Outcomes and prognostic factors of apical periodontitis by root canal treatment and endodontic microsurgery-a retrospective cohort study

Abstract

Background: The aim of this study was to analyze the outcome and prognostic factors of root canal treatment (RCT) and endodontic microsurgery (EMS) in the treatment of apical periodontitis (AP), respectively, and to compare the outcome and prognostic factors between initial RCT and nonsurgical retreatment (re-RCT) for AP.Methods: Patients with AP were recruited from the Stomatology Department of Peking University Third Hospital from January 2016 to December 2019. Data were collected by medical records review. Univariate analysis of treatment outcome was performed for the total RCT group, initial RCT group, re-RCT group and EMS group, respectively. Multivariate logistic regression was performed for the three RCT groups, respectively, but not for the EMS group. Results:The overall success of treatment for AP was 73.8%. The success rate of RCT in 229 cases was 70.7%, while that of EMS in 34 cases was 94.1%. The failure of RCT was significantly higher for elderly patients [odds ratio (OR) =1.025, P=0.013], teeth with incomplete fracture (OR =7.082, P=0.013), teeth with a greater crown root ratio (OR =1.198, P=0.029), teeth treated by a general dentist (OR =2.16, P=0.042) and teeth with unqualified treatment (OR =2.841, P=0.002). Of the 166 teeth treated by initial RCT, the success was 68.1%. A greater crown root ratio (OR =1.333, P=0.004) was identified as a risk factor for treatment.Of the 63 teeth treated by re-RCT, the success was 77.8%. A lower success was observed in teeth with unqualified treatment (OR =5.291, P=0.018). With regard to EMS, the univariate analysis showed that none of the variables were significantly related to the outcome.Conclusions: For AP treated by RCT, age, incomplete tooth fracture, crown root ratio, doctor classification and unqualified treatment had a strong impact on determining outcome. For initial RCT, crown root ratio was a significant outcome predictor, while for re-RCT, unqualified treatment was a strong statistically significant factor. No significant difference was found between the success of initial RCT and re-RCT for AP.

Treatment outcome of surgical and non‐surgical endodontic retreatment of teeth with apical periodontitis

“…The impact of operator skill level and associated variations in technical quality was partly overcome in the present study by supervision and hands‐on guidance by experienced endodontist, but the inherent variation amongst graduate students' performance should be recognized. Our findings of no association of outcome after surgery with registered parameters agrees well with recent results (Liu et al, 2021).…”

Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography‐based retrospective study

“…An increase in 1 mm 3 in the initial volume of a periapical lesions increased the healing time by 0.3%. Liu et al (2021) analysed the prognostic factors of root canal treatment and nonsurgical retreatment for teeth with apical periodontitis. They observed that a statistically significant preoperative prognostic factor in the successful healing rate was the patient's age (p < .05).…”

“…They observed that a statistically significant preoperative prognostic factor in the successful healing rate was the patient's age ( p < .05). Younger patients had a more favourable outcome (Liu et al., 2021). Other authors disagree with this finding, for example, Saini et al., 2023 concluded that age was not a prognostic factor for the healing process.…”

Treatment of cracked teeth: A comprehensive narrative review

“…When it comes to a case deemed "successful," there is an even wider heterogeneity recorded in the literature. According to the consensus Despite the fact that some investigators conformed to the aforementioned guidelines (Krell & Caplan, 2018;Malentacca et al, 2021) others evaluated success only by disappearance of symptoms (Kim et al, 2013;Lee et al, 2021b) and reduction in the size of the periapical lesion (Liu et al, 2021). On the contrary, a broader range of prerequisites for success was implemented by other research teams, which further considered no increase in crack-associated periodontal probing (Davis & Shariff, 2019;de Toubes et al, 2022), periapical index (PAI) score ≤2 (de Toubes Dow, 2016), no increase in crestal bone loss, no sensitivity in percussion, palpation or bite test, as well as the presence of an occlusally, equilibrated full-coverage restoration (Davis & Shariff, 2019).…”

“…On the contrary, a broader range of prerequisites for success was implemented by other research teams, which further considered no increase in crack‐associated periodontal probing (Davis & Shariff, 2019 ; de Toubes et al, 2022 ), periapical index (PAI) score ≤2 (de Toubes et al, 2022 ; Dow, 2016 ), no increase in crestal bone loss, no sensitivity in percussion, palpation or bite test, as well as the presence of an occlusally, equilibrated full‐coverage restoration (Davis & Shariff, 2019 ). Respectively, two studies recorded as “failures” cases with an unchanged periapical lesion, although they were followed up for a mean period of 19 months (Liu et al, 2021 ) and 23.3 months (Chen et al, 2021 ), instead of the proposed 4‐year time span (Endodontology, 2006 ). In addition, other studies (Lee et al, 2021b ; Lu et al, 2021 ) had a shorter follow‐up than the minimum required (1 year) for the assessment of success (Endodontology, 2006 ).…”