Comparative evaluation of success rates in endodontic therapy versus oral medicine interventions in the management of chronic periapical lesions

INTRODUCTION. Chronic periapical lesions are an outcome of pulpal necrosis that necessitates final treatment. Although the traditional endodontic treatment is still the gold standard, the use of adjunctive interventions based on oral medicine and conservative pharmacological approaches as potential modes of treatment have been proposed.

MATERIALS AND METHODS. A prospective comparative study was performed on 180 patients with chronic periapical lesions who were grouped as Group A (conventional endodontic therapy only, n = 60), Group B (endodontic therapy plus systemic pharmacological intervention, n = 60) and Group C (conservative oral management and delayed endodontic intervention, n = 60). The main outcomes were the level of healing success, reduction of the size of the lesion, and the resolution of the symptoms measured at 3, 6, and 12 months. Secondary outcomes were pain scores, quality of life and treatment complications.

RESULTS. 12 months overall success rates were: Group A (83.3%), Group B (91.7%), Group C (45.0%), p < 0.001. The lesion size reduction in terms of the mean was also 4.82 ± 1.24 mm (Group A), 5.67 ± 1.18 mm (Group B) and 2.14 ± 1.52 mm (Group C), p < 0.001. Total periapical healing Group A (76.7), Group B (85.0) and Group C (33.3), p < 0.001. The Group B (4.2 + 1.8 days) and the Group C (12.6 + 4.8 days) had significantly shorter pain resolution times when compared to Group A (6.8 + 2.4 days), p < 0.001. The highest level of patient satisfaction was obtained in Group B (8.64 + 1.12) in comparison to Group A (7.92 + 1.34) and Group C (5.28 + 1.86), p = 0.001. Group A, 10.0%: Group B, 5.0%: Group C, 41.7%: treatment failure requiring surgical intervention was found.

CONCLUSIONS. Endodontic therapy with systemic pharmacological intervention has better results compared to endodontic therapy or conservative oral medicine treatment. The outcome of conservative pharmacological treatment without conclusive endodontic therapy is far worse and thus there is a need to treat the infectious etiology to achieve success in treating periapical lesions.

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