Correlation of Bone Defect Dimensions with Healing Outcome One Year after Apical Surgery


      This clinical study prospectively evaluated the healing outcome 1 year after apical surgery in relation to bony crypt dimensions measured intraoperatively. The study cohort included 183 teeth in an equal number of patients. For statistical analysis, results were dichotomized (healed versus non-healed cases). The overall success rate was 83% (healed cases). Healing outcome was not significantly related to the level and height of the facial bone plate. In contrast, a significant difference was found for the mean size of the bony crypt when healed cases (395 mm3) were compared with non-healed cases (554 mm3). In addition, healed cases had a significantly shorter mean distance (4.30 mm) from the facial bone surface to the root canal (horizontal access) compared with non-healed cases (5.13 mm). With logistic regression, however, the only parameter found to be significantly related to healing outcome was the length of the access window to the bony crypt.

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        • Kim S.
        • Kratchman S.
        Modern endodontic surgery concepts and practice: a review.
        J Endod. 2006; 32: 601-623
        • Skoglund A.
        • Persson G.
        A follow-up study of apicoectomized teeth with total loss of the facial bone plate.
        Oral Surg Oral Med Oral Pathol. 1985; 59: 78-81
        • Hirsch J.M.
        • Ahlstroem U.
        • Henrikson P.A.
        • Heyden G.
        • Peterson L.E.
        Periapical surgery.
        Int J Oral Surg. 1979; 8: 173-185
        • Grung B.
        • Molven O.
        • Halse A.
        Periapical surgery in a Norwegian county hospital: follow-up findings of 477 teeth.
        J Endod. 1990; 16: 411-417
        • Jansson L.
        • Sandstedt P.
        • Laftman A.C.
        • Skoglund A.
        Relationship between apical and marginal healing in periradicular surgery.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83: 596-601
        • Wesson C.M.
        • Gale T.M.
        Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.
        Br Dent J. 2003; 195: 707-714
        • Lustmann J.
        • Friedman S.
        • Shaharabany V.
        Relation of pre- and intraoperative factors to prognosis of posterior apical surgery.
        J Endod. 1991; 17: 239-241
        • Danin J.
        • Strömberg T.
        • Forsgren H.
        • Linder L.E.
        • Ramsköld L.O.
        Clinical management of nonhealing periradicular pathosis: surgery versus endodontic retreatment.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82: 213-217
        • Rahbaran S.
        • Gilthorpe M.S.
        • Harrison S.D.
        • Gulabivala K.
        Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91: 700-709
        • Wang N.
        • Knight K.
        • Dao T.
        • Friedman S.
        Treatment outcome in endodontics: the Toronto study—phases I and II: apical surgery.
        J Endod. 2004; 30: 751-761
        • von Arx T.
        • Jensen S.S.
        • Haenni S.
        Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery.
        J Endod. 2007; 33: 123-128
        • Rud J.
        • Andreasen J.O.
        • Jensen J.E.M.
        Radiographic criteria for the assessment of healing after endodontic surgery.
        Int J Oral Surg. 1972; 1: 195-214
        • Molven O.
        • Halse A.
        • Grung B.
        Observer strategy and the radiographic classification of healing after endodontic surgery.
        Int J Oral Maxillofac Surg. 1987; 16: 432-439
        • Zuolo M.L.
        • Ferreira M.O.F.
        • Gutmann J.L.
        Prognosis in peririadicular surgery: a clinical prospective study.
        Int Endod J. 2000; 33: 91-98
        • Fleiss J.L.
        • Cohen J.
        The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability.
        Educ Psychol Meas. 1973; 33: 613-619
        • Cohen J.
        A coefficient of agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 37-46
        • Holm S.
        A simple sequentially rejective multiple test procedure.
        Scand J Statist. 1979; 6: 65-70
        • Nagelkerke N.J.
        A note on a general definition of the coefficient of determination.
        Biometrika. 1991; 78: 691-692
        • Dietrich T.
        • Zunker P.
        • Dietrich D.
        • Bernimoulin J.P.
        Apicomarginal defects in periradicular surgery: classification and diagnostic aspects.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94: 233-239
        • Harrison J.W.
        • Jurosky K.A.
        Wound healing in the tissues of the periodontium following periradicular surgery.
        J Endod. 1991; 17: 544-552
        • von Arx T.
        • Cochran D.L.
        Rationale for the application of the GTR principle using a barrier membrane in endodontic surgery: a proposal of classification and literature review.
        Int J Periodontics Restorative Dent. 2001; 21: 127-139
        • Dietrich T.
        • Zunker P.
        • Dietrich D.
        • Bernimoulin J.P.
        Periapical and periodontal healing after osseous grafting and guided tissue regeneration treatment of apicomarginal defects in periradicular surgery: results after 12 months.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 474-482
        • Jensen S.S.
        • Nattestad A.
        • Egdo P.
        • Sewerin I.
        • Munksgaard E.C.
        • Schou S.
        A prospective, randomized, comparative clinical study of resin composite and glass ionomer cement for retrograde root filling.
        Clin Oral Investig. 2002; 6: 236-243
        • Halse A.
        • Molven O.
        • Grung B.
        Follow-up after periapical surgery: the value of the one-year control.
        Endod Dent Traumatol. 1991; 7: 246-250
        • Jesslén P.
        • Zetterqvist L.
        • Heimdahl A.
        Long-term results of amalgam versus glass ionomer cement as apical sealant after apicectomy.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 79: 101-103