Prognostic Factors of Long-Term Outcomes in Endodontic Microsurgery: A Retrospective Cohort Study over Five Years

Abstract

The aim of this study was to analyze the long-term outcomes of endodontic microsurgeries in a cohort and identify their association with prognostic factors. A cohort of endodontic microsurgeries followed up periodically with complete clinical and radiographic records for at least 5 years were reviewed retrospectively. Their survival and healing status and profile characteristics were analyzed by Pearson chi-square test and logistic regression (α = 0.05) to identify prognostic factors that influenced outcomes. Of 652 cases in the cohort, 225 (34.5%) were included. The mean follow-up period was 90.4 months (range, 60–168 months). The long-term success rate was 80.5%, and the 5-year survival rate was 83.5%. Logistic regression showed higher success in anteriors compared to molars (OR = 5.405, (95% CI, 1.663–17.571; p = 0.005)) and in teeth with crown restorations (OR = 10.232, (95% CI, 3.374–31.024; p < 0.001)). Conversely, lower success was found in teeth with periodontal disease (OR = 0.170, (95% CI, 0.032–0.900; p = 0.037)) and maxillary sinus involvement (OR = 0.187, (95% CI, 0.035–0.994; p = 0.049)). Endodontic microsurgery has a highly favorable long-term outcome. Tooth position, crown restoration, periodontal disease, and maxillary sinus involvement were identified as main prognostic factors.

Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis

“…Then, the remaining 34 articles were subjected to full-text analysis to assess eligibility, with 21 articles being excluded [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] according to the reasons listed in Table S2 . Therefore, 13 articles were included in the qualitative assessment: one randomized controlled trial [ 8 ], four prospective cohort studies [ 13 , 14 , 15 , 51 ], and eight retrospective cohort studies [ 9 , 10 , 11 , 17 , 26 , 52 , 53 , 54 ]. For the quantitative analysis, only six articles were included: two prospective cohort studies [ 13 , 15 ] and four retrospective cohort studies [ 9 , 11 , 26 , 54 ].…”

“…The diagnostic criteria of endodontic-periodontal lesions differed between studies: some resorted to the classification proposed by Kim and Kratchman [ 9 , 11 , 13 , 15 , 26 , 54 ], others used the criteria of marginal bone loss or probing depth above 3 mm [ 10 , 14 , 51 , 52 , 53 ], alveolar dehiscence [ 8 ], and periodontal involvement [ 17 ].…”

“…The anesthetic protocol mostly included 2% lidocaine and 1:80,000 epinephrine. However, two studies used 2% lidocaine and 1:100,000 epinephrine [ 8 , 17 ] and other two 4% articaine and 1:100,000 epinephrine [ 14 , 53 ]. For additional hemostasis, epinephrine, ferric sulphate or aluminum chloride were used in some cases [ 9 , 10 , 13 , 14 , 15 , 17 , 26 , 51 , 52 , 53 , 54 ].…”

“…However, two studies used 2% lidocaine and 1:100,000 epinephrine [ 8 , 17 ] and other two 4% articaine and 1:100,000 epinephrine [ 14 , 53 ]. For additional hemostasis, epinephrine, ferric sulphate or aluminum chloride were used in some cases [ 9 , 10 , 13 , 14 , 15 , 17 , 26 , 51 , 52 , 53 , 54 ].…”

“…Additionally, root-end filling encompasses the placement of biocompatible materials which ensure a hermetic seal of the root canal system and enable healing as it forms an apical barrier between the affected root and surrounding tissues [ 7 , 11 , 13 , 14 , 15 , 16 ]. These surgical advancements allow EMS to be executed with precision and predictability, eliminating the difficulties associated with traditional endodontic surgery such as poor visualization, inaccurate root-end preparation and large osteotomy [ 15 , 16 , 17 ]. EMS success rate increased from 59% to 94% after the introduction of modern surgical techniques [ 18 ].…”