Numerous studies dealing with the outcome of surgical endodontic treatment have been published. However, study design, treatment protocols, follow-up periods, and inclusion and exclusion criteria are extremely variable. Thus, variable and confusing results have been reported. The aim of the present study was to assess the outcome of surgical endodontic treatment performed with a modern technique and to evaluate factors influencing the outcome by means of a meta-analysis.
An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify prospective case series or randomized clinical trials that deal with surgical endodontic treatment.
A successful outcome in a follow-up of more than 1 year postoperatively was 91.6%. Age, gender, tooth type, root-end filling material, and magnification type had no significant effect on the proportion of success.
Surgical endodontic treatment done by using a modern technique is a predictable treatment. Additional large-scale prospective clinical studies are needed to evaluate possible predictors of success and failure.
"These microcracks can create a communication pathway between the root canal and the periodontium. Therefore, the local bacteria in the complex apical ramifications, such as isthmuses, canal fins and lateral canals can leak through these cracks and prevent healing of apical tissues [6,7]. Min et al.  in an electron microscopic study of extracted teeth reported an increased appearance of cracks and fissures on using ultrasound tips. "
[Show abstract][Hide abstract] ABSTRACT: To compare three various methods in the diagnosis of dentinal cracks formed in the apical third after root resection.
One hundred extracted human maxillary central incisors were selected. The root canals were prepared with step-back technique. Then 3mm from the apical end of all roots was cut perpendicular to the long axis of the tooth. The apical end of each root was evaluated to make sure there were no cracks. Fifty specimens were randomly chosen and connected to an apparatus especially designed for application of force (50-60N) by a universal testing machine for crack formation. The cracked (no=50) and non-cracked (no=50) specimens were examined by three methods of fiber optic transillumination, methylene blue staining and combination of the two. Sensitivity and specificity of the methods were evaluated. The most suitable method for detecting cracks was determined using Youden index. To compare agreement between studied methods with the gold standard, kappa statistics and odds ratio of McNemar were utilized.
The sensitivity of transillumination, staining and the combination method were 82.0, 50.0 and 90.0%, respectively. The staining technique had the lowest sensitivity and the highest specificity. Both transillumination and the combination method had Youden index of 0.56, but the combination method diagnosed truly cracked samples more than the other techniques.
The efficacy of transillumination in identification of apical root-end cracks undetectable by unaided vision was similar to the combination method. However, the efficacy of 2% methylene blue without transillumination was significantly lower than the other two methodologies.
"In order to compare our results with those of the above authors, we summed the percentages of success and improvement to obtain a healing rate after 12 months of 94.2%, which falls within the described ranges. Tsesis et al. (26) published a metaanalysis quantifying the outcomes of periapical surgery and studying the influence of different factors upon treatment outcome. These authors obtained a periapical surgery success rate after one year of follow-up of 91.6%, which coincides with our own findings and with those of von Arx et al. in their metaanalysis (91.4% for teeth filled with MTA)(27). "
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery.
Design: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl™). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery.
Results: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p>0.05).
Conclusion: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant.
Key words:Aluminum chloride, bleeding control, hemostasis, periapical surgery, outcome.
"These lesions require the removal of infected dentin root-apex and large portions of periapical bone tissue  and the filling of the root-apex cavity with a root-end sealing material preferably biocompatible, osteoconductive or osteoinductive. The failure rate of surgical root-end therapy with conventional materials, such as zinc-oxide cements and silver-amalgam, was reported approximately as 8–24%    . The consequences are bone resorption and tooth extraction. "
[Show abstract][Hide abstract] ABSTRACT: An innovative light-curable calcium-silicate cement containing a HEMA-TEGDMA-based resin (lc-MTA) was designed to obtain a bioactive fast setting root-end filling and root repair material.
lc-MTA was tested for setting time, solubility, water absorption, calcium release, alkalinizing activity (pH of soaking water), bioactivity (apatite-forming ability) and cell growth-proliferation. The apatite-forming ability was investigated by micro-Raman, ATR-FTIR and ESEM/EDX after immersion at 37°C for 1-28 days in DPBS or DMEM+FBS. The marginal adaptation of cement in root-end cavities of extracted teeth was assessed by ESEM/EDX, and the viability of Saos-2 cell on cements was evaluated.
lc-MTA demonstrated a rapid setting time (2min), low solubility, high calcium release (150-200ppm) and alkalinizing power (pH 10-12). lc-MTA proved the formation of bone-like apatite spherulites just after 1 day. Apatite precipitates completely filled the interface porosities and created a perfect marginal adaptation. lc-MTA allowed Saos-2 cell viability and growth and no compromising toxicity was exerted.
HEMA-TEGDMA creates a polymeric network able to stabilize the outer surface of the cement and a hydrophilic matrix permeable enough to allow water absorption. SiO(-)/Si-OH groups from the mineral particles induce heterogeneous nucleation of apatite by sorption of calcium and phosphate ions. Oxygen-containing groups from poly-HEMA-TEGDMA provide additional apatite nucleating sites through the formation of calcium chelates. The strong novelty was that the combination of a hydraulic calcium-silicate powder and a poly-HEMA-TEGDMA hydrophilic resin creates the conditions (calcium release and functional groups able to chelate Ca ions) for a bioactive fast setting light-curable material for clinical applications in dental and maxillofacial surgery. The first and unique/exclusive light-curable calcium-silicate MTA cement for endodontics and root-end application was created, with a potential strong impact on surgical procedures.
Dental materials: official publication of the Academy of Dental Materials 07/2011; 27(7):e134-57. DOI:10.1016/j.dental.2011.03.011 · 3.77 Impact Factor
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