taken during the second surgical procedure for membrane removal.
Table 1 shows the results of the radiographic evaluation of the size of the periapical lesions, comparing initial and final measurements. In group A, there was a tendency towards reduction of the size of the lesion, with only one case in which the periapical radiolucent image increased in size (Fig. 1d). Group B had a tendency towards reduction of the size of the lesion in all treated cases, except in one case where the lesion remained the same size. In group C, complete resolution of the periapical lesions was observed in all cases.
The student’s t-test for the radiographic analysis of healing by individual groups, showed that a significant difference existed between the initial and final values for groups B (P = 0.02) and C (P = 0.0002) in relation to bone healing. There was no significant difference between the initial and final values for group A (P = 0.1).
The results of the statistical analysis of the binary comparison with groups for the radiographic evaluation, showed that there was no significant difference between the size of the lesions in the initial radiographic evaluation amongst the groups, whilst the results of the Kruskal-Wallis test for the final data of the radiographic evaluation showed that there was a significant difference when comparing groups A and C (P ј 0.016), but no statistically significant difference between groups A and B (P = 0.285) or between B and C (P = 0.082).
For radiographic healing by groups, a year after surgery (Table 2), in group A, there were four out of nine cases with complete healing; in group B, there were six out nine cases with complete healing; and in group C, all eight cases (100%) had complete healing.

Table 1. Radiographic size of periapical lesion in mm2 by group comparing initial and final measurements

Radiographic size of periapical lesion in mm2 by group comparing initial and final measurements

Table 2. Radiographic healing one year after surgery by experimental group

Radiographic healing one year after surgery by experimental group

Table 3. Histological healing one year after surgery by experimental group.

Histological healing one year after surgery by experimental group
Note: Data based on 23 patientswith 24 surgical sites.
a. One group A patient without re-entry surgery.
b. One group B patient without histolgical sample.

Table 3 summarizes the histological findings of biopsies taken during the second surgical procedure. The cases diagnosed as apical granuloma exhibited identical characteristics to the ones observed for the initial samples (Fig.1  c,f).The cases with scar tissue were characterized by a vascularized dense fibrous connective tissue. The cases registered as bone showed new formation of normal trabecular bone surrounded by osteoblastic activity (Figs 2 d,f and 3  d,f). None of the biopsies showed any remains of the membrane or crystals of the hydroxylapatite material.
The re-entry procedures showed evidence of filling of the bone defect with a dense hard tissue in those cases that showed that the surgery had been successful at the final radiographic exam (Fig. 3 e), except for a case (group A) in which granulomatous tissue was found. In cases with uncertain or unsatisfactory healing radiographically, there was granulomatous tissue (Fig.1 e). In cases with incomplete healing, fibrous tissue was strongly attached to the radicular surface in three cases, and granulomatous tissue in the two remaining cases. The membranes appeared to have been mechanically integrated to the tissue, offering resistance to removal.