A retrospective study of periapical microsurgery outcome

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Tita Polpalangkul
Supachai Sutimuntanakul
Jeeeraphat Jantarat



Objectives: To evaluate treatment outcomes and prognostic factors on the success of periapical microsurgery.

Materials and Methods: Patients who were treated with periapical microsurgery at Endodontic Clinic of Dental Hospital and Endodontic Clinic of Golden Jubilee Medical Center, Faculty of Dentistry, Mahidol University, Thailand, from January 2005 to December 2015, were recruited. The outcomes were assessed clinically and radiographically with a recall period of at least one year after the endodontic microsurgery. All radiographic images were scanned and analysed using Image J software, to measure sizes of periapical radiolucency. Modified Friedman’s criteria was employed to classify the outcome as healed, healing, or disease. Pre-operative, intra-operative, and post-operative factors were taken into consideration, and analysed using logistic regression in order to identify any significant factors.

Results: Of all 175 teeth in 154 patients, one-hundred and twenty-nine teeth were recruited.  The recall rate was 83.7%(108 teeth) with a mean recall period of 30.8 months(ranging from 12 to 108 months). The outcomes were 86 teeth healed (79.6%), 20 teeth healing (18.5%) and2 teeth diseased (1.9%). Multivariate logistic regression analysis showed that quality of the pre-operative root canal filling was a significant prognostic factor (P<0.05). Teeth with inadequate root canal fillings had six times higher chance of ‘disease’ than teeth with adequate quality fillings.

Conclusion: The healed rate in this study was 79.6%. Inadequate quality of pre-operative root canal filling was the significant negative prognostic factor of the outcomes.

Keywords:endodontic microsurgery, prognostic factors, retrospective study, root-end filling, success and failure, treatment outcome.



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Polpalangkul T, Sutimuntanakul S, Jantarat J. A retrospective study of periapical microsurgery outcome. M Dent J [Internet]. 2019 Dec. 26 [cited 2023 Nov. 29];39(3):231-4. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/205358
Original articles


Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006; 32: 601-23.

Jesslen P, Zetterqvist L, Heimdahl A. Long-term results of amalgam versus glass ionomer cement as apical sealant after apicoectomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79: 101-3.

Augusr DS. Long-term, postsurgical results on teeth with periapical radiolucencies, J Endod 1996; 22: 380-3.

Schwartz-AradD, Yarom N, Lusting JP, Kaffe I. A retrospective radiographic study of root-end surgery with amalgam and intermediate restorative material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 472-7.

Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature-part 1: Comparison of traditional root-end surgery and endodontic microsurgery. J Endod 2010; 36: 1757-65.

Wang N, Knight K, Dao T, Friedman S. Treatment outcome in endodontics-The Toronto Study. Phases I and II: apical surgery. J Endod. 2004; 30: 751-61.

Barone C, Dao TT, Basrani BB, Wang N, Friedman S. Treatment outcome in endodontics: the Toronto study--phases 3, 4, and 5: apical surgery. J Endod 2010; 36: 28-35.

Sutimuntanakul S, Jirathanyanatt T, Theinkaprasit H, Jantarar J, Yanpiset K. Retrospective study of endodontic apical surgery outcome. M Dent J 2017; 37: 339-56.

Lui JN, Khin MM, Krishnaswamy G, Chen NN. Prognostic factors relating to the outcome of endodontic microsurgery. J Endod 2014; 40: 1071-6.

Caliskan MK, Tekin U, Kaval ME, Solmaz MC. The outcome of apical microsurgery using MTA as the root-end filling material: 2- to 6-year follow-up study. Int Endod J 2016; 49: 245-54.

Kim S, Song M, Shin SJ, Kim E. A randomized controlled study of mineral trioxide aggregate and super epoxybenzoic acid as root-end filling materials in endodontic microsurgery: Long-term Outcomes. J Endod 2016; 42: 997-1002.

Zhou W, Zheng Q, Tan X, Song D, Zhang L, Huang D. Comparison of mineral trioxide aggregate and iRoot BP plus root repair material as root-end filling materials in endodontic microsurgery: a prospective randomized controlled study. J Endod 2017; 43: 1-6.

Song M, Nam T, Shin SJ, Kim E. Comparison of clinical outcomes of endodontic microsurgery: 1 year versus long-term follow-up. J Endod. 2014; 40: 490-4.

Song M, Chung W, Lee SJ, Kim E. Long-term outcome of the cases classified as successes based on short-term follow-up in endodontic microsurgery. J Endod. 2012; 38: 1192-6.

Villa-Machado PA, Botero-Ramirez X, Tobon-Arroyave SI. Retrospective follow-up assessment of prognostic variables associated with the outcome of periradicular surgery. Int Endod J 2013; 46: 1063-76.

von Arx T, Penarrocha M, Jensen S. Prognostic factors in apical surgery with root-end filling: a meta-analysis. J Endod. 2010; 36: 957-73.

Friedman S. The prognosis and expected outcome of apical surgery. Endod Topics 2005; 11: 219-62.

Rud J, Andreasen JO, Jensen JE. Radiographic criteria for the assessment of healing after endodontic surgery. Int J Oral Surg 1972; 1: 195-214.

Molven O, Halse A, Grung B. Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg. 1987; 16: 432-9.

Rubinstein RA, Kim S. Long-term follow-up of cases considered healed one year after apical microsurgery. J Endod 2002; 28: 378-83.

Rahbaran S, Gilthorpe MS, Harrison SD, Gulabivala K. Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91: 700-9.

Molven O, Halse A, Grung B. Incomplete healing (scar tissue) after periapical surgery--radiographic findings 8 to 12 years after treatment. J Endod 1996; 22: 264-8.

Orstavik D. Time-course and risk analyses of the development and healing of chronic apical periodontitis in man. Int Endod J 1996; 29: 150-5.

Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med 2008; 3: 17.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-74.

Wang ZH, Zhang MM, Wang J, Jiang L, Liang YH. Outcomes of endodontic microsurgery using a microscope and mineral trioxide aggregate: A Prospective Cohort Study. J Endod 2017; 43: 694-8.

Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod 2009; 35: 930-7.

von Arx T, Jensen SS, Hanni S, Friedman S. Five-year longitudinal assessment of the prognosis of apical microsurgery. J Endod 2012; 38: 570-9.

Maseki T, Nakata K, Kohsaka T, Kobayashi F, Hirano S, Nakamura H. Lack of correlation between the amount of eugenol released from zinc oxide-eugenol sealer and cytotoxicity of the sealer. J Endod 1991; 17: 76-9.

Ho YC, Huang FM, Chang YC. Mechanisms of cytotoxicity of eugenol in human osteoblastic cells in vitro. Int Endod J 2006; 39(5): 389-93.

Al-Sa'eed OR, Al-Hiyasat AS, Darmani H. The effects of six root-end filling materials and their leachable components on cell viability. J Endod 2008; 34: 1410-4.

Song M, Kim E. A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery. J Endod 2012; 38: 875-9.

Gagliani MM, Gorni FG, Strohmenger L. Periapical resurgery versus periapical surgery: a 5-year longitudinal comparison. Int Endod J 2005; 38: 320-7.

Song M, Kim SG, Shin SJ, Kim HC, Kim E. The influence of bone tissue deficiency on the outcome of endodontic microsurgery: a prospective study. J Endod 2013; 39: 1341-5.

Pecora G, Kim S, Celletti R, Davarpanah M. The guided tissue regeneration principle in endodontic surgery: one-year postoperative results of large periapical lesions. Int Endod J 1995; 28: 41-6.

Kim E, Song JS, Jung IY, Lee SJ, Kim S. Prospective clinical study evaluating endodontic microsurgery outcomes for cases with lesions of endodontic origin compared with cases with lesions of combined periodontal-endodontic origin. J Endod 2008; 34: 546-51.