A Dental Blog With The Latest Dental News & Dental Technology For Your Dental Practice.
Wednesday, April 25, 2012
Five-Year Longitudinal Assessment of the Prognosis of Apical Microsurgery
I think this is a good study to reference for helping to determine whether to recommend an apicoectomy or extraction. MJ
Journal of Endodontics Volume 38, Issue 5 , Pages 570-579, May 2012
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.
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
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).
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.