# Two- and three-dimensional evaluation of endodontic microsurgery outcomes in maxillary anterior teeth with through-and-through lesions: a retrospective cohort study

## TL;DR

This study evaluates healing outcomes after endodontic surgery in maxillary anterior teeth with large lesions using both X-rays and 3D imaging.

## Contribution

The study introduces a comparative analysis of 2D and 3D healing criteria for endodontic microsurgery in teeth with through-and-through lesions.

## Key findings

- Complete healing was observed in 62.5% of cases using 2D criteria and 31.3% using 3D criteria.
- Lesion volume decreased significantly from preoperative to follow-up assessments.
- CBCT provided a more comprehensive and stringent evaluation of healing than 2D radiographs.

## Abstract

This retrospective cohort study evaluated healing outcomes following endodontic microsurgery (EMS) in maxillary anterior teeth with through-and-through periapical lesions (PALs) using periapical radiographs and cone-beam computed tomography (CBCT).

Permanent teeth with through-and-through PALs treated by EMS and followed for more than 24 months were included. Two calibrated endodontic specialists independently assessed two-dimensional (2D) healing according to the Molven criteria and three-dimensional (3D) healing using the PENN 3D criteria. Treatment outcomes were dichotomized as success (complete and incomplete/limited healing) or failure (uncertain and unsatisfactory healing). Preoperative and follow-up lesion volumes were calculated using Mimics software.

Sixteen patients (22 teeth, 16 through-and-through lesions) with a follow-up period ranging from 24 to 61 months (mean, 33 months) were included. Complete healing was observed in 62.5% of cases according to the 2D criteria and in 31.3% according to the 3D criteria. The mean lesion volume significantly decreased from 856.97 ± 566.06 mm³ preoperatively to 95.74 ± 180.45 mm³ at follow-up (P < 0.0001).

Favorable healing outcomes were observed following EMS in maxillary anterior teeth with through-and-through lesions. CBCT-based assessment applied more stringent healing criteria than periapical radiographs and provided a more comprehensive evaluation of periapical bone regeneration.

The online version contains supplementary material available at 10.1186/s12903-025-07614-7.