Assessment of Simultaneous Surgery for Odontogenic Sinusitis: Endoscopic Sinus Surgery With Endoscopic Apicoectomy.

Odontogenic sinusitis (OS) is a disease commonly encountered by otolaryngologists and oral surgeons. There is currently no standard consensus for the management of the causative teeth of OS, and the therapeutic outcomes of endodontic surgery remain unclear. The authors herein report the outcomes of simultaneous surgery for OS, endoscopic sinus surgery (ESS) with endoscopic apicoectomy. Twenty-one OS patients who underwent ESS were included in the intent-to-treat population. Eleven patients who simultaneously underwent endoscopic apicoectomy were included as the study group, and another 10 patients who were subjected to the extraction of the causative teeth preceding or during surgery were included as the control group. The postoperative tooth course after surgery in the study group was assessed as the primary outcome by periodic radiographs. The postoperative sinus course was compared between the 2 groups as the secondary outcome. Seventeen teeth were subjected to endoscopic apicoectomy concurrently with ESS, and the treatment success rate for periapical lesions was 94.1% (16 out of 17 teeth), which was consistent with previously reported outcomes for endodontic microsurgery. Ten of 11 patients (90.9%) had good postoperative sinus courses, and the mean wound-healing period of the sinus mucosa was 6.9 ±â€Š3.5 weeks. These results were not significantly different from those obtained for the control group (90% and 6.1 ±â€Š3.2 weeks). This surgical procedure may contribute to the preservation of causative teeth without having an impact on the successful treatment of sinusitis. A comprehensive surgical approach by otolaryngologists and oral surgeons is desirable for the treatment of OS.

The resection angle in apical surgery: a CBCT assessment.

OBJECTIVES: The primary objective of the present radiographic study was to analyse the resection angle in apical surgery and its correlation with treatment outcome, type of treated tooth, surgical depth and level of root-end filling. MATERIALS AND METHODS: In the context of a prospective clinical study, cone beam computed tomography (CBCT) scans were taken before and 1 year after apical surgery to measure the angle of the resection plane relative to the longitudinal axis of the root. Further, the surgical depth (distance from the buccal cortex to the most lingual/palatal point of the resection plane) as well as the level of the root-end filling relative to the most coronal point of the cut root face was determined. Treated teeth were categorized into four groups (maxillary and mandibular anterior and posterior teeth). The final material comprised 62 treated roots in 55 teeth. RESULTS: The mean calculated resection angle of all roots was 17.7° ± 11.4° (range -9.6° to 43.4°). Anterior maxillary roots presented the highest mean angle (25.8° ± 10.3°) that was significantly different from the mean angle in posterior maxillary roots (10.7° ± 9.4°; p < 0.001) and from the mean angle in posterior mandibular roots (15.1 ± 9.8°; p < 0.05). In roots with a shallow resection angle (≤20°), the rate of healed cases was higher than in roots with an acute resection angle (>20°), however without reaching statistical significance (p = 0.0905). Angles did not correlate either with the surgical depth or with the retrofilling length. CONCLUSIONS: Statistically significant differences were observed comparing resection angles of different tooth groups. However, the angle had no significant effect on treatment outcome. CLINICAL RELEVANCE: Contrary to common belief, the resection angle in maxillary anterior teeth was greater than in the other teeth. The surgeon is advised to pay attention to the resection angle when bevelling maxillary anterior teeth in apical surgery.

Three-year outcomes of apicectomy (apicoectomy): Mining an insurance database.

OBJECTIVES: The outcome of apicectomy in clinical reality is supposed to be different compared to outcomes reported from clinical trials. The objective of this study was to measure the outcome of apicectomies under practice conditions by mining an insurance data base. METHODS: This retrospective study was based on claims data of a major German national health insurance company (BARMER GEK). Through the company's data warehouse fee codes and treatment dates were accessible and allowed the tracing of clinical courses. Kaplan-Meier survival analyses for the target event 'extraction' were conducted for all teeth that underwent apicectomies within a 3 year period. Testing for differences among survival rates across groups was performed with the Log-Rank-test. RESULTS: A total of 93,797 teeth in 77,636 patients could be traced after apicectomy. The cumulative 3-year survival rate was 81.6%. Anterior teeth showed a significantly higher survival rate of 84.0% compared to premolars (80.4%) and molars (80.2%). The survival rate in men (83.5%) was significantly higher than in women (80.6%). Analysis of survival by age revealed continuously declining survival rates with age (93.3% for subjects under 18 years of age to 75.6% for subjects over 84 years of age). CONCLUSIONS: The 3-year outcomes of apicectomy were still acceptable for an intervention that is mostly conducted as a retreatment after failure of a preceding measure. However at a population level, the question remains to be answered whether other treatment options would potentially be more effective.

Assessment of root surfaces of apicected teeth: a scanning electron microscopy evaluation.

OBJECTIVES: The aim of this study was to determine the apical surface characteristics and presence of dental cracks in single-rooted premolars, resected 3.0 mm from the root apex, using the Er: YAG laser, tungsten carbide bur, and diamond-coated tip, by scanning electron microscopy (SEM). EXPERIMENTAL DESIGN: Thirty single-rooted premolar teeth were collected. The instrumented and obturated teeth were divided into three groups according to the root resection method (2.94 µm, 100 mj, 20-Hz Er: YAG laser, plain tapered fissure tungsten carbide bur at a low speed of 40,000 rpm, or a diamond-coated SG6D tip coupled to the handpiece of a conventional ultrasound device). The specimens were prepared for SEM and analyzed by the Kruskal-Wallis and Mann-Whitney statistical tests. RESULTS: The SEM images showed that tungsten carbide burs produced significantly smoother resected root surfaces than the diamond-coated tip. There was no statistically significant difference between the Er: YAG and tungsten carbide bur groups. The analysis of scores obtained for the cut quality by the Kruskal-Wallis test revealed no significant differences among the groups. In our study, five teeth had no cracks after the apical resection. The mean number of cracks per tooth was 3.5 ± 1.780 (Er: YAG laser group), 2.5 ± 1.716 (tungsten carbide bur group), and 4.5 ± 2.593 (diamond-coated tip group). CONCLUSIONS: Under the tested conditions smoother surfaces were observed in the groups treated with the tungsten carbide bur and Er: YAG laser when compared with the diamond-coated tips.

Assessment of marginal adaptation after apicoectomy and apical sealing with Nd:YAG laser.

OBJECTIVE: Recurrent periapical disease poses a substantial challenge to the dental practitioner. However, the use of novel methods and materials in periapical surgery has increased the success rates of treatment. The objective of this study was to assess the effects of mineral trioxide aggregate (MTA) retrofilling and apical sealing with Nd:YAG laser (at 10 Hz, 150 mJ, 1.5 W, in 60 sec pulses) as adjuncts to apicoectomy. METHODS: Perpendicular root end resection was performed with diamond-coated burs on 40 canine teeth previously subjected to endodontic treatment. Teeth were randomly allocated into four groups: group A, apicoectomy alone; group B, apicoectomy+Nd:YAG laser; group C, apicoectomy+MTA retrofilling; group D, apicoectomy+MTA retrofilling+Nd:YAG laser. Specimens were embedded in epoxy resin and sliced lengthwise and crosswise. RESULTS: Scanning electron microscopy (SEM) analysis showed more homogeneous and canaliculi-free apical surfaces in groups B and D (p<0.01). Marginal gaps between the dentin surface and filling material were observed in decreasing order of gap size in groups B, A, D, and C (p<0.01) for cross-sectional analysis. Energy-dispersive X-ray spectrometry (EDS) revealed greater phosphorus (p<0.01) and lower calcium (p<0.01) ion content in the Nd:YAG-irradiated groups. CONCLUSIONS: In this study, Nd:YAG laser irradiation had a positive effect on dentin surface sealing, despite an untoward dimensional effect when associated with MTA retrofilling.

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

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.

Morphological assessment of dentine and cementum following apicectomy with Zekrya burs and Er:YAG laser associated with direct and indirect Nd:YAG laser irradiation.

OBJECTIVES: This study aimed to assess the apical surface morphology of maxillary central incisors resected 3.0 mm from the tooth apex using Zekrya burs or Er:YAG laser, with or without subsequent direct Nd:YAG laser irradiation (apical and buccal surfaces) and indirect irradiation (palatal surface). STUDY DESIGN: Forty maxillary central incisors were instrumented and obturated. The roots were divided into 4 groups according to the root resection method (Zekrya bur or Er:YAG laser - 1.8 W, 450 mJ, 4 Hz, 113 J/cm(2)) and further surface treatment (none or Nd:YAG laser - 2.0 W, 100 mJ, 20 Hz, 124 J/cm(2)). The teeth were prepared for SEM analysis. Scores ranging from 1 to 4 were attributed to cut quality and morphological changes. The data were analyzed by the Kruskal-Wallis test and by Dunn's test. RESULTS: SEM images showed irregular surfaces on the apical portions resected with Zekrya burs, with smear layer and grooves in the resected dentine and slight gutta-percha displacement and plasticization. On the other hand, apicectomies carried out with Er:YAG laser showed morphological changes compatible with ablated dentine, with rough surfaces and craters. In spite of the presence of plasticized gutta-percha, with the presence of bubbles, an irregular adaptation of the filling material to the root walls was also observed. Direct Nd:YAG laser irradiation of the apical and buccal surfaces of the resected roots resulted in areas of resolidification and fusion in the dentine and cementum, with a vitrified aspect; indirect Nd:YAG laser irradiation of the palatal surfaces yielded a lower number of changes in the cementum, with irregular resolidification areas. CONCLUSIONS: There were no differences in terms of cut quality between the use of burs and Er:YAG laser or between the 2 surfaces (apical and buccal) treated with Nd:YAG laser with direct irradiation. However, morphological changes were significantly less frequent on surfaces submitted to indirect irradiation (palatal) when compared with those directly irradiated.

Tissue response following CO2 laser application in apical surgery: light microscopic assessment in dogs.

The potential advantages of CO2 laser in apical surgery have not been established histologically. Therefore, the long-term effects of CO2 laser on the apical and periapical tissues were examined histologically in dogs 6 months after apical surgery. Lased specimens and unlased controls showed periapical inflammatory and osteogenic reactions. Lased root surfaces revealed craters with a superficial charred layer closely associated with new cementum-like matrix. The subjacent dentin appeared tubule-free and eosinophilic. Lased bone trabeculae showed a charred layer with a deeper osteocyte-free zone. The charred layer was covered by new bone. Detached charred segments in the marrow space and periapical inflammatory infiltrate were intimately associated with multinucleated giant cells, some containing minute char particles. Such cells were absent from the root and trabecular char linings. In addition, the charred surfaces were free of hard tissue resorption. These results suggest that CO2 laser does not hinder healing when applied in apical surgery.