Newly Perio-Endo Combined Lesion Classification and Clinical Prognostic Analysis in 637 Cases of Endodontic Microsurgery

Abstract

Aim: The aim of this study was to investigate the clinical implications of the newly proposed classification system for periodontal-endodontic (perio-endo) combined lesions in a cohort of 637 cases undergoing endodontic microsurgery.

Methodology: Clinical and radiographic data from patients undergoing endodontic microsurgery at the Department of Endodontics, West China School of Stomatology, Sichuan University from January 2013 to October 2022 were collected and analyzed. The clinical and radiographic data of all the combined periodontal and pulpal lesions of Class II3 cases that underwent endodontic microsurgery were collected and analysed. Patients with vertical root fracture (VRF) (determined by IOPA radiographs or CBCT or discovered after surgical extraction) in follow-up cases were included in the collection even if less than a year had gone by. Inclusion criteria required accurate, detailed records and at least one year of follow-up. CBCT imaging was used preoperatively, and apical X-rays postoperatively. Patients with vertical root fracture (VRF) were included, even with less than one year of follow-up. Exclusion criteria included root fracture, external root absorption, or incomplete data.

Result: In this study, data from 637 cases of combined lesions were analysed using SPSS25.0. Among them, 436 cases (68.42%) showed successful treatment outcomes, while 201 cases failed after one year of observation. Significant differences were observed in the success rate of endodontic microsurgery among different classes of combined lesions (P<0.05), except between subclasses Ⅰ1 and Ⅰ2, Ⅱ1, and Ⅱ2. Subclasses II1 and II2 showed better healing outcomes compared to subclasses I1, I2, and I3 (P<0.05). Additionally, the incidence of VRF in subclass Ⅱ3 cases was the highest, contributing to the lowest success rate in this subclass. Notably, preoperative CBCT manifestations of symmetric bone lesions in the buccolingual direction correlated significantly with the detection of VRF (P<0.05), particularly in subclass Ⅱ3 cases.

Conclusion: Endodontic microsurgery is effective for combined lesions but less so than for chronic periapical inflammation. The new classification helps predict outcomes, with class II lesions performing better than class I. Success rates decrease with severe periodontal damage and are higher for anterior teeth. Preoperative CBCT exams are crucial for detecting vertical root fractures (VRF), especially in subclass II3 lesions, which have the highest VRF incidence and lowest success rates, necessitating cautious surgical selection.