The aim of this study was to assess in a multi-modular manner the bone healing 1 year post root-end surgery (RES) with leukocyte- and platelet-rich fibrin (LPRF) and Bio-Gide® (BG; Geistlich Pharma North America, Inc., Princeton, USA) as an occlusive membrane. A randomized controlled clinical trial (RCT) of RES +/− LPRF and +/− BG was performed. The follow-up until 1 year post RES was performed by means of ultrasound imaging (UI), periapical radiographs (PR), and cone-beam computed tomography (CBCT). From the 50 included patients, 6 dropped-out during follow-up. For the 44 assessed patients (34 with UI and 42 with PR and CBCT), there was no evidence (p > 0.05) for an effect of LRPF, neither on UI measurements nor on CBCT assessments. On the contrary, there was an indication for a better outcome with BG. UI presented significant shorter healing time for the bony crypt surface (p = 0.014) and cortical opening (p = 0.006) for the groups with BG. The qualitative CBCT assessment for the combined scores of the apical area and cortical plane was significantly higher for BG (p = 0.01 and 0.02). The quantitative CBCT measurement for bone healing after 1 year was lower with BG (p = 0.019), as well as the percentage of non-zero values (p = 0.026), irrespective of the preoperative lesion size and type. Furthermore, UI seemed to be safer for frequent follow-up during the early postoperative stage (0–3 months), whereas CBCT gave more accurate results 1 year post RES. Amongst the assessors, the qualitative PR analysis was inconsistent for a favorable outcome 1 year post RES with LPRF (p = 0.11 and p = 0.023), but consistent for BG (p = 0.024 and p = 0.023). There was no evidence for improvement of bone healing when RES was applied with LPRF in comparison with RES without LPRF. However, RES with BG gave evidence for a better outcome than RES without BG. The addition of an occlusive membrane rather than an autologous platelet concentrate improved bone regeneration 1 year post RES significantly, irrespective of the assessment device applied. The accuracy of PR assessment is questionable.

Introduction: The aim of this study was to present ultrasound imaging (UI) techniques as promising and safe tools for the follow-up of root-end surgery (RES) in vivo. Methods: The study included 8 patients who underwent RES. All were followed up using UI at 1 week, 1 month, 2 months, 3 months, and 6 months (if necessary) after RES. The bony crypt was defined on the ultrasound image, and the following observations were made during follow-up: cortical bone interruption and surface area measurement of the residual echoic bony crypt image. Results: In all cases, the hypo echoic image became hyperechoic, indicating gradual bone healing of the crypt. Compared with baseline, at 3 months a remaining cortical opening of 51.2% (+/- 12.6%) and a bony crypt surface area of 24.3% (+/- 10.8%) was detected for all patients. For 50% of the patients, the echographic follow-up ended at 3 months because the ultrasound waves could no longer enter the bony crypt. For 4 patients who attended the 6-month recall, a remaining cortical disruption of 43.2% (+/- 9.9%) and a bony crypt surface area of 17.2% (+/- 7%) compared with the baseline was noted. Conclusions: UI is a promising follow-up tool for RES. It helps clinicians understand the initial stages of bone healing, allows close healing monitoring, and is radiation free.

The aim of this study was to investigate the impact of the adjunct of leukocyte- and platelet-rich fibrin (LPRF) to root-end surgery (RES) on the patients’ quality of life during the first week post RES.