Defense Date
2026
Document Type
Thesis
Degree Name
Master of Science in Dentistry
Department
Dentistry
First Advisor
Garry Myers
Second Advisor
Robert Grover
Third Advisor
Caroline Carrico
Fourth Advisor
Luciano Andrada
Abstract
Objectives: To assess periapical healing of non-surgical root canal treatments and retreatments treated with minimally invasive apical preparation and a standardized laser-assisted irrigation protocol using CBCT with a minimum 6-month follow up.
Methods: Retrospective review of 152 pre-op and 6–14-month post-op CBCT scans of teeth treated by a single endodontist in private practice with non-surgical root canal treatment or retreatment with a minimum apical preparation size of 20/.04 and a standardized Fotona Er:YAG laser-assisted irrigation (LAI) protocol. All CBCT scans were evaluated by a single calibrated observer to assess periapical healing using the validated CBCT-PAI scale. Descriptive statistics were used to describe the variables among patients. Chi-squared test and Kruskal-Wallis test were used to determine the association between healing and pre-treatment diagnosis, and healing and follow-up time, respectively.
Results: One hundred and sixteen patients returned for post-op evaluation at 6-14 months, yielding a recall rate of 76.3%. The mean follow-up time was 9.6 months and mean patient age was 65.4 years old. Loose criteria success (healed or healing) was demonstrated by 91% of roots and 90% of teeth. Strict criteria success (healed) was seen in 59% of roots and 49% of teeth. Pre-treatment pulpal and periapical status was significantly associated with healing—symptomatic irreversible pulpitis, previously treated, and normal apical tissue had significantly higher rates of healing. The median follow-up time for healed cases was 10 months, compared to 9 months for cases that were healing, no change, or uncertain.
Conclusions: In this retrospective cohort of 116 teeth treated with minimally invasive endodontic preparation to a 20/.04 apical size and a standardized LAI protocol, 90% of teeth and 91% of roots achieved a healed-or-healing outcome by CBCT-PAI assessment at a mean of 9.6 months, with a 76.3% patient participation rate. The results suggest that LAI provides adequate disinfection of the root canal system irrespective of apical preparation size, evidenced by the high rate of periapical healing achieved within a short follow up window.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
6-11-2026