Relation of Pre- and Intraoperative Factors to Prognosis of Posterior Apical Surgery

By Lustmann J, Friedmann S, Shaharabany V

Date: 10/1991
Journal: Oral Surg Oral Med Oral Patho

Purpose: To examine the relation of various preoperative and intraoperative factors to the treatment results of apical surgery in posterior teeth (treated by different operators)

N = 91 patients were reexamined after having apical surgery performed on 103 premolar or molar teeth.

– Preoperative and intraoperative data collected from records

– surgery performed by different operators

– Retrograde filling with amalgam

– Results were observed over 6 months to 8 years

– Upon re-examination, data collected regarding clinical signs and symptoms since surgery and at present, including pain, swelling, sinus tract, mobility, and sensitivity to percussion.

– Follow-up radiographs were taken at the same angulation as the immediate postoperative radiographs (single examiner)

– Classification of the treatment results included combination of the radiographic and clinical findings:

Successful: complete healing radiographically without any clinical signs or symptoms.

Doubtful: either incomplete or uncertain radiographic healing without any clinical signs or symptoms, or complete radiographic healing with sensitivity to percussion.

Unsuccessful: either incomplete or uncertain radiographic healing with sensitivity to percussion, or the   presence of clinical signs or symptoms, or unsatisfactory radiographic healing.

Most highlighted Results:

•Higher success rate was observed: lack of clinical signs and symptoms, well-defined radiographic borders, small periapical lesions, well-condensed root canal obturation, obturating materials other than gutta percha and surgery performed in less than 1 month after RCT.

•Roots obturated 2 mm or shorter of the apex were significantly more successful than in roots obturated to or beyond apex and without post restoration.

•Prognosis differed significantly following the treatment by various operators.

Clinical significance:

Understanding rationale of Apical surgery is important for post-op status expectations. Case selection is important,