Periapical Lesion Size and Regenerative Materials as Prognostic Factors in Endodontic Microsurgery: A 12-Month Retrospective Cohort Study

Abstract

Objective: This study evaluated the influence of initial periapical lesion size and the use of bone graft and/or membrane materials on endodontic microsurgery outcomes, considering other clinical factors. Methods: A retrospective cohort study included 127 teeth treated with endodontic microsurgery, with or without adjunctive bone graft and/or membrane placement, between January 2021 and December 2024. Based on the initial Periapical Index (PAI) scores, patients were classified into 2 groups: small lesions (PAI ≤3) and large lesions (LL, PAI ≥ 4). Treatment outcomes were assessed at 12 months according to established criteria. Statistical analyses included chi-square or Fisher’s exact tests, t-tests and multivariate logistic regression (P < .05). Results: The overall success rate was 64.6%. The use of bone graft and/or membrane was associated with significantly higher success rates (72.0% vs. 53.8%; odds ratio [OR]=2.34, 95% CI: 1.10-4.98; P=.03), particularlyin LLs (69.6% vs. 42.3%; OR=2.90, 95% CI: 1.08-7.78; P = .03). In multivariate analysis, regenerative material use(adjusted OR=2.48, 95% CI: 1.12-5.50; P=.03) and anterior tooth position (adjusted OR=2.71, 95% CI: 1.24-5.93; P=.01) were significantly associated with treatment success. Conclusion: Within the limitations of this 12-month retrospective cohort study, the adjunctive use of regenerative materials and anterior tooth position were associated with higher success rates in endodontic micro-surgery. Preoperative lesion size alone was not significantly associated with treatment success.