Background   Root canal therapy is the most common and effective method for the treatment of chronic periapical periodontitis in the elderly. However, with more and more extensive application of bisphosphonates, root canal therapy in the treatment of chronic apical periodontitis in the elderly shows its uncertainty, and there are few relevant reports.

  Objective  To evaluate the efficacy of root canal therapy in chronic periapical periodontitis elderly patients with a history of bisphosphonates.

  Methods  From January 2017 to December 2019, 35 elderly patients (age ranged from 60 to 82 years old) with chronic periapical periodontitis and a history of osteoporosis treated with bisphosphonates in Beijing Rehabilitation Hospital of Capital Medical University were selected as BP group. Another 70 elderly patients (age ranged from 60 to 84 years old) with chronic periapical periodontitis who did not use bisphosphonates visited the First Medical Center of Chinese PLA General Hospital were randomly selected as the control group (NC). Root canal therapy was performed, and the healing of periapical lesions was observed at 6 and 12 months after operation.

  Results  PAI score of the two groups decreased significantly after root canal treatment, and the difference was statistically significant (P < 0.01). The success rate at 6 months after root canal treatment was greater than 77% and at 12 months after surgery was greater than 88% in both groups. At 6 months and 12 months after operation, the treatment success rate of BP group was lower than that of NC group, and the PAI score of BP group showed that the recovery of periapical lesion bone destruction was worse than that of NC group, but the difference was not statistically significant.

  Conclusion   The recovery of periapical bone destruction is delayed in patients with the history of bisphosphonates, but the long-term efficacy of endodontic therapy is not affected.