Effectiveness of Osteo-conductive Treatments for Bone Repair After Apical Surgery

Objectives: Apical surgery (AS) is a surgical procedure performed in the dental apex to solve problems involving chronic infectious processes or post-endodontic complications. Aim: To evaluate the effectiveness of biomaterials acting as osteoconductive elements for the treatment of peri-apical lesions.
Methods: We followed 61 patients of both sexes for 24 months with apical pathology at the anterior superior level. The patients were divided by treatment: 1) conventional AS (CAS, n=17), 2) AS with placement of fascia lata membrane (MB) (Biotar, Rosario Argentina) (n=21) on the bone defect and 3) AS with placement of MB and human lyophilized bone powder (Ostium Biotar, Rosario, Argentina) (n= 23). Treated teeth criteria: 1) pieces endodontically treated, with persistence or development of apico-periapical lesion and clinical symptoms; 2) pieces with periapical lesions and clinical manifestation, with post-endodontic reconstruction with rigid root anchorage, whose removal put in risk root integrity; and 3) pieces with chronic periapical lesion with persistent clinical symptoms. Radiographic and tomographic records were performed. To assess the overall success, von Arx and Kurt´s criteria were followed, considering: a) success, when bone regeneration is equal or greater than 50% and none of the clinical values is 1, b) failure, when bone regeneration is less than 50% and at least one of the clinical values ​​is 1. The data were analyzed by χ² test of Pearson.
Results: The results show a success rate of 64.70 % for CAS, 90.47 % for patients treated with MB alone (p<0.001 vs CAS), and 95.65 % for the combined treatment of MB and lyophilized bone (p<0.001 vs CAS). Histopathological examinations associated to removed inflammatory tissue showed high frequency of inflammatory epithelial cysts, followed by apical granulomas and inflammatory odontogenic cysts.
Conclusions: The results demonstrate the effectiveness of osteo-conductive treatments for peri-radicular bone repair and support its use in apical surgery.