Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9303
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
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.
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.
Through evaluating the degree and characteristics of periapical swelling after apical microsurgery to determine the potential risk factors of periapical swelling.
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.
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.
Young patients with larger volume and density of shadow around the tooth apical in CBCT were more likely to develop swelling after apical microsurgery.
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.