@misc{Bieszczad_Daniel_An_2023,
 author={Bieszczad, Daniel},
 address={Kraków},
 howpublished={online},
 year={2023},
 school={Rada Dyscypliny Nauki medyczne},
 language={pol; eng},
 abstract={In recent decades, endodontic surgery evolved into endodontic microsurgery. This was due to the development of treatment techniques involving magnification, high-power illumination, ultrasonic root-end preparation, microinstuments, and the introduction of biocompatible materials. Regardless of this development, there is still deficiency in evidence-based data regarding local factors affecting the success of endodontic microsurgery, especially since many of studies were published before the advent of the “CBCT era”. Among the factors that were proven to have a significant influence on the treatment outcome of endodontic microsurgery are: retrograde filling material (biocompatible materials), ultrasonic microtips for retrograde preparation, microsurgical technique with the use of illumination and magnification (microscopes, loupes), tooth group, and apicomarginal lesions. In the literature some factors were found to have ambiguous influence on the outcome of surgery: volume and dimensions of a lesion, presence/absence of cortical bone destruction, type of lesion restriction, apical extend of root canal filling, use of GTR technique, angle of resection, depth of retrograde filling and others. The introduction of cone-beam computed tomography (CBCT) into daily practice was one of key factors impacting the increased success rate of EMS. The data collected from CBCT (e.g., volume of},
 abstract={a lesion, bone destruction pattern, height of the buccal bone plate, and presence/absence of cortical bone destruction) allow for exclusion of cases with poor prognosis, thus increasing the EMS success rate. The main limitation of CBCT is radiation exposure (relatively low, especially with a small imaging field), but this is outweighed by the ability for meticulous assessment of the local tooth-related factors affecting the success of endodontic microsurgery and the healing process, which is impossible in conventional radiographs. CBCT gives the opportunity to re-evaluate factors that have not been clearly assessed in the literature so far. The aim of the first study [Bieszczad D. et al. Factors Affecting the Success o f Endodontic Microsurgery: A Cone-Beam Computed Tomography Study. J. Clin. Med. 2022,11(14),3991] was to verify preoperative local parameters (tooth-related factors) of periapical lesions evaluated on cone­ beam computed tomography scans as a potential prognostic factor in endodontic microsurgery (EMS). The following tooth-related factors were measured on preoperative CBCT images before EMS: the volume of a lesion, dimensions of lesion, bone destruction pattern, presence/absence of cortical bone destruction, the height of a buccal bone plate, presence/absence of communication with neighboring anatomical structures, apical extent of a root canal filling, the type},
 abstract={of lesion restriction. Additionally, patient-related factors (age, gender), preoperative clinical symptomatology of a lesion and use of the GTR technique were studied together with their influence on the treatment outcome of EMS. At least one year after surgery the outcome of EMS was classified as a success or a failure. The success was ascertained when radiographic healing was classified as “complete healing” or “incomplete healing” and when during the follow-up period (at least 12 months after surgery) no clinical signs or symptoms (pain, sinus tract formation, loss of function, tenderness on percussion or palpation) were recorded. Failure was ascertained when radiographic healing was graded as “uncertain healing” or “unsatisfactory healing” and/or any of the clinical signs or symptoms were confirmed during the follow-up period. Radiographic healing was evaluated on CBCT images by two examiners according to modified 3D PENN Criteria or - on periapical radiographs - according to criteria by Rud and Molven. The mean follow-up period was 2.75 years. Among 89 roots ten cases (11.24%) were classified as a failure and 79 as a success (88.76%). Symptomatic lesions [OR = 0.088 (95% CI 0.011-0.731); P = 0.02], apicomarginal lesions [OR = 0.092 (0.021-0.402); P = 0.001] and an association with molar teeth [OR =0.153 (0.032- 0.732); P = 0.019] were found as negative predictive factors i},
 abstract={n the univariate analysis, whereas large apicocoronal dimension [OR = 0.664 (0.477-0.926); P = 0.016], apicomarginal lesions [OR = 0.058 (0.006-0.55); P = 0.013], and an association with molar teeth [OR = 0.047 (0.003-0.869); P = 0.04] were identified as negative predictive factors in the multivariate analysis model. The mean ICC2 for quantitative variables was 0.99 (95% CI 0.994- 0.999), and for qualitative variables the mean kappa value was 0.947 (95% CI 0.702-1), which shows excellent agreement between two examiners, and the need to use CBCT in both verifying and the healing assessment process. To sum up symptomatic lesions, apicomarginal lesions, lesions associated with molar teeth and large apicocoronal dimensions of a lesion are significantly associated with the failure of EMS. In the second study [Bieszczad D. et al. Treatment-Related Factors Affecting the Success o f Endodontic Microsurgery and the Influence of GTR on radiographic Healing-A Cone-Beam Computed Tomography Study. J. Clin. Med 2023,12(19), 6382] the primary objective was to assess the correlation between treatment-related factors (resection angle, depth of retrograde filling, length of resected root and use of guided tissue regeneration—GTR) evaluated using CBCT scans and the treatment outcomes of endodontic microsurgery (EMS). The secondary aim of this retrospective research was to investigate the influenc},
 abstract={e of the GTR technique on the radiographic healing state, taking into account the initial parameters of periapical lesions. In 161 cases, the local factors (the volume of a lesion, bone destruction pattern, presence/absence of cortical bone destruction) were measured using preoperative CBCT images before undergoing EMS. Using postoperative CBCT images, treatment-related factors (the resection angle, the depth of retrograde filling, and the length of resected root) were measured twice (like other linear measurements, within at least 4 weeks intervals) and the mean of two measurements was taken for subsequent analyses. The status of the radiographic healing was qualitatively evaluated by two clinicians according to modified PENN 3D Criteria using CBCT scans performed 1 year after the surgery. At least one year after surgery the outcome of EMS was classified as a success or a failure (based on radiographic and clinical criteria). The mean follow-up period was 3.17 years. Eighteen cases (11.18%) were classified as a failure, and 143 were classified as a success (88.82%). The success was ascertained when radiographic healing was classified as “complete healing” or “incomplete healing” and when during the follow-up period (at least 12 months after surgery) no clinical signs or symptoms (pain, loss of function, sinus tract formation, tenderness on percussion or palpation) were recorde},
 abstract={d. Failure was ascertained when radiographic healing was graded as “uncertain healing” or “unsatisfactory healing” and/or any of the clinical signs or symptoms were confirmed during the follow-up period. Univariate analysis showed that there was no statistically significant influence of treatment-related factors on the healing outcome of EMS. An exact Fischer’s test showed the significant impact of GTR on radiographic healing (P < 0.001) in apical lesions (P< 0.001), lesions with a volume between 100 mm3 and 450 mm3 (P < 0.009) and over 450 mm3 (P < 0.001), lesions with the destruction of one plate (P < 0.001), and lesions with the destruction of two plates (through and through) (P = 0.022). The interexaminer agreement of radiographic healing was assessed using the Cohen kappa coefficient. The mean kappa value for qualitative variables was 0.885 (95% CI 0.819-0.951), which demonstrates a high level of agreement between the two examiners (an agreement over 0.8 is considered high). 3 In conclusion, the use of GTR in apical lesions, lesions with volumes over 100 mm3 , and lesions with the destruction of at least one cortical plate is associated with significantly better radi ographic healing. The resection angle, depth of retrograde filling, extent of resection and GTR technique have no marked impact on healing outcomes. CBCT should be considered a mandatory step in the postsurgic},
 abstract={al evaluation of the healing progress of EMS.},
 title={An attempt to determine local factors affecting the success of apical microsurgery based on pre- and postoperative cone-beam computed tomography},
 type={Praca doktorska},
 keywords={prognostic factors, endodontic microsurgery, cone-beam computed tomography, guided tissue rege­neration},
}