Investigation of the effect of different irrigation-activation techniques on healing of large periapical lesions with CBCT scans

Aim: Volumetric comparison of lesion healing rates with the help of CBCT in single-rooted mandibular teeth with large periapical lesions and root canal treatments using different irrigation activation methods. Material and Method: Systemically healthy 56 male/female patients with mandibular single-rooted teeth with PAI (periapical index score) of 3 or higher were included in the study. After the periapical lesion volumes were determined by CBCT before the procedure, the patients were randomly divided into 3 study and control groups (n=14). Root canal treatments were performed in the study group by applying different activation methods with PUI, SWEEPS, and MDA. In the control group, irrigation was done with the traditional syringe method and no activation was applied. Control was done with clinical evaluations with 3-6-9-12 months follow-up. Changes in lesion volumes before treatment and after the 12th month follow-up were made with 3D volume calculation via ITK SNAP. Pre-procedure and follow-up values were statistically analyzed with the Wilcoxon test. Results: In all groups, pre-treatment lesion volume averages were found to be statistically significantly higher than post-treatment volume averages (p=0,001). In terms of pre-treatment lesion volume averages, the SWEEPS (210,4 mmᶟ) group was found to be statistically significantly higher than PUI (158,3 mmᶟ). In our study, lesion healing percentages were found to be SWEEPS (%86,9) > PUI (%85,4) > MDA (%80,4) > Conventional syringe (%74,5) by volume. However, there was no statistically significant difference between the groups in terms of lesion changes (p>0,05). No growth was detected in lesion volumes after treatment in any of the groups. Conclusion: Although there was no statistically significant difference between the percentages of lesion change during the 1-year follow-up, the volumetric healing of the periapical lesion was the highest in the SWEEPS group with %86,9, while the lowest improvement was observed in the conventional syringe group with %74,5. It can be thought that well-filled root canals and a correct hermetic occlusion are more effective on lesion healing than the irrigation activation method. Key words: İrrigation activation, periapical healing, CBCT