EVALUATION OF BONE HEALING AFTER APICAL RESECTION BY ULTRASONOGRAPHY

Abstract

<h3>Background</h3> Apical resection is a reliable method for the treatment of teeth with persistent periapical lesions or in cases where nonsurgical treatment is not successful. Generally, outcome assessment of apical resection is based on 2-D periapical radiographs. Ultrasound imaging is based on reflection of sound waves at the interface between 2 different tissues and is also recognized as the most risk-free imaging modality. <h3>Objective(s)</h3> Our aim was to evaluate healing of bone after apical resection by using ultrasonography. <h3>Study Design</h3> Ethical approval and patient consent were obtained. Three patients with periapical lesions of endodontic origin were examined with cone beam computed tomography (CBCT) and ultrasonography before surgery. ACUSON S 2000 color Doppler ultrasonography unit with 15 MHz intraoperative probe was used to obtain ultrasound images. In all patients, root canal treatment and apical resection surgery were performed. In 1 patient, during apical surgery, bone graft (Creos Greft, Nobel Biocare Services AG, Zurich, Switzerland) and resorbable collagen membrane (Creos xenoprotect, Nobel Biocare Services AG, Zurich, Switzerland) were used. The other cases were left to secondary healing. Three months after apical resection, periapical radiographs and ultrasonographic examination were performed for follow-up assessment. <h3>Results</h3> The resection area was filled with bone, and hyperechogenic bone healing was monitored by ultrasonography in the patient in whom bone graft and membrane were placed. In 1 patient, the resection area was filled with soft tissue, and ultrasound showed an echogenic area surrounded a hyperechogenic bone border. No internal vascularization was detected. In the other patient, ultrasonography showed a well-contoured anechogenic area with no vascularization, and 3 months after apical surgery, the tooth was extracted. <h3>Discussion/Conclusions</h3> Ultrasound imaging can be a useful tool for the monitoring of apical surgery outcomes without ionizing radiation. Further research is essential with inclusion of more patients.