Correlation between histology and radiography in the assessment of healing after endodontic surgery

Abstract

In order to correlate the radiographic and histologic findings after endodontic surgery, 70 cases were investigated by both methods. Histologically, a quantitative determination of periapical inflammation was made, and the presence of fibrous scar tissue was noted. These findings were correlated with a number of radiographic variables. The following radiographic picture was found to be characteristic of inflammation: a periapical rarefaction of more than twice the width of the normal periodontal space, the outline of the rarefaction being circular or semicircular with a funnel-shaped extension into the periodontal space. Furthermore, there may be a collar-shaped increase of the lamina dura lateral to the root, and normal bone structure outside the rarefaction. In some cases the rarefaction tended either to increase or to remain stationary. The presence of scar tissue was characterized by a rarefaction which tended to decrease, had an irregular outline, and extended angularly into the periodontal space. Furthermore, the rarefaction may be located asymmetrically around the root apex, with a fine meshed or coarse bone structure peripheral to the lamina dura and no bone structure within the rarefaction. Ra-diographically it is impossible to determine whether a large rarefaction which shows signs of scar tissue is also inflamed. A bone healing normally is characterized first of all by a decrease in the extent of rarefaction.