Abstract
Abstract Objective To evaluate the clinical and radiographic efficacy of Vitapex paste in the treatment of periapical lesions and to analyze the influence of lesion type and lesion size on treatment outcomes. Methods Data from 428 patients with refractory apical periodontitis who received Vitapex treatment at the Stomatological Hospital in Fujian Province between January 2024 and March 2026 were retrospectively analyzed. A self-controlled pre-post design was employed, and standardized radiographic criteria (PAI, lesion area, bone healing) were combined with patient-reported outcomes (VAS pain scores) to comprehensively assess efficacy. Follow-up ranged from 1 to 9 months. Results The overall treatment success rate was 92.5% (396/428). Lesion types included periapical abscess (n = 400, 93.5%), radicular cyst (n = 24, 5.6%), and other types (n = 4, 0.9%). The success rate for periapical abscesses was 98.5% (394/400), whereas that for radicular cysts was only 8.3% (2/24). Lesion area significantly decreased after treatment (from 27.37 ± 12.14 to 2.48 ± 8.88 mm2, P 100 mm2). Lesion size was significantly negatively correlated with lesion reduction rate (r = -0.424, P < 0.001) and PAI improvement (r = -0.095, P = 0.049). Conclusion Vitapex demonstrated high efficacy for periapical abscesses (98.5%) but limited effectiveness for radicular cysts (8.3%) with lesion type and size identified as critical predictors of treatment outcome. Its dual antimicrobial and tissue-reactive properties suggest that Vitapex may serve not only as a conservative intracanal medicament but also as a biologically active adjunct in bone healing, particularly for abscesses in clinical settings where surgical options are limited.