Comparative Outcome Analysis of Endodontic Microsurgery for Through-and-Through Lesions Using Propensity Score Matching: A Retrospective Cohort Study

Abstract

Introduction Through-and-through (T-T) lesions present unique anatomical challenges in endodontic microsurgery (EMS), often resulting in delayed or incomplete healing. This study aimed to evaluate the clinical outcomes of EMS in T-T lesions, compare them with non-T-T lesions using propensity score matching. Methods This retrospective case-control study reviewed 89 T-T teeth and 294 non-T-T teeth that underwent EMS in anterior regions, excluding those treated with bone grafts. Propensity score matching was performed at a 1:2 ratio (T-T: non–T-T), resulting in 89 T-T and 178 non–T-T matched teeth for cumulative outcome assessment with Kaplan–Meier analysis, and 75 T-T with 150 non–T-T, and 34 T-T with 68 non–T-T matched teeth for the 1- and 3-year evaluations of clinical and radiographic outcomes, respectively. Results The 1-year success rate was 88.0% in the non-T-T group and 77.3% in the T-T group ( P < .05). For 3-year outcomes, the success rates were 97.1% (non-T-T) and 88.2% (T-T), respectively. Lesion type significantly influenced the 1-year outcome, with T-T lesions associated with higher failure rates. No statistically significant difference was identified for 3-year outcomes. The cumulative survival analysis showed no significant differences between the groups. Conclusions EMS appears to be a reliable treatment option for T-T lesions. Although short-term outcomes at 1 year were less favorable than those of the non-T-T lesions, these differences were no longer evident at 3 years. A follow-up period longer than 1 year may be necessary to accurately assess the healing dynamics of T-T lesions. © 2025 American Association of Endodontists.