Radiographic evaluation of periapical healing after obturation of infected root canals: An in vivo study

Aim: To radiographically compare periapical repair of roots with infected root canals obturated in one-step or with calcium hydroxide (Ca(OH)₂) intracanal medication in two steps. Methodology: Standardized preoperative periapical radiographs were taken of 72 roots of vital dogs' teeth. All roots were then aseptically instrumented to ISO size 45. As negative controls, 12 roots were aseptically obturated. The remaining roots were infected with dental plaque and closed. Six weeks later, apical periodontitis was radiographically confirmed in the infected roots. The roots were divided into the following groups: group 1, one-step (n = 24); roots were irrigated with 10 cc saline, obturated, and permanently restored. Group 2, Ca(OH)₂ (n = 24); roots were treated as in group 1, except that after saline irrigation Ca(OH)₂ medicament was placed in the canal 1 week before obturation. Group 3, positive control (n = 12); the roots were irrigated with saline, access permanently closed but canals not obturated. Group 4, negative control (n = 12); previously aseptically obturated roots were permanently restored. After 6 months, standardized postoperative radiographs were obtained. Three independent evaluators blinded to the treatment groups evaluated the preoperative and postoperative radiographs. The evaluators were instructed to rate each root, based on changes on the radiographs, as failed, improved or healed. Results: Radiographically, the percentage of cases that completely healed were similar for the one-step and Ca(OH)₂ groups (35.3% vs. 36.8%). However, the Ca(OH)₂ group had fewer failed cases (15.8% vs. 41.2%) and more improved cases (47.4% vs. 23.5%) than the one-step group. Conclusion: Power statistics demonstrated that at 43 cases per group, Ca(OH)₂ treatment would be statistically superior to one-step treatment. We consider this number to be clinically important.