Success rates of molar apicectomy with amalgam root-end filling

Abstract

Aim To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. Design and Setting Multicentre, prospective study. The departments of oral and maxillo-facial surgery in two district general hospitals. Method During 1974–1995, 1,007 molar apicectomy procedures, combined with amalgam root-end filling were expedited. A five-year review of each tooth was carried out or attempted between 1979–2000. Results Of the 790 (78%) operated molars successfully reviewed at 5 years or later, 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), including 12 which were assumed to be of periodontal origin. Mandibular first molars had the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20–21% of mandibular molar procedures. In the majority of cases (79–80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy. Conclusions Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.