Integrated Endodontic and Oral Surgical Management in Autism Spectrum Disorder: A Clinical and Radiographic Outcome Study

Abstract

Background: Children and adolescents with autism spectrum disorder (ASD) experience a disproportionate burden of dental disease, frequently requiring complex restorative, endodontic, and oral surgical interventions. Behavioural and sensory characteristics of ASD complicate in-office dental care and often necessitate adjunctive techniques such as sensory adaptation, sedation, or general anaesthesia, yet integrated outcome data on combined endodontic and surgical management remain limited.

Objective: To evaluate the clinical and radiographic outcomes of integrated non-surgical endodontic and oral surgical treatment in patients with ASD compared with neurotypical controls, and to assess associated treatment characteristics, complications, and tooth survival.

Methods: A prospective comparative clinical and radiographic study was conducted on 60 patients (30 with confirmed ASD diagnosis as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and 30 age- and sex-matched neurotypical controls) aged 6 to 18 years presenting with pulpal pathology and/or indication for surgical extraction. Treatment was performed using a tiered behavioural-pharmacological protocol involving sensory-adapted dental environment, conscious sedation, or general anaesthesia, as required. Pre- and postoperative periapical radiographs were scored using the Periapical Index (PAI). Patients were reviewed at 6 and 12 months for clinical signs, radiographic healing, tooth survival, and complications.

Results: Endodontic success was achieved in 89.5% of teeth in the ASD group compared with 93.5% in controls (p > 0.05). Tooth survival at 12 months was 96.6% in the ASD group and 98.4% in controls. Surgical extraction sites healed uneventfully in 90.5% of ASD patients. Postoperative behavioural disturbances were reported in 13.3% of ASD patients but in none of the controls. General anaesthesia was used in 80% of ASD treatments versus 13.3% of controls.

Conclusion: Integrated endodontic and oral surgical management is feasible and produces clinical and radiographic outcomes in ASD patients comparable to those in neurotypical peers when delivered through a structured, behaviourally adapted protocol. Postoperative behavioural disturbances and the high reliance on general anaesthesia warrant pre-treatment counselling and individualised care pathways