ĐÁNH GIÁ MỨC ĐỘ ĐAU, SƯNG VÀ QUÁ TRÌNH LÀNH THƯƠNG MÔ MỀM VÙNG PHẪU THUẬT SAU PHẪU THUẬT NỘI NHA SỬ DỤNG KÍNH HIỂN VI PHẪU THUẬT

Abstract

Background: The surgical microscope plays an increasingly important role in modern endodontic surgery due to its ability to provide clear magnified images and focused illumination, enhancing precision in microsurgical procedures such as bone window opening, apicoectomy, sinus creation, and retrograde filling. When combined with ultrasonic instruments and biocompatible retrograde filling materials like Mineral Trioxide Aggregate (MTA), the microscope not only facilitates effective access to the apical region but also helps reduce tissue trauma, thereby minimizing postoperative complications and improving soft tissue healing. Objectives: To evaluate the levels of pain, swelling, and the process of soft tissue healing in the surgical area following endodontic surgery performed with a surgical microscope. Methods: This clinical interventional study without a control group was conducted on a sample of 18 maxillary anterior permanent teeth from 12 patients presenting periapical lesions requiring endodontic surgery. Patients were treated at Ho Chi Minh City Odonto-Stomatology Hospital, from July 2024 to July 2025. Endodontic surgery was performed under surgical microscopy combined with ultrasonic surgical instruments and retrograde filling using MTA. Pain and swelling were measured at 1, 3, and 7 days postoperatively using the Visual Analog Scale (VAS) by Pasqualini D (2005). Soft tissue healing was assessed at 3 days (inflammatory phase), 7 days (proliferative phase), and 30 days (remodeling phase) according to the Inflammatory–Proliferative–Remodeling (IPR) scale by Hamzani Y (2018). Results: The mean pain scores were 0.75 ± 0.62, 0.17 ± 0.39, and 0.00 ± 0.00 at 1, 3, and 7 days respectively, showing statistically significant differences (p = 0.0015). Mean swelling scores were 1.58 ± 0.52, 0.67 ± 0.49, and 0.00 ± 0.00 at 1, 3, and 7 days respectively, with statistically significant differences (p < 0.001). Average soft tissue healing scores were 6.25 ± 0.45 out of 8 points in the inflammatory phase (day 3), 4.42 ± 0.52 out of 5 in the proliferative phase (day 7), and a maximum of 3 points in the remodeling phase (day 30). The total average healing score was 13.67 ± 0.89 out of 16, indicating good healing. Conclusions: Endodontic surgery using a surgical microscope combined with ultrasonic instruments and MTA retrograde filling is an effective treatment method that provides good control of postoperative pain and swelling while actively supporting soft tissue healing. This approach significantly contributes to improved treatment quality and patient quality of life