Apical surgery: endoscopic findings at the resection level of 168 consecutively treated roots.

By von Arx T, Steiner RG, Tay FR.

Date: 03/2012
Journal: JOE


•Purpose: to document and analyze macro- and microfindings detected with endoscopic inspection at the cut root face after root-end resection during apical surgery.  

•n: 138 teeth with 168 treated roots in 114 patients undergoing apical surgery.


•Roots were resected approximately 3 mm from apex. Staining of the area with methylene blue, the cut root face was inspected using a rigid endoscope.

•The following primary study parameters were assessed:

Macrofindings: number of canals\root and presence of isthmus per root. Microfindings: presence and location of a craze line, crack, gap & frosted dentine Fig.1.

•Microfindings were correlated with secondary study parameters, i.e. age, tooth type & presence/absence of post.

Most highlighted Results: 

  1. The teeth most often included were mandibular first molars with M root most frequently assessed.

2.The overall presence of an isthmus in posterior teeth including all premolar & molar roots was 44% (highest frequency seen in M roots of mandibular 1st molars 88.5%)

3.Overall, (9.5%) had a craze line or crack majority were located in B segment

4.Frosted dentine was observed in 80% of roots most often in B segment .  5.Gaps were found in 83.3% mostly found in the B segment. 

6.The age groups and the presence or absence of a post/screw did not sig influence the findings.

7.Roots of premolars had sig more craze lines/ cracks than anteriors & molars. With regard to frosted dentine, roots of premolars & molars were sig more frequently affected than of anteriors. 

Clinical significance:   

  Multiple canals per root were mainly found in premolars and molars, but not exclusively. Mesial roots of mandibular first molars had the highest frequency of a canal isthmus. ‘gap’ was the most frequently seen anomaly cracks and craze line were infrequent findings.