Two- and three-dimensional evaluation of endodontic microsurgery outcomes in maxillary anterior teeth with through-and-through lesions: a retrospective cohort study

OBJECTIVE: This retrospective cohort study evaluated healing outcomes following endodontic microsurgery (EMS) in maxillary anterior teeth with through-and-through periapical lesions (PALs) using periapical radiographs and cone-beam computed tomography (CBCT). METHODS: Permanent teeth with through-and-through PALs treated by EMS and followed for more than 24 months were included. Two calibrated endodontic specialists independently assessed two-dimensional (2D) healing according to the Molven criteria and three-dimensional (3D) healing using the PENN 3D criteria. Treatment outcomes were dichotomized as success (complete and incomplete/limited healing) or failure (uncertain and unsatisfactory healing). Preoperative and follow-up lesion volumes were calculated using Mimics software. RESULTS: Sixteen patients (22 teeth, 16 through-and-through lesions) with a follow-up period ranging from 24 to 61 months (mean, 33 months) were included. Complete healing was observed in 62.5% of cases according to the 2D criteria and in 31.3% according to the 3D criteria. The mean lesion volume significantly decreased from 856.97 ± 566.06 mm³ preoperatively to 95.74 ± 180.45 mm³ at follow-up (P < 0.0001). CONCLUSIONS: Favorable healing outcomes were observed following EMS in maxillary anterior teeth with through-and-through lesions. CBCT-based assessment applied more stringent healing criteria than periapical radiographs and provided a more comprehensive evaluation of periapical bone regeneration.