Outcome assessment of apical surgery: A study of 234 teeth.

BACKGROUND/PURPOSE: Apical surgery is an option for management of endodontically-treated tooth with persistent periapical lesions or symptom and sign. The objective of this study was to investigate the correlation between the demography, preoperative, postoperative factors and healed rate of apical surgery. METHODS: Subjects were retrospectively collected from patients who received apical surgery/apicoectomy at the Endodontic Department, National Taiwan University Hospital from January 2013 to June 2015. The standard apical surgery procedures were performed. The demography, preoperative clinical and radiographic examination data as well as postoperative variables were collected. The outcome assessment was carried out after surgery. Statistical analysis was performed by chi square test to evaluate the potential outcome predictors. RESULTS: Total 187 patients and 234 teeth receiving apical surgery were included. 53 male and 134 female patients were collected. The age was ranged between 17 and 89 years old and the mean age was 43.64 years old. Better healed rate with significant differences were observed in female patient (p < 0.05), age ≤60 years old (p < 0.01), preoperative root canal filling material >2 mm short of apex (p < 0.01), lesion size from ≤2 mm to ≤12 mm (p < 0.05) and follow-up period â‰§12 months (p < 0.01) groups. CONCLUSION: Gender, age, preoperative root canal filling material extent, lesion size and follow-up period may affect the outcome of apical surgery. Tooth type, post, prosthesis, and lesion area showed no marked effect on apical healing. These results provide more detailed information for the clinical practitioners to make treatment plans and are important for clinical endodontic practices.

Factors that cause endodontic failures in general practices in Japan.

BACKGROUND: Bacterial biofilms that develop on root surfaces outside apical foramens have been found to be associated with refractory periapical periodontitis. However, several other factors cause endodontic failures apart from extraradicular biofilms. The aim of this study was to identify the factors causing endodontic failures in general practices in Japan. METHODS: Patients diagnosed as having refractory periapical periodontitis by general practitioners and who requested endodontic treatment at Osaka University Dental Hospital were selected by checking medical records from April 2009 to March 2013. Factors causing endodontic failures were identified. RESULTS: A total of 103 teeth were selected, and 76 teeth completed root-canal treatment. Tooth extractions were required for 18 teeth after or without endodontic treatment. Six teeth required apicoectomy after endodontic treatment. One tooth needed hemisection. One tooth needed intentional replantation. One tooth needed adhesion and replantation. The main causes of treatment failure were open apices (24 teeth), perforation (18 teeth), and root fracture (13 teeth). In six teeth with open apices that required apicoectomy or extraction, extraradicular biofilms may have been related to endodontic failure. CONCLUSIONS: Most endodontic cases diagnosed with refractory periapical periodontitis by general practitioners were compromised by any other factors rather than extraradicular biofilms.

Reasons for Apical Surgery Treatment in an Underserved New York City Population.

Endodontic retreatment often involves remaking restorations. The total cost may steer the treatment towards surgery. The aim of this study was to retrospectively record the reasons for performing apical surgery in an economically deprived patient population. The clinical reasons (59%) for apical surgery were most common, but the nonclinical (financial) reasons (41%) emerged as a major cause. The finding that 41% of the apicoectomies were performed because of nonclinical constraints is a high figure and may not reflect the situation generally. Still, economic factors potentially play a major role in the selection of surgical versus nonsurgical endodontic retreatment.

A survey of endodontic practices among dentists in Nigeria.

AIM: To investigate the pattern of routine endodontic practices among Nigerian dentists. MATERIALS AND METHODS: This study was a questionnaire-based survey of samples of dentists in the Nigerian cities of Enugu and Benin. The self-administered questionnaire contained 25 close-ended questions with multiple choice options. The data collected included demographic details of respondents, root canal preparation techniques, irrigants and intracanal medicaments used, the number of appointments, method of working length determination, root filling techniques, cements used, and the scope of treatment performed. RESULTS: Most respondents used sodium hypochlorite as the irrigant, the step back technique for canal preparation, and lateral condensation with a zinc oxide-eugenol-based sealer for obturation. Most respondents did root canal treatment on all types of teeth and used radiographs to determine the working length 70% of the time. Most respondents followed up their patients for less than 12 months and most treated teeth with periapical areas larger than 10 mm by root canal therapy combined with apical surgery. CONCLUSION: Most Nigerian dentists use step back technique for canal preparation and lateral condensation for obturation. CLINICAL SIGNIFICANCE: Endodontic practice by Nigerian dentists differs from some established practice quality guidelines in many other countries, particularly in nonperfusion of modern techniques into practice, popularity of antibiotic use for endodontic emergencies and a high rate of perforations.

Root-end resection.

AIM: The aim of the retrospective clinical study was to analyse a complex of patients who underwent a root end resection in the Department of Dentistry and Maxillofacial Surgery, Comenius University, St. Elisabeth Hospital, Bratislava, Slovakia between January 2006 and December 2009 on the small surgery court. PATIENTS: A total number of 285 patients who underwent root end resection. METHODS: Factors examined include sex, patients age structure, total number of resected teeth and their position in upper or lower jaw and the 10 most resected teeth. RESULTS: From 285 patients 103 (36.14 %) were males and 182 (63.86 %) were females. A total number of 378 root end resections was performed, 55 (14.55 %) in the lower jaw and 323 (85.45 %) in the upper jaw. The most resected teeth are from the first and second quadrant. CONCLUSION: There is a decrease trend by the number of patients who underwent root end resection and teeth which were resected in the timeline between 2006-2009. This process is positive and matches the worldwide trend, by making better and successfull endodontic treatment which results in healing of periapical pathology without the need of root end resection (Tab. 2, Fig. 2, Ref. 20). Full Text in PDF www.elis.sk.

An epidemiologic study of tooth retention after nonsurgical endodontic treatment in a large population in Taiwan.

In this study, tooth retention and untoward events were assessed over a 5-year follow-up period for 1,557,547 teeth receiving nonsurgical root canal treatment (NSRCT) in Taiwan in 1998. We found that 1,446,199 (92.9%) of teeth receiving NSRCT were retained in the oral cavity 5 years after treatment and that a total of 111,348 (7.1%) of the studied teeth were extracted. Untoward events occurred in 159,680 (10.3%) teeth during the 5-year follow-up period. Of this small subpopulation, nonsurgical retreatment was performed for 50,587 teeth (31.7%), apical surgery was performed on 4,502 (2.8%) teeth, and extractions were performed on 104,591 (65.5%) teeth. Approximately 40% of the nonsurgical retreatments and 81% of the apical surgeries occurred in the first follow-up year. However, the yearly incidence of tooth extractions was nearly even within the 5-year study period. We conclude that NSRCT is a valuable dental procedure because of the high rate (92.9%) of tooth retention 5 years after NSRCTs in Taiwan.

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.

Case selection for apical surgery: a retrospective evaluation of associated factors and rational.

Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.

Analysis of a referral-based endodontic practice: Part 2. Treatment provided.

Little information exists in the dental literature regarding the range of treatment provided by specialist endodontists. This study was undertaken to analyze the range and incidence of treatment procedures performed on 2000 patients referred to a specialist endodontist in Perth, Western Australia. There were 312 people that did not require endodontic treatment, resulting in 1688 patients having treatment on 2221 teeth. Routine treatment without complications was provided to 313 teeth (14%) while a total of 451 teeth (20.3%) had calcified or blocked canals. Endodontic retreatment was necessary in 815 teeth (36.7%), 210 teeth (9.4%) had posts removed, and 236 (10.6%) had endodontic surgery. Perforations were present in 119 teeth (5.4%) and these were treated either conservatively (81 teeth, 3.6%) or with surgery (38 teeth, 1.7%). Dental trauma was the reason for referral of 258 patients who required treatment on 217 teeth (9.8%). The wide range of treatment procedures required indicates that endodontists must be highly skilled in all aspects of the discipline.

Treatment outcome in endodontics-The Toronto Study. Phases I and II: apical surgery.

This study prospectively assessed the 4 to 8 yr outcome of apical surgery performed by graduate students in phases I and II of the Toronto Study. The study cohort included 155 teeth in 138 patients. Outcome was assessed by a blinded and calibrated examiner. Clinical and radiographic measures were used for a dichotomous outcome: healed (no signs and symptoms, Periapical Index score /= 3). The recall rate was 85% and the overall healed rate 74%. Healed rate was significantly higher for teeth with small (

Long-term, postsurgical results on teeth with periapical radiolucencies.

Reported high failure rates of endodontic surgical procedures seemed to be inconsistent with the clinical impression of a high success rate. A retrospective study of endodontic surgical cases treated longer than 10 yr ago was done to look at long-term results. Forty-one teeth in 39 patients were able to be evaluated. These teeth had either an apicoectomy, an apicoectomy with a root-end amalgam, or in two cases, a root amputation. Of the 23 teeth that had an apicoectomy, 19 (82.6%) completely healed. Of the 16 teeth that had an apicoectomy followed by a root-end amalgam, 10 (62.5%) completely healed. Surgical endodontic procedures performed before the use of magnification, newer root-end filling materials, and ultrasonics, still had a high rate of success.

Nonsurgical root canal therapy treatment with apparent indications for root-end surgery.

The recent introduction of the surgical microscope to the practice of endodontics, especially for surgery, has allowed clearer visualization of the periapex during root-end resection and filling. However, despite this and other technologic advances, it has not been demonstrated that in the absence of thorough canal debridement the success rate of periapical surgery has improved over the 50% to 60% demonstrated in most long-term prognosis studies. Therefore it remains important to fully instrument and obturate the root canal system with conventional therapy before surgery is considered; this considerably improves the long-term prognosis. Each of the case reports in this article involves a situation in which conventional treatment was performed when a surgical approach might have been considered as the treatment of choice. Surgery should not be considered to be the primary treatment when root canal treatment or retreatment may be readily achieved. Indeed, the operating microscope and other technical aids will probably allow more cases to be treated and retreated conventionally that might otherwise have required surgical intervention.

Survival rates of hemisected teeth: an attempt to compare them with survival rates of alloplastic implants.

Use of hemisection in an attempt to preserve multirooted teeth that have furcation involvement has increased in recent years. However, there are few long-term studies of the success of this treatment. Furthermore, it is difficult to compare results of different studies because of differences in the length of follow-up and the criteria for failure. Results of various studies were reduced to a common denominator to allow comparison. The compiled results of studies on hemisection revealed an average reported failure rate of 13.1%. This rate was compared with results of studies on implants; the failure rates of the two treatment alternatives are not substantially different. Thus, because hemisection is a relatively simple, inexpensive treatment with a good chance of success (given appropriate case selection), it should always be considered as an option before molar extraction.

The provision of oral surgery services in England and Wales 1984-1991.

Data from the Department of Health and the Dental Practice Board demonstrate substantial increases in the volume of oral surgery performed in England and Wales both in the General Dental and Hospital Services during the period 1984-1991. In the General Dental Service, although the number of routine extractions decreased by 10%, the number of surgical procedures increased by 20%, with a substantial increase (33%) in the number of third molar extractions in the period 1988-1991. There have been no decreases in the annual rate of extractions of permanent and deciduous teeth in the GDS since 1987. In at least one Regional Health Authority, there was a five-fold increase in the number of oral surgery patients aged 0-9 years treated in the hospital service (1982-1991). Overall, although this study takes no account of extractions carried out in the Community Service, these findings suggest that numbers of deciduous extractions may have actually risen in some areas, particularly after 1987. In the Hospital Service there was a 55% increase in numbers of day-cases, from 30,090 (1984) to 46,499 (1990); a 10% increase in throughput of in-patients and a 13% decrease in numbers of people waiting for in-patient surgery. These changes were in the same direction as those in plastic and ENT surgery; though plastic surgery achieved a greater utilisation of day-care services. The implications of these changes and their possible effect on the future provision of oral and maxillofacial surgery services are discussed.

Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.

AIM: To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. DESIGN: Multicentre, prospective study. SETTING: The departments of oral and maxillo-facial surgery in two district general hospitals. METHOD: One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. RESULTS: Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy. CONCLUSIONS: Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.

Root canal treatment in the General Dental Service 1948-1987.

Endodontic treatment has been available under NHS Regulations since its inception in 1948, and details of the incidence of treatment carried out is available from the Dental Estimates Board, Eastbourne. These records are analysed to show that, among other trends, the amount of root canal treatment provided has increased to a peak in 1984, with highest incidence in the 21-30 age group, and in single rooted anterior teeth.

Minor oral surgery 'specialisation' in general dental practice.

A practitioner with 4 years' hospital oral surgery experience undertook minor oral surgery procedures within a general dental practice over a 4-year period. The variety of work completed is shown. The National Health Service fees for the procedures indicate that a practice limited to minor oral surgery is both practically and financially viable when referral fees and x-rays are included. Differences in the types of procedure undertaken by visiting 'specialist' practitioners and 'specialist' practices is highlighted. A population of 310,000 is suggested for a 'specialist' practice in minor oral surgery to be feasible.

Trends in oral surgery in England and Wales 1991-2000.

OBJECTIVE: To investigate trends in oral surgery in England and Wales 1991-2000. METHODS: Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics. RESULTS: There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period. CONCLUSIONS: The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.

Routine follow-up after periradicular operations: current practice in UK hospitals.

Questionnaires were circulated to all Fellows of the British Society of Oral and Maxillofacial Surgeons in 1999, 75% of whom replied (n = 194). There was a wide range of responses for both the timing of review appointments and the taking of radiographs. Most patients were first followed up 1 week after operation (46%), but 38% were reviewed in the second week. Five surgeons did not review patients at all and two did not review until 6 or 9 months, respectively. Nearly two-thirds routinely offered a second follow-up appointment but only 14% offered more than two, the maximum being seven. Most arranged postoperative radio-graphs but the timing ranged from immediately postoperatively to 1 year after the procedure. Less than one-third requested a second postoperative radiograph between 1 month and 1 year. The largest disparity was in the time of discharge to the general dental practitioner, which ranged from immediately to 5 years, the most popular time of discharge being at 3 months. The wide variations may reflect unnecessary recall of patients and misuse of valuable clinical time.

Follow-up study of apicectomised anterior teeth.

A retrospective study was carried out on anterior teeth which had undergone apicectomy between 1995 and 1997. More maxillary teeth were treated (94.7%) than mandibular teeth (5.3%). Radicular cyst was the most frequently diagnosed reason for the treatment (47.3%), followed by chronic apical infection/granuloma (44.0%). The overall success rate was 71.9%, while treatment outcome was doubtful in 14.0% of the apicectomised teeth. The presence of pre- or postoperative signs and symptoms did not have any statistically significant effect on the treatment outcome. A higher percentage of roots with retrograde amalgam fillings healed successfully than roots with orthograde fillings, but the difference was not statistically significant (P > 0.05). More lesions classified histopathologically as radicular cysts healed successfully than those classified as granulomas (Fisher exact test, 2-tailed P value = 1.0).