Clinical and imaging aspects associated with persistent apical periodontitis: subsides for the treatment decision-making process.

OBJECTIVES

To evaluate cases of persistent apical periodontitis (PAP) and what are the imaging and clinical aspects that could be considered in the PAP diagnosis and in their treatment decision-making process.

METHODOLOGY: 423 patients with apical periodontitis at the time of non-surgical root canal treatment (NSRCT) were followed-up for at least 1 year. Periapical radiographic images were used to compare and determine periapical status at each time using the PAI scoring system. Cases scored as PAI 5 at the follow-up appointment were evaluated by CBCT, using the CBCTPAI scoring system. Associated, the data from imaging exams and from clinical evaluation were considered to make a decision for PAP treatment.

RESULTS

Regarding sample composition, it was observed an association with ethnicity and PAP (p = 0.045). After follow-up, cases classified as PAI Score 1 and 2 and absence of symptoms/complaint were classified as successful. Cases classified as PAI Score 3 and absence of symptoms/complaint were referred for new follow-up visits until complete resolution of PAP. Cases scored as PAI 4 with clinical symptoms were indicated for non-surgical root canal retreatment. Cases scored as PAI 5 were assessed by CBCT, and in the presence of symptoms/complaint and a CBCTPAI score 3 were related to non-surgical root canal retreatment, while CBCTPAI scores 4 and 5 were refereed for endodontic surgery.

CONCLUSIONS

Clinical data, PAI and CBCTPAI scoring systems from image exams can be useful for PAP diagnosis and their treatment.

CLINICAL RELEVANCE: In the decision-making process, clinical and imaging data are fundamental for the choose of an ideal protocol for treating PAP.