Periapical Microsurgery: Can Ultrasonic Root-end Preparations Clinically Create or Propagate Dentinal Defects?

INTRODUCTION This clinical study evaluates the effect of ultrasonic root-end preparations on dentinal defect creation and propagation. METHODS Eighty-four teeth were treated with periapical microsurgery using a modern microsurgical protocol in a private practice setting. The root apices were resected and inspected for dentinal defects with a surgical operating microscope and a 0.8-mm diameter light-emitting diode microscope diagnostic probe light, both before and after ultrasonic root-end preparations. A 3-grade scale (none, partial, and full dentinal defect) was used to assess the status of the roots before and after ultrasonic root-end preparation. RESULTS Of the 84 treated teeth, 3 had a vertical root fracture, leaving a total of 81 teeth for assessment. Fifty-one teeth were intact upon resection and remained intact after root-end preparation. Twenty-six teeth had partial dentinal defects, and 14 (54%) of these propagated into full dentinal defects after root-end preparation. CONCLUSIONS This periapical microsurgery study showed that ultrasonic root-end preparations are safe to use on intact roots. Preexisting dentinal defects can be propagated by ultrasonic root-end preparations. Through the use of light-emitting diodes, dentinal defects can be detected, special root-end management can be implemented, and more predictable outcomes may be achieved.