Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2022; 10(26): 9303-9309
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9303
Incidence and risk factor analysis for swelling after apical microsurgery
Cheng Bi, Si-Qi Xia, Yu-Chi Zhu, Xin-Zhu Lian, Li-Jun Hu, Chen-Xing Rao, Hai-Bin Jin, Xiao-Dan Shang, Fei-Fan Jin, Jing-Yu Li, Pei Zheng, Shu-Hua Wang
Cheng Bi, Si-Qi Xia, Yu-Chi Zhu, Xin-Zhu Lian, Li-Jun Hu, Chen-Xing Rao, Hai-Bin Jin, Xiao-Dan Shang, Fei-Fan Jin, Jing-Yu Li, Pei Zheng, Shu-Hua Wang, School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Cheng Bi, VIP Center, Hangzhou Stomatology Hospital, Hangzhou 310006, Zhejiang Province, China
Author contributions: Bi C and Xia SQ contributed equally to this work; Bi C, Xia SQ, Zheng P and Wang SH gave the conception and designed the research study; Shang XD, Jin FF and Li JY performed the research; Zhu YC, Hu LJ and Jin HB analyzed the data; Xia SQ, Lian XZ and Rao CX wrote the manuscript; all authors gave their final approval and agree to be accountable for all aspects of the work.
Supported by Natural Science Foundation of Zhejiang Province, China, No. LQ21H270001.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Hangzhou Dental Hospital (approval No. 2021-6-9).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at 385164787@qq.com. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Hua Wang, DDS, MD, PhD, Doctor, Teacher, School of Stomatology, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou 310053, Zhejiang Province, China. 385164787@qq.com
Received: February 13, 2022
Peer-review started: February 13, 2022
First decision: June 7, 2022
Revised: June 15, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: September 16, 2022

Swelling after apical microsurgery is a postoperative reaction and may reduce quality of life during healing.


To evaluate periapical swelling after apical microsurgery and determine potential risk factors.


Ninety-eight apical microsurgery patients were selected for this study. Before surgery, bone shadow volume and density of pathological tissue were measured by cone beam computed tomography. The other variables (age, gender, operative teeth number, fistula, preoperative swelling, drug use and preoperative root canal treatments) were assessed during examination. Swelling degree was confirmed by questionnaires for patients on postoperative days 1, 7, 14 and 21. Statistical analyses were performed to identify predictors for swelling.


Majority of patients reported moderate (45.9%) or severe (34.7%) swelling on day 1, and moderate (44.9%) or mild (45.9%) on postoperative day 7. Ninety-nine percent of patients had no or mild swelling on postoperative day 14. The average swelling level peaked on day 1 postoperatively and gradually decreased. Of statistical significance, age, bone shadow volume and density of pathological tissue acted as predictors of swelling (P < 0.05). However, there was no significant difference in gender, tooth number, fistula, preoperative swelling, drug use, or preoperative root canal treatments (P > 0.05).


Younger patients with larger shadow volume and density were significantly more likely to develop swelling after apical microsurgery.

Keywords: Apical microsurgery, Swelling, Incidence, Risk factor, Prognosis

Core Tip: The impact of postapical swelling on daily life was viewed from the patients’ perspective. The conclusions demonstrate that postoperative swelling is more severe in those with larger volume and density of apical lesions, so the importance of preoperative cone beam computed tomography examination is emphasized. Younger patients with high postoperative prognostic requirements may have more severe postoperative swelling than older patients and should be given more clinical attention.