Comparison of Healing in the Surgical and Non-Surgical Management of Periapical Lesions: A Prospective Clinical Study

Background: Periapical lesions require accurate diagnosis and effective treatment, with healing serving as a key indicator of endodontic success. Advances in three dimensional imaging and volume analysis have enhanced the evaluation of treatment outcomes . This study assessed the outcomes of surgical and non-surgical endodontic treatments using three-dimensional (3D) volume analysis with a minimum 18-month follow-up. The study aimed to evaluate periapical lesion healing based on modified Penn’s 3D criteria and periapical index (PAI) scores using intraoral periapical radiographs (IOPA) and cone-beam computed tomography (CBCT) and analyze the impact of age, lesion size, treatment type, and materials on healing. Methods: Ninety-six patients with periapical lesions larger than 10 mm, who underwent CBCT scans and received surgical, non-surgical root canal treatment, or surgical decompression (2017–2021), were included in this study. After dropouts, 64 patients received non-surgical treatment (n =31) and periapical surgery (n =31), respectively, and 1 patient received surgical decompression. Volume analysis was performed using ITK SNAP. Healing was assessed using the modified Penn’s 3D criteria and PAI scores derived from IOPA and CBCT. Finally, statistical analysis was conducted by paired sample t-tests, Levene’s test, and Mann-Whitney U test using SPSS 24. Results: Mean lesion volume significantly decreased from 696.3961 mm³ to 79.7605 mm³ over 18–48 months. Initial lesion volumes differed significantly between non-surgical and surgical groups (P=0.001), but follow-up volumes demonstrated no difference (P =0.473). Similarly, the Mann-Whitney U test showed no statistically significant difference (P =0.094) between the surgical and non-surgical groups. Conclusion: No statistical significance was observed in periapical lesion healing between surgical and non-surgical treatments despite the surgical group having larger initial volumes, supporting the efficacy of the treatment protocol and emphasizing proper case selection.