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
Research background

Apical microsurgery is a newly developed procedure that can achieve a high success rate in controlling periapical infection, so as to promote periapical healing and tissue regeneration. However, apical microsurgery cannot avoid some swelling, which is one of the most common postoperative complications.

Research motivation

Many studies have focused on swelling after tooth extraction or root canal treatments and illustrated predictors of pain after apical microsurgery. However, few studies have clarified predictors of swelling after apical microsurgery. So, our study focused on swelling after apical microsurgery and tried to clarify the predictors.

Research objectives

Through evaluating the degree and characteristics of periapical swelling after apical microsurgery to determine the potential risk factors of periapical swelling.

Research methods

Ninety-eight apical microsurgery patients were selected for this study. Before surgery, cone beam computed tomography (CBCT) was used to measure the bone shadow volume and density of pathological tissue. The other variables (age, gender, operative teeth number, etc.) were assessed during examination and the swelling degree was confirmed by questionnaires for patients on postoperative days 1, 7, 14 and 21 after surgery. The predictors for swelling were performed by statistical analyses.

Research results

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

Research conclusions

Young patients with larger volume and density of shadow around the tooth apical in CBCT were more likely to develop swelling after apical microsurgery.

Research perspectives

For patients who need microscopic apical surgery, preoperative CBCT is necessary as bone shadow volume and pathological tissue density are predictors of postoperative swelling. Based on these indicators, physicians can take appropriate measures in the treatment plan to reduce the swelling after microsurgery and the impact on the patients’ daily life.