Elsevier

Journal of Endodontics

Volume 40, Issue 8, August 2014, Pages 1071-1076
Journal of Endodontics

Clinical Research
Prognostic Factors Relating to the Outcome of Endodontic Microsurgery

https://doi.org/10.1016/j.joen.2014.04.005Get rights and content

Abstract

Introduction

The aim of this retrospective study was to evaluate the outcome of endodontic microsurgery and to examine prognostic factors related to healing.

Methods

The clinical records of all patients who had undergone endodontic microsurgery from 1997–2003 at the National Dental Centre of Singapore were examined. Teeth with a recall period of 1–2 years were selected. All surgical procedures, except for flap raising and suturing, were performed under a surgical operating microscope. Root-end cavities prepared with ultrasonic tips were filled with Intermediate Restorative Material (Caulk, Milford, DE) or mineral trioxide aggregate. Teeth were evaluated for clinical signs and symptoms after surgery. Preoperative and postoperative radiographs were evaluated independently by 2 endodontists.

Results

Of 243 root-end surgeries performed, 93 were eligible for the study. Outcomes were categorized as healed, healing, or persistent disease; 78.5% of teeth were assessed to be healed or healing, and 21.5% had persistent disease. The percentages of healed and healing teeth for anterior and posterior root-end surgeries were 76.5% and 80.4%, respectively, with no significant difference in the procedures (P = .8). Ordinal logistic regression showed a higher likelihood of healing in females compared with males (P = .001) and maxillary anterior teeth compared with mandibular anterior teeth (P = .03). Preoperative probing depths of ≤3 mm were significantly associated with healing (P = .05).

Conclusions

The use of modern endodontic surgical techniques resulted in 78.5% healed and healing teeth with a recall period of 1–2 years. Prognostic factors affecting successful healing include sex, tooth type, and preoperative probing depths.

Section snippets

Case Selection

Clinical records of all patients who had undergone an endodontic microsurgery over a 6-year period (January 1997–December 2003) at the National Dental Centre of Singapore were examined. All teeth had been assessed before surgery by endodontists for adequacy of previous root canal treatment and necessity for endodontic microsurgery. Anterior and posterior permanent teeth with a recall period after surgery of between 1 and 2 years were selected for this study. Teeth with previous root-end

Results

Of the 243 patients who had undergone an endodontic microsurgery during the study period, the following exclusions were made: teeth with vertical root fractures (1.2%), root resorption (1.2%), and perforations (1.6%); teeth with previous apical surgery (15%); and teeth not in the recall period after surgery of 1–2 years (43%).

Finally, 93 teeth (38%) were eligible for the study and subjected to further analysis. A univariate description of patient characteristics and preoperative,

Discussion

The percentage of healed and healing teeth in this study was found to be 78.5% after a recall period of 1–2 years. This percentage is lower than results published in other studies using modern techniques including the use of an SOM; ultrasonic surgical tips; and root-end filling materials such as Super EBA, IRM, or MTA 8, 11. A 1- to 2-year recall period was chosen because previous studies have shown that outcomes at 1 year are highly predictive of future outcomes, and teeth healed at 1 year

Conclusions

The use of modern endodontic surgical techniques and materials resulted in 78.5% healed and healing teeth with a recall period of 1–2 years. Regression analysis showed that females had higher success rates than males. Surgery performed on maxillary anterior teeth had a significantly higher success rate than mandibular anterior teeth. Preoperative probing depths of ≤3 mm were associated with a higher success rate.

Acknowledgments

The authors wish to thank Dr John Allen, Duke-NUS Graduate Medical School Singapore, for his quantitative contribution.

The authors deny any conflicts of interests related to this study.

References (33)

Cited by (33)

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    In previous studies with mineral trioxide aggregate (MTA) as root-end filling materials, the tooth type, periodontal-endodontic combined lesions, and the presence of dehiscence defects have been reported to have a significant impact on the surgical outcome.3,4,7–9 Lui et al.8 reported that maxillary anterior teeth (anteriors) have a significantly higher success rates than mandibular anteriors. Other studies showed that posterior teeth have lower success rates than anteriors.4,9

  • Prognostic Predictors of Endodontic Microsurgery: Radiographic Assessment

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    However, our study showed that there was no significant difference between sexes in both CPR6,7 and CBCT14 evaluation, which is consistent with previous studies.35-39 Regarding tooth-related factors, some studies have shown that maxillary teeth had a higher success rate than mandibular teeth.30,32,40 This may be related to access to the surgical approach, complexity of the root canal anatomy, presence of isthmus, and axis of root canal preparation, amongst other factors.40

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