title: Five-year longitudinal assessment of the prognosis of apical microsurgery.
abstract: BACKGROUND
  Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported.
  
  
  METHODS
  Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression.
  
  
  RESULTS
  At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤ 3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P < .02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P < .004).
  
  
  CONCLUSIONS
  This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used.
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland. thomas.vonarx@zmk.unibe.ch
authors.forename: Thomas
authors.initials: T
authors.lastname: von Arx
authors.forename: Simon S
authors.initials: SS
authors.lastname: Jensen
authors.forename: Stefan
authors.initials: S
authors.lastname: Hänni
authors.forename: Shimon
authors.initials: S
authors.lastname: Friedman
mesh_terms: D017607:Aluminum Compounds / Q000627:therapeutic use; D000539:Alveolar Process / Q000473:pathology; D001047:Apicoectomy / Q000379:methods*; D017438:Bisphenol A-Glycidyl Methacrylate / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use; D015331:Cohort Studies; D017220:Dentin-Bonding Agents / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use; D010485:Periapical Periodontitis / Q000601:surgery; D011379:Prognosis; D012184:Retrograde Obturation / Q000379:methods; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D017640:Silicates / Q000627:therapeutic use; D016037:Single-Blind Method; D019237:Tooth Cervix / Q000473:pathology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D017607:Aluminum Compounds; D017610:Calcium Compounds; D017220:Dentin-Bonding Agents; D004338:Drug Combinations; D010087:Oxides; D012387:Root Canal Filling Materials; D017640:Silicates; C086631:mineral trioxide aggregate; D017438:Bisphenol A-Glycidyl Methacrylate; C084074:Super EBA