Apical surgery: Effect of dimensions of root-end fillings and peripheral root dentine on healing outcome

Abstract

HIGHLIGHTSObjective: The objective of this study was to assess dimensions of root-end fillings (REFs), as well as peripheral root dentine (PRD) and their effects on the healing outcome of apical surgery. Methods: Cone beam computed tomography (CBCT) scans were utilized to measure the REF length and width and the PRD thickness in 61 roots of 53 teeth 1 year after apical surgery. Measurements were taken in the mesio-distal as well as bucco-lingual directions. The REF alignment with respect to the root axis was also evaluated. In addition, the dimensions of REF and PRD were assessed for possible correlations with the healing outcome. Criteria for determining the healing outcome included clinical and radiographic parameters. Results: The mean REF length was 2.02±0.52 mm. No significant differences were observed with regard to tooth groups, but one-canal roots had a significantly longer mean REF than two-canal roots (P=0.006). The mean REF widths were 1.14±0.24 mm mesio-distally and 2.61±1.24 mm bucco-lingually. Roots with two canals presented a significantly wider REF (P<0.001) in the bucco-lingual dimension but had a significantly narrower REF in the mesio-distal direction (P<0.001) compared to roots with single canals. PRD measured on average 1.19±0.23 mm at the resection level and 1.44±0.27 mm at the coronal end of the REF. Almost all REFs were perfectly aligned with the longitudinal axis of the roots. With regard to healing outcomes, no correlations were found with REF and PRD values, respectively. Conclusion: The mean REF length was 2.02 mm. On average, a thickness >1 mm of peripheral root dentine was maintained. The REF or PRD dimensions had no statistical effect on the healing outcome.

Factors that influence the outcomes of surgical endodontic treatment

“…Although not many root‐end surgery studies provide equivalent data on restorative status, an adequate coronal restoration is considered a prerequisite for embarking on such surgery (Azim et al, 2021; Çalışkan et al, 2016; Chan et al, 2020; Rahbaran et al, 2001; Safi et al, 2019; Shinbori et al, 2015; Taha et al, 2021; Truschnegg et al, 2020). Unfortunately, many recent studies fail to declare the quality of the pre‐operative coronal restoration (Buniag et al, 2021; Kim et al, 2020; Pallarés‐Serrano et al, 2021; Sutter et al, 2020; von Arx, Janner, et al, 2020; von Arx, Jensen, et al, 2019; Von Arx, Marwik, & Bornstein, 2019; Yoo et al, 2020).…”

“…The wider variation may also be accounted for by the fact that in earlier studies, oral surgeons used the traditional root‐end surgery approach, which accrue relatively low success rates. Conversely, oral surgeons have also achieved high success rates in more recent studies, where they exhibit expert knowledge and skills in application of modern principles and techniques (Von Arx, Marwik, & Bornstein, 2019).…”

“…Given that the quality of root‐end management has a profound effect on periapical healing (Azim et al, 2021; Von Arx, Marwik, & Bornstein, 2019), the operator's understanding of the biological rationale, possession of fine tactile and 3D visualization skills should dominate considerations of their specialty background. More specifically, the operator's ability to visualize the correct canal path to avoid excessive stresses via the ultrasonic tip on thin root dentine are of utmost importance.…”

“…Unfortunately, most recent studies on root‐end surgery have failed to report or analyse the effect of restoration quality at review (Buniag et al, 2021; Kim et al, 2020; Sutter et al, 2020; von Arx, Janner, et al, 2020; von Arx, Jensen, et al, 2019; Von Arx, Marwik, & Bornstein, 2019), in particular, those following‐up the cases long‐term (Kim et al, 2020; von Arx, Jensen, et al, 2019).…”

Influence of root width and dentin wall thickness evaluated by endoscopy upon the outcome of periapical surgery. A cohort study

“…To date, only one clinical study, published by von Arx et al . ( 15 ), has analyzed the in vivo mean thickness of the dentin wall remaining around the retrograde filling. These authors performed four measurements in the buccolingual and mesiodistal planes of the roots using cone-beam computed tomography (CBCT) at 12 months after surgery.…”