| Objective:In this experiment,by treating the sinus periapical periodontitis in four different ways,we compared the regression of the sinus and the number of visits and gum tip removal rate and the quality of root exact filling in each group,and observed the difference of the treatment effect for three months to provide clinical basis for the treatment of sinus periapical periodontitis.Methods:80 patients with sinus periapical periodontitis were randomly divided into four groups:group C?n=20?,group G?n=20?and group GW?n=20?.Group C was filled with traditional warm gutta percha,group G was filled with modified warm gutta percha,group CW was treated with traditional warm gutta percha plus extraoral microwave,and group GW was treated with modified warm gutta percha plus extraoral microwave.The following patients are not included in the scope of the experiment:undeveloped root canal orifice,combined periodontal and dental pulp lesions,systemic diseases such as diabetes or mental illness affecting the operator.The patients who were diagnosed as sinus periapical periodontitis by clinical examination and X-ray auxiliary examination at the first visit were opened,pulled out the pulp,dredged the root canal,and then prepared the root canal with M3Promachine Ni-Ti instrument combined with 17%EDTA gel.Before each replacement of the root canal file,rinse alternately with 2%chlorhexidine solution and 0.9%normal saline,dry the root canal,Calcium hydroxide paste is sealed in root canal,and temporarily seal the root canal.CW and GW groups were irradiated with MTC-3 multi-functional microwave operating device?25W?for 15 minutes,and the patients were revisited about a week later.During the revisit,the sinus regression criteria established by Blanscet m L et al.[1]were used to evaluate and record the sinus regression of the four groups.If the sinus subsided or improved and there were no clinical symptoms,Group C:the gutta percha tip consistent with the root canal preparation file was selected as the main tip,adjusted the main tip,X-ray test tip film,and filled with traditional warm gutta percha filling method.Group G:the 04 conical gutta percha tip of the same type as the root canal preparation file was selected as the main tip,the main tip was adjusted,the X-ray test tip was taken and filled with modified warm gutta percha.CW group:the operation is consistent with the C group,the root filling should be supplemented with the extraoral microwave?25W?for 15 minutes;GW group:the operation was the same as that of group G,and the root canal filling was supplemented with extraoral microwave irradiation?25W?for 15 minutes.In the process of root canal filling,the belt rate of the main gutta percha tip of each group was recorded.After the root canal filling was completed,the root canal filling was restored with resin or full crown.The completed root canal filling films were taken in all the four groups,and the proper root canal filling rate was observed and recorded,The next visit is in about three months later.If the sinus does not improve,continue to change dressing,about a week later revisit,wait for sinus regression or improvement and asymptomatic filling.Finally,the regression of sinus,the extraction rate of gutta percha,the proper filling rate of root canal and the clinical symptoms after 3 months of root canal filling were summarized,and the results were statistically analyzed.Results:1.In terms of the regression of sinus tract and the number of visits:the sinus regression rates of traditional warm gutta percha filling method?group C?,modified warm gutta percha filling method?group G?,traditional warm gutta percha filling method+extraoral microwave?CW?,modified warm gutta percha filling method+extraoral microwave?GW?group)were 70%,75%,90%and 95%,respectively.the number of visits was 2.95±0.36,2.75±0.64,2.1±0.42,2.05±0.59respectively.Both the CW group and the GW group were significantly better than the C and G groups in terms of sinus resolution and treatment frequency with statistical significance?P<0.05?,however,there was no statistical significance between the CW and GW groups or between the C and G groups?P>0.05?.2.In terms of the removal rate of gum tip and root canal filling,the gum tip removal rates of the four groups were23.53%,5.6%,22.86%and 2.94%respectively,the accurate filling rate was 73.53%,91.67%,71.42%and 94.12%respectively.Gum tip removal rate in the C and CW groups was higher than that in the G and GW groups,and the root canal exact filling rate was lower than that in the G and GW groups,both of which had statistical significance?P<0.05?,there was no statistical significance between the C and CW groups or between the G and GW groups?P>0.05?.3.In terms of the clinical efficacy after three months,the success rate of the four groups was 90%,100%,95%and 95%respectively,and there was no statistical significance between CW and the four groups?P>0.05?.Conclusion:1?Modified warm gutta percha plus extraoral microwave group and traditional warm gutta percha plus extraoral microwave group are superior to modified warm gutta percha filling group and traditional warm gutta percha filling group in sinus regression and number of visits.2?The modified warm gum filling group and the modified warm gum filling+outer-mouth microwave group showed better performance than the traditional warm gum filling group and the traditional warm gum filling+outer-mouth microwave group in terms of the root canal filling rate and the gum tip removal rate in the root canal filling process.3?In terms of clinical symptoms for three months,there was no significant difference between the four groups in this experiment.In conclusion,the combination of the modified warm gum filling method and the microwave outside the mouth for the treatment of sinus periapical periodontitis not only reduces the intraoperative error rate,but also reduces the number of visits and shortens the treatment time for patients,which can be used clinically. 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