Selective Curettage and Tissue Adhesive in Endodontic Microsurgery (Microsurgery)

Impact of Selective Curettage and Tissue Adhesive on the Clinical Outcomes of Endodontic Microsurgery: A Randomized Controlled Trial

The goal of this randomized clinical trial is to determine whether selective curettage combined with cyanoacrylate tissue adhesive improves clinical outcomes in endodontic microsurgery compared with the conventional approach. The study purpose is to evaluate the postoperative healing associated with this conservative surgical protocol.

The main questions it aims to answer are:

Does selective curettage with tissue adhesive reduce postoperative pain, swelling, and complications compared to complete curettage with suturing?

How does selective curettage affect clinical and radiographic healing of persistent periapical lesions?

Researchers compared complete lesion curettage with suturing to selective curettage (40-70% lesion removal) with cyanoacrylate tissue adhesive closure to assess differences in healing and patient-related outcomes.

Participants :

Underwent endodontic microsurgery using one of the two surgical protocols Attended follow-up visits at 1, 3, and 7 days for clinical evaluation of pain, swelling ,Discomfort , Bleeding , Local reaction and Wound Dehiscence

Attended follow-up visits at 3, 6, and 12 months for clinical and radiographic evaluation of periapical healing using 2D radiographs and CBCT

Study Overview

• Status: Active, not recruiting
• Conditions: Healing and Patient Related Outcomes
• Intervention / Treatment: Procedure: Complete Periapical Lesion Curettage and Suturing; Procedure: Selective Lesion Curettage and Cyanoacrylate Tissue Adhesive

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Al Mansurah, Egypt
    • Faculty of Dentisrty , Mansoura University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age 18 years and older consenting to the surgical procedure as well as agreeing to preoperative and at least 1 follow-up CBCT evaluation.
2. Noncontributory medical history (American Society of Anesthesiologists class I, II).
3. Teeth with periapical lesions that had been previously treated or retreated but symptoms persist or recurrent.
4. Radiographic presence of true endodontic lesion close to vital critical structure.

Exclusion Criteria:

1. Nonconsenting patients and patients younger than 18 years of age.
2. Medical history with the American Society of Anesthesiologists class III to V.
3. Insufficient coronal restoration.
4. Nonrestorability or traumatized teeth.
5. Mobility > 1.
6. Vertical root fracture.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Complete Periapical Lesion Curettage and Suturing; patients underwent conventional endodontic microsurgery with complete removal of the periapical lesion followed by flap repositioning and closure using sutures.	Procedure: Complete Periapical Lesion Curettage and Suturing; Complete Periapical Lesion Curettage and Suturing is a conventional endodontic microsurgical procedure performed to manage persistent periapical pathology following root canal treatment. After administration of local anesthesia, a full-thickness mucoperiosteal flap is elevated to expose the periapical region. The periapical lesion is completely curetted and removed, followed by apical root-end resection. A retrograde cavity is prepared using ultrasonic tips and sealed with a biocompatible root-end filling material. Hemostasis is achieved, and the surgical flap is repositioned and stabilized using conventional sutures. This approach represents the standard surgical protocol for endodontic microsurgery and serves as the active comparator in this study.
Experimental: Selective Lesion Curettage and Cyanoacrylate Tissue Adhesive; Patients underwent endodontic microsurgery with selective removal of approximately 40-70% of the periapical lesion, followed by flap closure using cyanoacrylate tissue adhesive without sutures.	Procedure: Selective Lesion Curettage and Cyanoacrylate Tissue Adhesive; Selective curettage is a conservative approach to treat periapical lesions by removing part of the granulomatous tissue while avoiding complications and damage to the neighboring structures. It also provides the least traumatic approach with minimal post-operative complications. It had an additional advantage, which is providing tissue samples for biopsy of the lesion, especially in cases where there was a diagnostic dilemma regarding its origin . In the selective curettage technique, approximately 50-70% of the granulomatous tissue was removed while preserving the portion in close proximity to critical areas, followed by standard root-end resection and retrofilling then Clinical and radiographic assessments, including CBCT, for bone healing assesment .

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain intensity is assessed using the Visual Analogue Scale (VAS, 0-10)	(1st, 3rd, and 7th day post-operative)
Swelling	Presence of swelling is assessed clinically by visual inspection and physical examination and recorded as a binary outcome (present / absent)	1st, 3rd, and 7th day post-operative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bleeding	Post-operative bleeding presence is assessed as a binary outcome (Yes / No)	1st, 3rd, and 7th day post-operative
Radiographic Bone healing	Radiographic bone healing is assessed using standardized periapical radiographs (2D) and cone beam computed tomography (CBCT, 3D)	3, 6 , and 12 months

Collaborators and Investigators

• Sponsor: Mansoura University
• Investigators: Principal Investigator: Mohamed A El-dreny, Assis.Lec, Faculty of dentistry , Mansoura university

Publications and helpful links

General Publications

• Nesari R, Kratchman S, Saad M, Kohli MR. Selective Curettage: A Conservative Microsurgical Approach to Treating Large and Complicated Lesions. J Endod. 2020 Nov;46(11):1782-1790. doi: 10.1016/j.joen.2020.07.023. Epub 2020 Jul 29.

Study record dates

Study Major Dates

• Study Start (Actual): December 25, 2024
• Primary Completion (Estimated): January 29, 2026
• Study Completion (Estimated): February 27, 2026

Study Registration Dates

• First Submitted: January 7, 2026
• First Submitted That Met QC Criteria: January 18, 2026
• First Posted (Actual): January 20, 2026

Study Record Updates

• Last Update Posted (Actual): January 20, 2026
• Last Update Submitted That Met QC Criteria: January 18, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Surgical Equipment; Equipment and Supplies; Surgical Fixation Devices; Sutures
• Other Study ID Numbers: A02010024 RC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No