Five-Year Longitudinal Assessment of the Prognosis
of Apical Microsurgery
Thomas von Arx, DMD,* Simon S. Jensen, DDS,*† Stefan Ha€nni, DMD,‡
and Shimon Friedman, DMD§
Abstract
Introduction: Apical surgery is an important treatment
option for teeth with post-treatment apical periodon-
titis. Knowledge of the long-term prognosis is necessary
when weighing apical surgery against alternative treat-
ments. This study assessed the 5-year outcome of apical
surgery and its predictors in a cohort for which the
1-year outcome was previously reported. Methods:
Apical microsurgery procedures were uniformly per-
formed using SuperEBA (Staident International, Staines,
UK) or mineral trioxide aggregate (MTA) (ProRoot MTA;
Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end
fillings or alternatively Retroplast capping (Retroplast
Trading, Rorvig, Denmark). Subjects examined at
1 year (n = 191) were invited for the 5-year clinical
and radiographic examination. Based on blinded, in-
dependent assessment by 3 calibrated examiners, the
dichotomous outcome (healed or nonhealed) was deter-
mined and associated with patient-, tooth-, and
treatment-related variables using logistic regression.
Results: At the 5-year follow-up, 9 of 191 teeth were
unavailable, 12 of 191 teeth were extracted, and 170
of 191 teeth were examined (87.6% recall rate). A total
of 129 of 170 teeth were healed (75.9%) compared with
83.8% at 1 year, and 85.3% were asymptomatic. Two
significant outcome predictors were identified: the
mesial-distal bone level at #3 mm versus >3 mm
from the cementoenamel junction (78.2% vs 52.9%
healed, respectively; odds ratio = 5.10; confidence
interval, 1.67-16.21; P < .02) and root-end fillings
with ProRoot MTA versus SuperEBA (86.4% vs. 67.3%
healed, respectively; odds ratio = 7.65; confidence
interval, 2.60-25.27; P < .004). Conclusions: This study
suggested that the 5-year prognosis after apical micro-
surgery was 8% poorer than assessed at 1 year. It
also suggested that the prognosis was significantly
impacted by the interproximal bone levels at the
treated tooth and by the type of root-end filling material
used.
(J Endod 2012;38:570–579)
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