Abstract
The aim of this study was to analyze the long-term outcomes of endodontic microsurgeries in a cohort and identify their association with prognostic factors. A cohort of endodontic microsurgeries followed up periodically with complete clinical and radiographic records for at least 5 years were reviewed retrospectively. Their survival and healing status and profile characteristics were analyzed by Pearson chi-square test and logistic regression (α = 0.05) to identify prognostic factors that influenced outcomes. Of 652 cases in the cohort, 225 (34.5%) were included. The mean follow-up period was 90.4 months (range, 60–168 months). The long-term success rate was 80.5%, and the 5-year survival rate was 83.5%. Logistic regression showed higher success in anteriors compared to molars (OR = 5.405, (95% CI, 1.663–17.571; p = 0.005)) and in teeth with crown restorations (OR = 10.232, (95% CI, 3.374–31.024; p < 0.001)). Conversely, lower success was found in teeth with periodontal disease (OR = 0.170, (95% CI, 0.032–0.900; p = 0.037)) and maxillary sinus involvement (OR = 0.187, (95% CI, 0.035–0.994; p = 0.049)). Endodontic microsurgery has a highly favorable long-term outcome. Tooth position, crown restoration, periodontal disease, and maxillary sinus involvement were identified as main prognostic factors.
Highlights
Endodontic surgery is a treatment of last resort when nonsurgical retreatments fail with persistent lesions from cysts or extraradicular infections [1]
There were 148 (66%) completely healed and 33 (14%) incompletely healed cases that accounted for the 80.5% overall success rate (Table 1)
This study’s potential success rate was even higher, as some teeth had been extracted for crown fractures from caries (7) and periodontal problems (7) that were unrelated to surgery
Summary
Endodontic surgery is a treatment of last resort when nonsurgical retreatments fail with persistent lesions from cysts or extraradicular infections [1]. Recent advancements in endodontic microsurgery include microscopes, ultrasonic instruments, biocompatible root-end fillings, and miniaturized armamentarium, which have enhanced access, visualization, operative procedures, and tissue responses [2,3]. An early meta-analysis reported that these microsurgeries are 1.58 times more successful than traditional surgeries with cumulative success rates of 93.52% after 6 month follow-up [4]. Their long-term success (>4 years, 82.5%) [5] and survival (8.7 years, 74%) [6] are comparable to nonsurgical retreatment. Long-term cumulative success rates for microsurgeries in cohorts have not been reported
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