[Root canal retreatment or surgical apicoectomy?].
ABSTRACT Failure of root canal therapy is usually due to re-infection of the root canal system. In most of these cases, an endodontic retreatment is indicated. Patients with persisting apical periodontitis frequently are referred to an oral surgeon for apical surgery, although endodontic retreatment would have been possible in a majority of these cases. When endodontic retreatment is not possible or does not resolve the patient's problems, surgical apicoectomy or extraction might be the only possibilities left. Apical surgery is usually performed by an oral sugeon or by a specially trained dentist. In most surgical clinics beveled resection, followed by an preparation and restoration is performed. New developments, such as microscopic sugery, ultrasonic preparation and newly developed restorative materials are described in this article. Since there is a lack of well-designed comparative clinical studies, no definite conclusions can be drawn with regard to the clinical value of these modern techniques.
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ABSTRACT: The purpose of this systematic review was to compare the clinical and radiographic outcomes of nonsurgical retreatment with those of endodontic surgery to determine which modality offers more favorable outcomes. The study began with targeted electronic searches of MEDLINE, PubMed, and Cochrane databases, followed with exhaustive hand searching and citation mining for all articles reporting clinical and/or radiographic outcomes for at least a mean follow-up of 2 years for these procedures. Pooled and weighted success rates were determined from a meta-analysis of the data abstracted from the articles. A significantly higher success rate was found for endodontic surgery at 2-4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%; P < .05). At 4-6 years, however, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83.0% compared with 71.8% for endodontic surgery (P < .05). Insufficient numbers of articles were available to make comparisons after 6 years of follow-up period. Endodontic surgery studies showed a statistically significant decrease in success with each increasing follow-up interval (P < .05). The weighted success for 2-4 years was 77.8%, which declined at 4-6 years to 71.8% and further declined at 6+ years to 62.9% (P < .05). Conversely, the nonsurgical retreatment success rates demonstrated a statistically significant increase in weighted success from 2-4 years (70.9%) to 4-6 years (83.0%; P < .05). On the basis of these results it appears that endodontic surgery offers more favorable initial success, but nonsurgical retreatment offers a more favorable long-term outcome.Journal of endodontics 08/2009; 35(7):930-7. · 2.95 Impact Factor