Periapical surgery in a norwegian county hospital: Follow-up findings of 477 teeth

Grung, Bjarte; Molven, Olav; Halse, Agnar

doi:10.1016/s0099-2399(06)81882-0

Cited by 126 publications

(99 citation statements)

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“…The size of the osteotomy is sufficient to excise the lesion and for the retrograde obturation. It is however kept minimal to improve healing [4,[15][16][17][18]. A bone scraper is used to exsect the apical lesion.…”

Section: Standardized Surgical Protocolmentioning

confidence: 99%

“…The canal and the cavity is dried, and haemostasis is achieved using an oxycellulose gauze (Surgicel R ). Obturation was completed with a zinc oxide-eugenol with polymer reinforcement (Intermediate Reinforcement Material -IRM R ) [18,24,25]. When surgical re-intervention was necessary, after failure of a first periapical surgery, Proroot Mineral Trioxide Aggregate (MTA R ) was used instead of IRM R to obturate the canal and, crown/root ratio allowing, the apex was resected of a further millimetre [25,26].…”

Section: Standardized Surgical Protocolmentioning

confidence: 99%

“…Furthermore they allow for deeper apical cavities, whose walls will remain parallel, respect the axis of the tooth [22,48], and access isthmuses [49]. The last advantage is to allow for a smaller osteotomy, thereby improving healing [15,16,18].…”

Section: Success Uncertain Healing and Failure Ratesmentioning

confidence: 99%

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Success rate and recurrence frequency of periapical surgery: prospective study on 132 cases

Alantar

Bloud²,

Galéazzi

et al. 2010

Med Buccale Chir Buccale

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-Objectives:Primary aim is to quantify the success rate of periapical surgery. Secondary objectives include the determination of the histological nature of the lesions, and the incidence of the different teeth on which this surgery is performed. Study design: This is a prospective cohort study conducted in one centre. The same operator following a standardized surgical protocol performed all surgeries. Follow-up (including clinical examination and periapical X-ray) was conducted at day 7, and months 6, 12 and 18. Statistical analysis included determination of the mean, standard deviation and paired two-tailed Student's t-test, for each of the variables. Results: 132 periapical surgeries were performed on 114 patients. Success and failure rate at 18 months, are 90%, and 6%, and uncertain in 4%. Histopathology confirmed that 72% of the lesions were granulomas, and 28% cysts. Periapical surgery pertains mostly to maxillary (70%) and posterior teeth (70%). Conclusion: Prognosis of conventional periapical surgery is very good. Failure rate peaks at 7 months, written informed consent is paramount.A radiolucent apex after endodontic treatment is a common finding with up to 45% of the treated teeth in certain studies [1,2]. These lesions can be found during a routine check-up, or during an emergency appointment when associated with pain. As orofacial pain is ascribed to periapical abscesses in 25% of the patients [3], these periapical radiolucencies, in the context of periapical surgery, can be a diagnostic challenge. Periapical abscesses are the consequence of a bacterial infection of the root canals [4]. Treatment classically consists of the elimination of necrotic and infected tissue, followed by obturation of the root canal system and a sealed restoration of the crown. Periapical surgery is indicated when root canal retreatment has failed or is contraindicated [4]. An osteo-mucoperiosteal flap followed by the appropriate osteotomy allows access to the apex of the tooth. The lesion is removed and the root canal system sealed [4]. Success rates reported vary between 40% [5] and 97% [6]. Correspondence: alpalantar@wanadoo.fr The main objective of this study is to assess the success rate of periapical surgery using a standardized protocol. Secondary objectives include the determination of the histological appearance of the lesions (granulomas or cysts), the incidence of the different teeth on which this surgery is performed, and the recurrence frequency.

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Section: Standardized Surgical Protocolmentioning

confidence: 99%

Section: Standardized Surgical Protocolmentioning

confidence: 99%

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Success rate and recurrence frequency of periapical surgery: prospective study on 132 cases

Alantar

Bloud²,

Galéazzi

et al. 2010

Med Buccale Chir Buccale

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“…It should be noted that scar tissue (at 1 year) only develops in <10% of cases. [8][9][10] In contrast, some of the included studies reported an "incomplete healing" as high as 27-50%, raising the possibility of misclassification of "uncertain healing" or "failure" cases as incomplete healing. Such misclassification would result in an overestimation of the outcome in individual studies, as well as the pooled estimate.…”

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confidence: 96%

Surgical endodontic treatment under magnification has high success rates

Azarpazhooh

2010

Evid Based Dent

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The advancement in surgical endodontics (eg, the use of the dental operative microscope, no or minimal bevel of the root-end resection, and ultrasonic retrograde canal preparation to a depth of 3-4 mm) has resulted in more precise and predictable surgical procedures, which could not normally be achieved using the traditional surgical endodontic treatment (by means of root-end resection with a 45-degree bevel, retrograde preparation of the canal with bur, and root-end filling under no magnification and inadequate illumination). Therefore, assuming a higher outcome for the modern versus the traditional procedure, 3 this study pooled six RCT and five prospective case-series to evaluate the outcome of the modern surgical endodontic treatment as well as the factors influencing the outcome.In order to critically appraise this paper, the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Metaanalyses) 4 was utilised. The search strategy appears to be exhaustive, although it was limited to English publications. The eligibility criteria and data collection process were detailed. Three reviewers worked independently in identifying and appraising the included studies and extracting the data. Such methodology would reduce bias in a review. With regards to the eligibility criteria of the level of evidence and study design, it should be noted that because of the nature of the question (outcome of only modern surgical endodontics), no control group is necessary. Therefore, even though the authors included six RCT, in fact for the purpose of the data synthesis, such RCT had to be handled as prospective case series, ie, only the results of the RCT arm(s) that utilised the modern endodontic surgery procedure and met the other inclusion criteria were considered for the data synthesis.No report was mentioned of attempting to contact authors of papers that partially met the inclusion criteria for further results (eg, Saunders 2008 5 for the outcome of cases with at least one year followup). Moreover, in some cases, the reasons for excluding a paper seem to be erroneous, since the paper by Gagliani et al. (2005) 6 was rejected for not using Rud 1 criteria even though it did so.There is no indication of risk of bias assessment of individual studies at the study or outcome level (eg, masking and/ or calibration of the examiners) and, thus, no sensitivity analysis was performed for the data synthesis. Moreover, no measure of consistency (eg, I 2 for testing heterogeneity) 7 was reported.In this meta-analysis, the radiographic healing categories of incomplete healing (scar) and complete healing were combined into one category of "success" with a pooled estimate of 91.6% (95% Surgical endodontic treatment under magnification has high success rates Data extraction and synthesis Studies were reviewed and data extracted independently by three observers, with disagreements resolved by discussion. Studies included were combined to estimate the pooled successes and 95% confidence intervals (CI), where success was considered ...

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“…It should be noted that scar tissue (at one year), when adequately diagnosed, has been reported to occur in <10% of teeth treated by apical surgery. [8][9][10] There was no attempt to critically investigate the percentage of the 'incomplete healing' in the individual studies that may raise the possibility of misclassification bias.…”

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confidence: 99%

Endodontic surgery prognostic factors

Azarpazhooh

Shah

2011

Evid Based Dent

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Understanding the prognostic predictors for any type of treatment might be important in the process of decision-making between different treatment modalities. For apical surgery, such information can help the clinicians in appropriate case selection, increasing the likelihood of a favourable outcome. In an attempt to update the previous reviews, (narrative and systematic), this meta-analysis pooled the results of 38 published clinical studies to assess the potential predictors of healing in apical surgery with root-end filling.The authors carefully designed and executed the search and clearly outlined the process of study selection. They extracted information from studies varying in design, from retrospective observational studies to randomized clinical trials. The primary aim to identify prognostic factors was explored through a series of forest plots for a number of factors, presented with raw data from eligible studies for readers to make their own impression regarding validity of the results. Tooth-related, patient-related and treatment-related factors were separately analysed and the data were presented. The rigour of the review notwithstanding, lapses in methodology 1 require attention before the results can be applied in clinical practice.The eligibility criteria of any clinical study with a minimum of ten subjects and a minimum follow-up period of six months are oversimplified. It is known that in general, 5-25% of teeth classified as healed after one year may regress to periapical radiolucency or clinical symptoms when followed-up longer. 4-6 Therefore, outcomes assessed in less than 3-4 years (reported in at least 14/35 included studies) should be considered to overestimate the potential for heal-

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Periapical surgery in a norwegian county hospital: Follow-up findings of 477 teeth

Cited by 126 publications

References 10 publications

Success rate and recurrence frequency of periapical surgery: prospective study on 132 cases

Success rate and recurrence frequency of periapical surgery: prospective study on 132 cases

Surgical endodontic treatment under magnification has high success rates

Endodontic surgery prognostic factors

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