Traditional endodontic surgery versus modern technique: a 5-year controlled clinical trial.
In this study, we compared outcomes of traditional apicoectomy versus modern apicoectomy, by means of a controlled clinical trial with a 5-year follow-up. The study investigated 938 teeth in 843 patients. On the basis of the procedure performed, the teeth were grouped in 3 groups. Differences between the groups were the method of osteotomy (type of instruments used), type of preparation of retrograde cavity (different apicoectomy angles and instruments used for root-end preparation), and root-end filling material used (gray mineral trioxide aggregate or silver amalgam). Outcome (tooth healing) was estimated after 1 and 5 years, postoperatively. Clinical success rates after 1 year were 67% (306 teeth), 90% (186 teeth), and 94% (256 teeth) according to traditional apicoectomy (group 1), modern microsurgical apicoectomy using burns for osteotomy (group 2) or using piezo-osteotomy (group 3), respectively. After 1 year, group comparison results were statistically significant (P < 0.0001). Linear trend test was also statistically significant (P < 0.0001), pointing out larger healing from group 1 to group 3. After 5 years, teeth were classified into 2 groups on the basis of root-end filling material used. Clinical success was 90.8% (197 teeth) in the silver amalgam group versus 96% (309 teeth) in the mineral trioxide aggregate group (P < 0.00214). Multiple logistic regression analysis found that surgical technique was independently associated to tooth healing. In conclusion, modern apicoectomy resulted in a probability of success more than 5 times higher (odds ratio, 5.20 [95% confidence interval, 3.94-6.92]; P < 0.001) compared with the traditional technique.
From the *Department of Stomatological Science, University of Palermo, Palermo; and †Department of Medical, Oral and Biotecnological Sciences, University of Chieti-Pescara, Chieti, Italy.
Silvia
S
Tortorici
Paolo
P
Difalco
Luigi
L
Caradonna
Stefano
S
Tetè
D000328:Adult; D017607:Aluminum Compounds; D001047:Apicoectomy / Q000295:instrumentation / Q000379:methods*; D017610:Calcium Compounds; D003723:Dental Amalgam; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D010087:Oxides; D012184:Retrograde Obturation / Q000295:instrumentation / Q000379:methods*; D017640:Silicates; D055815:Young Adult
D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D010087:Oxides; D017640:Silicates; C086631:mineral trioxide aggregate; D003723:Dental Amalgam