HEALING OF APICAL PERIODONTITIS AFTER UNINTENTIONAL EXTRUSION OF AH PLUS SEALER: A RETROSPECTIVE RADIOGRAPHIC ASSESSMENT

Sinziana Adina Scarlatescu, Ioana Suciu, Ruxandra Bartok, Cristina Preoteasa, Irina Gheorghiu, Stefan Manea

DOI : 10.62610/RJOR.2025.2.17.60

ABSTRACT

Aim of the study: to evaluate the healing of apical periodontitis, after unintentional extrusion of AH Plus sealer on root canal treatments and non-surgical retreatments. Materials and methods: sixty-four teeth with apical periodontitis (21 initial root canal treatment and 43 non-surgical retreatments) were treated by 2 endodontists. They were rotary prepared and filled using warm vertical condensation technique. All the teeth presented unintentional canal overfilling, recorded on postoperative radiograph. The patients were monitored clinically and radiographically at 1 and 2 years after the treatment. Two independent observers assessed the radiographs and determined the outcome according to PAI score pooled in a 3-category scale (1 or 2 – healed, 3 – uncertain, 4 or 5 – nonhealed). Mann-Whitney, Fischer’s exact, and Wilcoxon tests were used for group comparisons. Results: Initial PAI score and tooth location in the maxillary arch were the factors that significantly afected the outcome. Initial PAI score was statistically significant lower in healed than in nonhealed or uncertain outcomes (p<0.001). Healing occurred more frequently in the maxillary teeth, compared to mandibular teeth (p=0.007; p<0.05). At 1 year recall, a healed outcome was observed in 78.12% teeth and mean PAI score decreased from 3.42 to 1.28 (p<0.001). At 2 year recall, the healed outcome increased to 81,25%. The majority of teeth presented a persistence of extruded AH Plus, both at 1 (89.07%) and 2 (89.59%) years recall. Conclusions: Treatment outcome in teeth with apical periodontitis was not related to the persistence or resorption of sealer extrusion. The best results were registred in maxillary teeth, especially in teeth with lower initial PAI score.