Treatment Outcome in Endodontics: The Toronto Study—Phases 3, 4, and 5: Apical Surgery

By Barone C, Dao TT, Basrani BB, Wang N, Friedman S.

Date: 10/2011
Journal: JOE


Purpose: to assess healing 4–10 years after apical surgery, and to identify significant outcome predictors in the pooled samples of Phases 1–5

N= 134 teeth from phases 3–5 (n = 40) with Phases 1 & 2 (n = 94), surgery was done (Jan 1998 –Dec 2003)


1.All clinical &radiographic data ( before, intra & immediately after ) treatment were recorded

2.Subjects were mailed recall letters 4–10 years after treatment

3.The presence or absence of signs and symptoms (pain, swelling, sinus tract) and the PAI scores were used as an outcome measures; (tenderness to percussion was not considered as a clinical sign)

4. Teeth were classified as:

5. ”Healed” (a) clinically, absence of signs and symptoms (b) radiographically, PAI score was ≤ 2 or scar

6.‘‘Diseased’’ clinical signs and symptoms were present, or PAI score was ≥ 3 or higher

7.‘‘Functional’’ absence of any signs or symptoms, regardless of the PAI score 8.Recall rate 84%

Most highlighted Results:

1.Of the 134 examined teeth in the pooled sample, (74%) were healed, (94%) were classified as functional

2.Three significant outcome predictors were identified with healed rate: •age (≤ 45 years, 68%; >45 years, 84%)

preoperative root-filling length (adequate, 68%; inadequate, 84%) •intraoperative crypt size (≤ 10 mm, 80%; > 10 mm, 53%)

Clinical significance:

The prognosis of apical surgery was suggested to be significantly better for teeth with inadequate preoperative root-filling length, for patients older than 45 years, and for teeth with crypt size smaller than 10 mm in diameter.