title: Outcome of orthograde retreatment after failed apicoectomy: use of a mineral trioxide aggregate apical plug.
abstract: BACKGROUND
  This controlled, single-center historic cohort study project evaluates treatment outcomes of a nonsurgical treatment approach after failed apicoectomy.
  
  
  METHODS
  The treatment outcomes of nonsurgical retreatment after a failed apicoectomy were evaluated clinically and radiographically. The study cohort consisted of teeth that had received primary root canal treatment and subsequent apicoectomy elsewhere before the patients presented with post-treatment disease. Orthograde retreatment and obturation using an apical mineral trioxide aggregate plug was performed by postgraduate students and endodontic specialists in 25 cases between 2004 and 2012. Pre-, intra-, and postoperative information and the potential effect on the retreatment outcome were evaluated and statistically analyzed using the chi-square test.
  
  
  RESULTS
  Twenty-two patients with 23 teeth attended the follow-up examinations (recall rate = 92%). The follow-up periods ranged from 12 to 102 months (median = 35 months). Twenty teeth (87%) were classified as "success," and 3 teeth were considered (17%) "failure." The chi-square test confirmed that the preoperative factor "number of roots" had a statistically significant effect on treatment outcome (odds ratio = 0.08; 95% confidence interval, 0-1.76; P = .03). The factor "tooth location" was of borderline significance (odds ratio = 0.1; 95% confidence interval, 0-2.14; P = .05).
  
  
  CONCLUSIONS
  The results of the present study suggest that orthograde retreatment combined with orthograde placement of an apical mineral trioxide aggregate plug is a promising long-term treatment option for teeth with postsurgical pathosis. The success rates were higher for single-rooted teeth. The use of cone-beam computed tomographic imaging in cases of inconclusive periapical radiographs is recommended to minimize the risk of misinterpretation when assessing treatment outcome.
authors.affiliation: Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. Electronic address: johannes.mente@med.uni-heidelberg.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mente
authors.affiliation: Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
authors.forename: Meltem
authors.initials: M
authors.lastname: Leo
authors.affiliation: Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Michel
authors.affiliation: Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Gehrig
authors.affiliation: Institute of Medical Biometry and Informatics, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Saure
authors.affiliation: Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Pfefferle
mesh_terms: D000328:Adult; D017607:Aluminum Compounds; D001047:Apicoectomy; D017610:Calcium Compounds; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012086:Reoperation; D012184:Retrograde Obturation / Q000379:methods*; D012387:Root Canal Filling Materials; D017640:Silicates; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D010087:Oxides; D012387:Root Canal Filling Materials; D017640:Silicates; C086631:mineral trioxide aggregate
keywords: Failed apicoectomy; mineral trioxide aggregate; orthograde retreatment; treatment outcome