Prognostic factors in apical surgery with root-end filling: a meta-analysis.
BACKGROUND
Apical surgery has seen continuous development with regard to equipment and surgical technique. However, there is still a shortage of evidence-based information regarding healing determinants. The objective of this meta-analysis was to review clinical articles on apical surgery with root-end filling in order to assess potential prognostic factors.


METHODS
An electronic search of PubMed and Cochrane databases was performed in 2008. Only studies with clearly defined healing criteria were included, and data for at least two categories per prognostic factor had to be reported. Prognostic factors were divided into patient-related, tooth-related, or treatment-related factors. The reported percentages of healed teeth ("the healed rate") were pooled per category. The statistical method of Mantel-Haenszel was applied to estimate the odds ratios and their 95% confidence intervals.


RESULTS
With regard to tooth-related factors, the following categories were significantly associated with higher healed rates: cases without preoperative pain or signs, cases with good density of root canal filling, and cases with absence or size < or = 5 mm of periapical lesion. With regard to treatment-related factors, cases treated with the use of an endoscope tended to have higher healed rates than cases without the use of an endoscope.


CONCLUSIONS
Although the clinician may be able to control treatment-related factors (by choosing a certain technique), patient- and tooth-related factors are usually beyond the surgeon's power. Nevertheless, patient- and tooth-related factors should be considered as important prognostic determinants when planning or weighing apical surgery against treatment alternatives.
von Arx
Thomas
T
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland. thomas.vonarx@zmk.unibe.ch
Peñarrocha
Miguel
M
Jensen
Storgård
S
D000367:Age Factors; D001047:Apicoectomy / Q000379:methods*; D019723:Endoscopes; D005260:Female; D006801:Humans; D008297:Male; D010482:Periapical Abscess / Q000150:complications; D011379:Prognosis; D012184:Retrograde Obturation / Q000379:methods*; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000379:methods; D012737:Sex Factors; D014070:Tooth / Q000473:pathology; D014098:Toothache / Q000150:complications; D014945:Wound Healing / Q000502:physiology
D012387:Root Canal Filling Materials