Signos y síntomas clínicos predictores de cicatrización apical 12 meses después de microcirugía endodóntica / Apical Healing predicting Clinical Signs and Symptoms 12 Months after Endodontic Microsurgery
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RESUMEN. Objetivo: Analizar la presencia de dolor espontáneo/dolor a la percusión pre y posquirúrgicos, como predictores de la cicatrización periapical 12 meses después de microcirugía endodóntica (ME). Métodos: Se trató de un estudio observacional prospectivo en pacientes del Posgrado de Endodoncia de la Universidad Nacional de Colombia quienes fueron sometidos a ME. La muestra consistió en 61 dientes en 54 pacientes. Se compararon tomografías de tejido periapical pre y posquirúrgico, por medio de tres categorías de cicatrización (mejoría, en proceso y fracaso), en relación con los signos y síntomas clínicos pre y posquirúrgicos. Las variables analizadas fueron: categorías del índice periapical CBCT-PAI, perímetro axial y evidencia de dolor espontáneo/dolor a la percusión antes y después del tratamiento. Se construyó un modelo de regresión politómico para el análisis de los datos. Resultados: La prueba F (p>0,05) se usó para determinar la inexistencia de variabilidad intraexaminador. 70,49 % de los dientes se clasificaron como exitosos (mejoría), 13,11 % en proceso y 16,39 % fracaso. Se determinó mayor cicatrización para el rango edad < 45 años y para el sexo femenino (99 % de confianza). La interacción dolor a la percusión/tiempo posquirúrgico mostró alta significancia (p= 0,002) para clasificar dientes en las categorías fracaso y mejoría. Conclusiones: La presencia o ausencia de dolor posquirúrgico es un indicativo probable de cicatrización y permite clasificar el diente hacia el éxito o fracaso. La categoría “en proceso” no presentó asociación con el dolor a la percusión; sin embargo, podría definir a futuro el resultado de una ME.
ABSTRACT.
Purpose: To analyze spontaneous and percussion pain, as predictors of periapical healing, before and 12 months after endodontic microsurgery (EM). Methods: This was an observational prospective study in patients from the postdoctoral clinic in endodontics at the National University of Colombia who underwent EM. The sample consisted of 61 teeth of 54 patients. The size of apical lesions was compared using dental tomography. The healing process was classified as improvement, in-process, and failure, which were associated with the pre- and post-surgery clinical signs and symptoms. Variables were analyzed through periapical index CBCT-PAI categories, axial perimeter, and presence/absence of spontaneous/percussion pain before and after treatment. A polytomous regression model was developed to analyze data. Results: The absence of intra-examiner variability was determined though F-test (p>0.05). 70.49 % of teeth were classified as "improvement” (successful), 13.11 % as in-process, and 16.39 % as failure. Healing was higher among people younger than 45 years of age and females (99 % confidence). Association between percussion pain and post-surgical time was significant (p = 0.002) to classify teeth as failure and improvement. Conclusions: The presence or absence of post-surgical pain is likely indicative of healing allowing classifying teeth as success or failure. The in-process category did not show association with percussion pain; however, it could predict the result of EM.
apicectomía, diagnostico técnicas y procedimientos, endodoncia, microcirugía, pronóstico, regeneración ósea, signos y síntomas
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