Endodontic Microsurgery - You Need it!

In a study published recently in the Journal of Endodontics, cases of failed endodontic surgery/apicoectomy were treated with re-surgery (Song et al. 2011). A 12 month follow up with a 77.8% recall rate showed success (defined as healed or healing) in 92.9% of the cases treated. By far, the most common likely causes of failure were a poorly placed root end filling or a lack of root end filling.

This study nicely demonstrated two things. Firstly, endodontic surgery performed under the operating microscope and using microsurgical techniques including ultrasonic retropreparation and biocompatible filling materials such as MTA or Super EBA has a high success rate. The other thing it shows is that endodontic surgery done poorly doesn’t work particularly well. I’ve previously shown a case where an apicoectomy had been performed with no retrofilling placed and no consideration for the biological cause of disease. It was doomed to failure the moment it was even considered.

Success rates for modern endodontic surgery are around the 90% mark (Tsesis et al. 2009). This is a massive improvement on the expected outcome for surgery using traditional means such as micro handpieces and amalgam for retrofilling. In another recent study it was found that, at least in America, endodontic surgery was the least expensive intervention for failed RCT when compared to endodontic re-treatment and crown, extraction and fixed partial denture, or extraction and implant (Kim & Solomon, 2011).

I’m all for implants in the appropriate situation, but they are expensive and treatment can extend over a number of months and quite a few visits. The same can be said for endodontic re-treatment. I guess the message here is that endodontic surgery performed by a competent Endodontist should be considered a first line treatment option when dealing with persistent endodontic disease.

References:

Kim S, Solomon C. Cost-effectiveness of Endodontic Molar Retreatment Compared with Fixed Partial Dentures and Single-tooth Implant Alternatives. J Endod 2011;37:321–325.

Song M, Shin S, Kim E. Outcomes of Endodontic Micro-resurgery: A Prospective Clinical Study. J Endod 2011; 37:316–320

Tsesis I, Faivishevsky V, Kfir A, Rosen E. Outcome of surgical endodontic treatment performed by a modern technique: a meta-analysis of literature. J Endod 2009; 35: 1505–11.