Comparative study of surgical fenestration and conventional surgical and non-surgical techniques in the management of large periapical lesions

Abstract

Surgical Fenestration - a procedure of opening into a patholgical lesion for diagnostic and therapeutic purpose, was compared with conventional apicectomy and conservative endodontic treatment using calcium hydroxide, to assess the efficacy of surgical fenestration in terms of quality and rate of post-surgical healing and total treatment time. 44 cases having peri-apical lesions >2 cm in diameter on radiograph were included in the study. The age of the patient ranged from 15-45 years. The cases were randomly divided into the three study groups : Group I was treated with conservative endodontic treatment using intra-canal calcium hydroxide. Group II was treated by conventional root-canal treatment and apicectomy. Group III cases were treated by root-canal treatment and surgical fenestration. It was found that all the three modalities of treatment were effective in the management of large peri-apical lesions. However, treatment time in group II and III was much shorter (one week - in either single visit or in two visits) compared to group I (2-8 months) requiring multiple visits. Also, it was seen that surgical fenestration was simpler to perform, required less surgical time, was least traumatic with minimal post-surgical complications compared with conventional apicectomy procedure. Quality of post-operative healing was comparable in both the Group II and III cases. Rate of healing in Group III cases at 3 months follow-up was found to be greater in comparison to group II cases, however, at 6 months follow-up, healing in both, group II and III cases was comparable. Another interesting observation of the study was, that all but one of the tissue specimens from group II and group III cases (n-25) were found to be apical cyst (92.3%)