Effect of Irrigation-Activation Techniques on Healing in Large Periapical Lesions

Not Applicable

Completed

Interventions: Procedure: Laser activation
Procedure: Manual dynamic activation
Procedure: Passive ultrasonic activation

Brief Summary: The aim of this study was to highlight the healing rates of large periapical lesions after different irrigation activation treatments as manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), shock wave-enhanced emission photoacoustic streaming (SWEEPS) using CBCT scans based on volumetric change analysis during 1-year follow-up.

Detailed Description: The aim of this study was to highlight the healing rates of large periapical lesions after different irrigation activation treatments as manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), shock wave-enhanced emission photoacoustic streaming (SWEEPS) using CBCT scans based on volumetric change analysis during 1-year follow-up.

A total of 56 systemically healthy male/female patients with mandibular single-rooted teeth with a periapical index score (PAI) of 3 or higher were included in the study. Pretreatment lesion volumes were determined by CBCT. Patients were randomly divided into 3 study groups (PUI, SWEEPS, MDA) and control group (n=14). For the follow-up routine, 2D radiographs were taken at months 3, 6, and 9, as well as clinical examinations. At the end of 12 months, 3D evaluation of lesion volumes was performed using ITK SNAP. Pretreatment and follow-up values were statistically analyzed with the Wilcoxon test.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Patients with systemic diseases (diabetes, hypertension, chronic liver disease, coagulation disorders),
Patients with bone metabolism disease and/or
Patients using drugs that affect bone metabolism (such as steroids, bisphosphonates)
Patients with a history of radiotherapy
Pregnant patients
Teeth with mobility of 2 or more, periodontal pocket depth of 5 mm or more, generalized chronic periodontitis, internal and external resorption, and/or vertical and horizontal root fractures

Arm && Interventions

Group	Intervention	Description
Laser activation	Laser activation	-
Manual dynamic activation	Manual dynamic activation	-
Passive ultrasonic activation	Passive ultrasonic activation	-

Primary Outcome Measures

Name	Time	Method
Percentage Change in Lesion Volume at 12-months Follow-up	One year from the beginning of the study	3D volumes pre-operatively and at the end of 1 year were measured using the segmentation technique by slicing the image at 0.09 mm intervals. The borders of the lesion were determined with gray scale. The defined volume boundaries were automatically filled by bubbles until the entire defect was filled completely. If necessary, manual correction was applied at this stage of lesion volume measurements, allowing for small individual additions or subtractions. At the end, the well-defined size of the lesion could be visualized in 3D. After finishing the process, the software depicted the exact volume of the defects in mm3.The volume data were compared with the preoperative CBCT measurements in each case. The primary healing of the periapical tissues was assessed, volume changes were measured, and the long-term outcomes of the procedures were compared using percentage of the lesion volume change.
Distribution of Lesion Status in Different Irrigation Groups at 12-year Follow-up	One year from the beginning of the study

Secondary Outcome Measures