Five-year longitudinal assessment of the prognosis of apical microsurgery

TY - JOUR

T1 - Five-year longitudinal assessment of the prognosis of apical microsurgery

AU - von Arx, Thomas

AU - Jensen, Simon S

AU - Hänni, Stefan

AU - Friedman, Shimon

N1 - Copyright © 2012 American Association of Endodontists. All rights reserved.

PY - 2012/5

Y1 - 2012/5

N2 - Introduction: Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported. Methods: Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression. Results: At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P <.02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P <.004). Conclusions: This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used.

AB - Introduction: Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported. Methods: Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression. Results: At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P <.02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P <.004). Conclusions: This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used.

KW - Aluminum Compounds/therapeutic use

KW - Alveolar Process/pathology

KW - Apicoectomy/methods

KW - Bisphenol A-Glycidyl Methacrylate/therapeutic use

KW - Calcium Compounds/therapeutic use

KW - Cohort Studies

KW - Dentin-Bonding Agents/therapeutic use

KW - Drug Combinations

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Longitudinal Studies

KW - Male

KW - Microsurgery/methods

KW - Middle Aged

KW - Oxides/therapeutic use

KW - Periapical Periodontitis/surgery

KW - Prognosis

KW - Retrograde Obturation/methods

KW - Root Canal Filling Materials/therapeutic use

KW - Silicates/therapeutic use

KW - Single-Blind Method

KW - Tooth Cervix/pathology

KW - Treatment Outcome

KW - Wound Healing/physiology

U2 - 10.1016/j.joen.2012.02.002

DO - 10.1016/j.joen.2012.02.002

M3 - Journal article

C2 - 22515881

SN - 0099-2399

VL - 38

SP - 570

EP - 579

JO - Journal of Endodontics

JF - Journal of Endodontics

IS - 5

ER -