Clinical and Radiographic Characteristics and Outcomes of Guided Apicoectomy With Retrograde Mineral Trioxide Aggregate Filling for Periapical Cysts

Can Tho University of Medicine and Pharmacy42 enrolled

Overview

Patients with periapical cysts associated with premolar teeth often require apical surgery when conventional endodontic treatment cannot resolve the lesion. Guided apicoectomy using a three-dimensional surgical guide may improve surgical accuracy while minimizing bone removal and reducing the risk of damage to adjacent anatomical structures. This prospective single-arm interventional study aims to evaluate the clinical and radiographic characteristics of premolar teeth with periapical cysts and assess the treatment outcomes of guided apicoectomy with retrograde Mineral Trioxide Aggregate (MTA) filling. Forty-two participants will be treated and followed for six months. Clinical healing and radiographic bone healing will be evaluated one week, three months, and six months after surgery.

Periapical cysts are common inflammatory lesions caused by pulpal infection and necrosis. Although conventional root canal treatment is effective in most cases, surgical intervention becomes necessary when persistent periapical lesions remain or true cysts develop. Apicoectomy combined with retrograde filling using Mineral Trioxide Aggregate (MTA) has demonstrated high clinical success because of excellent sealing ability, biocompatibility, and stimulation of periapical tissue regeneration. Recently, computer-guided surgery integrating cone-beam computed tomography (CBCT), intraoral scanning, digital planning, and three-dimensional printing has improved surgical precision while minimizing unnecessary bone removal. This prospective, single-center, single-arm interventional study will enroll 42 patients diagnosed with periapical cysts involving premolar teeth. Eligible participants will undergo guided apicoectomy, cyst enucleation, root-end cavity preparation, and retrograde filling with Mineral Trioxide Aggregate (MTA). Clinical outcomes will be assessed one week, three months, and six months after surgery. Radiographic healing will be evaluated using cone-beam computed tomography (CBCT) at six months. The study aims to determine the effectiveness and safety of guided apicoectomy with MTA in treating premolar periapical cysts.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Interventions

Guided Apicoectomy With Retrograde Mineral Trioxide Aggregate FillingPROCEDURE

Patients undergo cone-beam computed tomography (CBCT) and intraoral scanning for digital treatment planning. A three-dimensional surgical guide is fabricated to accurately locate the root apex. Guided apicoectomy is performed with cyst enucleation, root-end resection, ultrasonic root-end cavity preparation, and retrograde filling using Mineral Trioxide Aggregate (MTA). Standard postoperative medications and follow-up examinations are provided.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Adults diagnosed with a periapical cyst involving a premolar tooth. * Diagnosis confirmed by clinical examination and CBCT. * Histopathological confirmation of periapical cyst after surgery. * Root canal treatment completed with acceptable obturation quality. * Tooth considered restorable. * No previous apicoectomy on the study tooth. * Able to provide written informed consent. Exclusion Criteria: * Uncontrolled systemic diseases. * Coagulation disorders. * Uncontrolled diabetes mellitus. * Active malignancy receiving radiotherapy. * Severe cardiovascular disease contraindicating surgery. * Vertical root fracture. * Grade IV tooth mobility. * Allergy to local anesthetics or study materials. * Previous surgery for recurrent periapical cyst at the study site. * Inability to comply with follow-up schedule.

Outcomes

Primary Outcomes

Treatment Success Rate

The treatment success rate will be assessed 6 months after surgery based on predefined clinical and radiographic success criteria. Success is defined as the absence of clinical signs and symptoms together with evidence of bone healing on cone-beam computed tomography (CBCT).

Time frame: 6 months after surgery

Secondary Outcomes

Number of Participants With Good Clinical Healing at 1 Week

Number of participants achieving good postoperative clinical healing according to the predefined postoperative evaluation criteria, including satisfactory wound healing without infection, wound dehiscence, excessive bleeding, or other clinically significant postoperative complications.

Time frame: 1 week after surgery

Number of Participants With Good Clinical Healing at 3 Months

Number of participants achieving good clinical healing based on the predefined clinical evaluation criteria, including the absence of pain, swelling, sinus tract, tenderness to percussion or palpation, and other signs of persistent periapical disease.

Time frame: 3 months after surgery

CBCT Bone Healing Score at 6 Months

Bone healing will be evaluated using cone-beam computed tomography (CBCT) according to the predefined CBCT healing criteria described in the study protocol. Bone healing will be summarized using the CBCT healing score.

Time frame: 6 months after surgery

Number of Participants With Postoperative Complications

Number of participants experiencing postoperative complications, including surgical site infection, wound dehiscence, persistent swelling, persistent pain requiring additional treatment, prolonged bleeding, paresthesia, or any surgery-related adverse event.

Time frame: 1 week, 3 months, and 6 months after surgery