Alghamdi Abdulwahed, Mominkhan Dana, Sabano Reem, Alqadi Noha F, Al-Habib Mey, Bukhari Sarah, Howait Mohammed, Alsofi Loai
Department of Endodontics, University Dental Hospital, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia.
Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Healthcare (Basel). 2025 Apr 25;13(9):995. doi: 10.3390/healthcare13090995.
: Endodontic microsurgery has become an integral part of daily endodontic practice. However, research on the correlation between the lesion characteristics observed via cone beam computed tomography (CBCT) and pain and swelling after endodontic microsurgery (EMS) is still lacking in the literature. The present study aims to examine the relationship between the radiographic characteristics of preoperative periapical lesions obtained from CBCT images and post-surgical symptoms such as pain and swelling. : A total of 61 patients undergoing EMS utilizing modern techniques were asked to report their level of pain and swelling at 8, 24, 48, and 72 h after EMS using VAS. Independent variables such as age, gender, tooth location, CBCT periapical index, endodontic diagnosis, cortical bone perforation by the lesion, duration of the EMS, preoperative analgesic consumption, antibiotic prescription, and pre-/postoperative mouthwash were analyzed using the Fisher Exact test. Multivariate regression analysis was also conducted to determine the independent significant factors associated with pain and swelling. A -value of ≤0.05 was considered statistically significant. : The maximum pain score was recorded at 8 h (4.26 ± 3.13), while peak swelling was measured after 24 h (6.46 ± 2.87). The risk of swelling was more likely to decrease by 75.7% for patients with a CBCT index score of >3 than those with a CBCT index score of ≤3 (AOR = 0.243; CI = 0.071-0.831; = 0.024). The effects of all other factors on pain, including cortical bone perforation by the lesion ( = 0.290), swelling ( = 0.071), postoperative mouthwash use ( = 0.062), and swelling ( = 0.934), did not reach statistical significance. Patients with periapical lesions larger than 4 mm will likely experience less swelling after EMS, while pain is not affected by lesion size, cortical bone perforation, or mouthwash use. : This study identified a new predictor of swelling after EMS based on the size of the periapical lesion. These results will improve the management of post-surgical sequelae after EMS and support shared decision making.
牙髓显微外科手术已成为日常牙髓治疗实践中不可或缺的一部分。然而，文献中仍缺乏关于通过锥形束计算机断层扫描（CBCT）观察到的病变特征与牙髓显微外科手术（EMS）后疼痛和肿胀之间相关性的研究。本研究旨在探讨从CBCT图像获得的术前根尖周病变的影像学特征与术后疼痛和肿胀等症状之间的关系。
共有61例接受现代技术EMS治疗的患者被要求使用视觉模拟评分法（VAS）报告EMS后8、24、48和72小时的疼痛和肿胀程度。使用Fisher精确检验分析年龄、性别、牙齿位置、CBCT根尖指数、牙髓诊断、病变导致的皮质骨穿孔、EMS持续时间、术前镇痛药使用情况、抗生素处方以及术前/术后漱口等自变量。还进行了多因素回归分析以确定与疼痛和肿胀相关的独立显著因素。P值≤0.05被认为具有统计学意义。
最大疼痛评分记录在8小时（4.26±3.13），而肿胀峰值在24小时后测量（6.46±2.87）。CBCT指数评分>3的患者肿胀风险比CBCT指数评分≤3的患者降低75.7%的可能性更大（比值比[AOR]=0.243；可信区间[CI]=0.071 - 0.831；P = 0.024）。所有其他因素对疼痛的影响，包括病变导致的皮质骨穿孔（P = 0.290）、肿胀（P = 0.071）、术后使用漱口液（P = 0.062），以及对肿胀的影响（P = 0.934），均未达到统计学意义。根尖周病变大于4mm的患者在EMS后可能肿胀较少，而疼痛不受病变大小、皮质骨穿孔或漱口液使用的影响。
本研究基于根尖周病变大小确定了EMS后肿胀的一个新预测指标。这些结果将改善EMS后手术后遗症的管理并支持共同决策。
