Periapical lesion healing in osteoporosis patients: an explorative retrospective, controlled pilot cohort study

Osteoporosis is a systemic disease characterized by reduced bone density. The aim of this exploratory, retrospective controlled pilot study following STROBE guidelines, was to descriptively assess periapical lesion healing following endodontic treatment in patients with osteoporosis compared with matched healthy controls and to generate hypotheses for future studies. Digital X-ray images of patients who underwent endodontic treatment at a German university dental clinic between January 2011 and December 2020 were evaluated. Patients with radiographically visible periapical lesions, a follow-up radiograph obtained 6–12 months after treatment, and a documented diagnosis of osteoporosis were included. Changes in periapical lesion size and Periapical Index (PAI) scores were assessed and compared with an age- and tooth-group-matched control cohort. Given the limited sample size, analyses were considered exploratory. Out of 103,385 screened patients, 13 patients with osteoporosis (4 male, 9 female) fulfilled all inclusion criteria and were matched to 13 healthy controls. Both groups demonstrated a reduction in periapical lesion size over time (mean change: -2.47 mm in the osteoporosis group and − 1.90 mm in controls). A mean improvement of one PAI grade was observed in both cohorts. No statistically significant group differences were detected. Within the limitations of this exploratory pilot study, no statistically significant differences in radiographic periapical healing were observed between patients with osteoporosis and matched healthy controls. Due to the limited sample size and the resulting limited statistical significance, these findings should be interpreted with caution, and further studies are needed to clarify the possible influence of osteoporosis on endodontic healing. With demographic change, the potential influence of osteoporosis on endodontic healing is of increasing clinical interest. This study highlights both feasibility and methodological challenges when addressing this question in retrospective clinical cohorts.