To Evaluate and Compare the Effect of Orthograde and Retrograde MTA Root End Filling After Periapical Surgery in Posteriors

To Evaluate and Compare the Effect of Orthograde and Retrograde MTA Root End Filling on Clinical, 2D and 3D Radiographic Success and Quality of Life After Periapical Surgery in Posteriors- A Randomised Control Trial

To evaluate and compare the effect of orthograde and retrograde MTA root end filling on clinical, 2D and 3D radiographic success and quality of life after periapical surgery in posteriors- A Randomised Control Trial

RATIONALE:

Mineral Trioxide Aggregate (MTA) has long been established as a reliable material in retrograde filling techniques, with extensive evidence supporting its biocompatibility and sealing ability. However, the use of MTA as orthograde root end filling has not been explored, leaving a gap in clinical evidence. Retrograde placement allows direct visualization whereas orthograde filling offers a less invasive approach that could potentially reduce patient morbidity and improve comfort. Comparing these two techniques is essential to determine whether orthograde MTA filling can achieve comparable or superior healing outcomes while enhancing patient quality of life. This study aims to systematically assess both approaches, providing evidence-based insights that may guide clinicians toward more effective and patient-friendly treatment strategies.

Aim: To evaluate and compare the effect of orthograde and retrograde MTA root end filling on clinical, 2D and 3D radiographic success and quality of life after periapical surgery in posteriors- A Randomised Control Trial

Primary objective: To evaluate and compare the effect of orthograde root end filling and retrograde root end filling on 2D and 3D radiographic and clinical healing at 1 year follow up

Secondary objective: To evaluate the quality of life after orthograde and retrograde root end filling

Setting: Study will be conducted in Post Graduate Institute of Dental Sciences, Rohtak in the department of Conservative Dentistry & Endodontics.

Study design: A randomized controlled trial

Time frame: 12Months

Inclusion Criteria:

• Patients in which non-surgical retreatment is unfeasible (anatomical complexity, iatrogenic errors) or previously failed treatment in cases of persistent symptomatic apical periodontitis involving posteriors.
• Tooth with a peri-radicular lesion of endodontic origin (chronic apical periodontitis) or endo-perio origin with the size of lesion ≥5mm.
• Teeth with less than 10 degree root curvature.
• Patients between 18-55 years of age.
• No general medical contraindications for oral surgical procedures (ASA-1 according to the classification of the American Society of Anesthesiologists)
• Tooth with adequate final restoration without clinical evidence of coronal leakage.
• Good periodontal health condition at tooth level.
• Able to completely understand and sign an informed consent form.

Exclusion Criteria:

• • Patients with systemic diseases (diabetes mellitus, uncontrolled hypertension grade III, hepatic/renal disease, or systemic bleeding disorders) (Bharathi et al 2021).

  • Patients on anticoagulant/ antiplatelet drugs.
  • Fractured/perforated teeth.
  • Presence of vertical root fracture.
  • Pregnancy.