Outcome of Endodontic Microsurgery Using Resorbable Membranes and Lyophilized Human Bone Graft: A Prospective Randomized Controlled Clinical Trial

Purpose: The aim of this prospective randomized controlled clinical study was to evaluate the effectiveness of a resorbable membrane with and without the complement of human lyophilized bone grafts used as aids in endodontic microsurgery. The study was conducted in patients that presented with periapical pathologies that had not responded to primary endodontic treatment and retreatment. Methods: From a cohort of 189 consecutive patients presenting with non-resolving periapical radiolucencies located at the maxillary anterior teeth with a size that covered at least two apices, 174 (92%) of them met the inclusion criteria. They were randomly allocated into three modalities of treatment ie. Group 1: conventional enucleation procedures (CENP; n=58). Group 2: enucleation with placement of resorbable Fascia Lata Membrane (FLM; n=58). Group 3: enucleation with placement of resorbable Fascia Lata membrane combined with lyophilized human bone graft (FLM-HBG; n=58). After enucleation the tissues were submitted for histopathological analysis. The surgical outcome was determined clinically and radiographically after 24 months postoperatively using standardized periapical radiographs and Cone Beam Computed Tomography (CBCT) imaging. Data was subjected to statistical analysis. Results: Of the initial 174 treated patients, 120 responded to the 24-month recall. In Group 1, 21 cases out of 39 (54%) had successfully healed. Patients in Group 2 showed a success rate of 93% in39 cases out of 42 while patients in Group 3 achieved a success rate of 95% in 37 cases out of 39. The histopathological analysis showed that the most frequent lesions were periapical granulomas. Groups 2 and 3 showed significant differences with Group 1 (P<0.001), however, no significant difference was found between Group 2 and 3 (P>0.05). Conclusions: The use of Fascia Lata resorbable membranes, whether with or without the addition of a lyophilized human bone graft, showed significantly better bone repair than conventional surgical procedures.