Key Points
-
Molar apicectomy with amalgam root-end filling attracted an overall 5-year 'complete healing' rate of 57%.
-
The results were best with mandibular first molars and worst with mandibular second molars. The prognosis was also better if there was 'good' orthograde root filling in situ at the outset, an associated radicular cyst rather than apical granulomatous change and where the buccal sulcus was deep rather than shallow. It was worse when orthograde root filling was absent and when there was disease at the furcation.
-
The apical ends of the roots were commoner sites of failure than the furcation. Purely lateral failure was not seen.
-
The significant complication was impaired sensation in the lower lip following mandibular molar apicectomy. This occurred for a variable period in 20–21% of cases. A permanent deficit followed in 1%. There was a three-fold increase in the frequency of the latter after second molar apicectomy compared with first molar apicectomy.
-
'Complete healing' at 1 year was maintained in 75% of cases at 5 years.
Abstract
Aim To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling.
Design Multicentre, prospective study.
Setting The departments of oral and maxillo-facial surgery in two district general hospitals.
Method One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974–1995. A five-year review of each operated tooth was carried out or attempted between 1979–2000.
Results Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20–21% of mandibular molar procedures. In the majority of cases (79–80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy.
Conclusions Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Kim S, Pecora G, Rubinstein RA . Colour atlas of microsurgery in endodontics. Philadelphia: W. B Saunders Co. 2001, pp. 95ff.
Carr GB . Ultrasonic root-end preparation. In Kim S. (Ed) 'Microscopes in Endodontics' Dent Clin N Amer 1997; 41: 541–554.
Rud J, Munksgaard EC, Andreasen JO, Rud V . Retrograde root filling with composite and a dentine-bonding agent. Part II. Endod Dent Traumatol 1991; 7: 126–131.
Rud J, Rud V, Munksgaard EC . Periapical healing of mandibular molars after root-end sealing with dentine-bonded composite. Int Endod J 2001; 34: 285–292.
Torabinejad M, Pitt Ford TR, McKendry DJ, Abedi HR, Miller DA, Kariyawasam SP . Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys. J Endod 1997; 23: 225–228.
Kim S, Pecora G, Rubinstein RA . Colour atlas of microsurgery in endodontics. Philadelphia: W B Saunders Co. 2001, pp.19, 127.
Saunders WP . Personal communication, 2001.
Altonen M, Mattila K . Follow-up study of apicectomised molars. Int J Oral Surg 1976; 5: 33–40.
Persson G . Periapical surgery of molars. Int J Oral Surg 1982; 11: 96–100.
Ioannides C, Borstlap WA . Apicectomy on molars: a clinical and radiographic study. Int J Oral Surg 1983; 12: 73–79.
Rud J, Andreasen JO, Möller Jensen JE . A follow-up study of 1,000 cases treated by endodontic surgery. Int J Oral Surg 1972; 1: 215–228.
Andreasen JO, Pitt Ford TR . A radiographic study of the effect of various retrograde fillings on periapical healing after replantation. Endod Dent Traumatol 1994; 10: 276–281.
Friedman S . Treatment outcome and prognosis of endodontic therapy in Ørstavik. D, Pitt Ford T R. (Ed.) Essential Endodontology. Oxford: Blackwell Science, 1998, pp367–401.
Siqueira JF . Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J 2001; 24: 1–10.
Sjögren U . Success and failure in endodontics. Umeo Univ. Odontological Dissertation. 1996 (Abst.60); 13f,24.
Swartz DB, Skidmore AE, Griffin JA . Twenty years of endodontic success and failure. J Endod 1983; 9: 198–202.
Smith CS, Setchell DJ, Harty FJ . Factors influencing the success of conventional root canal therapy: a five-year retrospective study. Int Endod J 1993; 26: 321–333.
Friedman S, Löst C, Zarrabian N, Trope M . Evaluation of success and failure after endodontic therapy using a glass ionomer cement sealer. J Endod 1995; 21: 384–390.
Peak JD, Hayes SJ, Bryant ST, Dummer PMH . The outcome of root canal treatment: A retrospective study within the Armed Forces (Royal Air Force). Br Dent J 2001; 190: 140–144.
Engström B, Hard AF, Segerstad L, Ramstrom G, Frostell G . Correlation of positive cultures with the prognosis for root canal treatment. Odontologisk Revy 1964; 15: 257–270.
Strindberg LZ . The dependence of the results of pulp therapy on certain factors: an analytic study based on radiographic and clinical follow-up examinations. Acta Odont Scand 1956; 14: Suppl 21.
Grahnen H, Hansson L . The prognosis of pulp and root canal therapy: a clinical and radiographic follow-up examination. Odontologisk Revy 1961; 12: 146–165.
Heling B, Tamshe A . Evaluation of the success of endodontically treated teeth. Oral Surg 1970; 30: 533–536.
Dummer PMH . The quality of root canal treatment in the general dental services. Dent Profile (J Dent Pract Board Eng Wales) 1997; 17: 5–6.
Simon JHS, Glick DH, Frank AL . The relationship of endodontic-periodontic lesions. J Periodontol 1972; 43: 202–208.
Rud J, Andreasen JO, Möller Jensen JE . Radiographic criteria for the assessment of healing after endodontic surgery. Int J Oral Surg 1972; 1: 195–214.
Kramer IRH . President's address: changing views on oral disease. Proc Roy Soc Med 1974; 67: 273.
Reit C . The influence of observer calibration on radiographic periapical diagnosis. Int Endod J 1987; 20: 75–81.
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.
Kramer IRH . The vascular architecture of the human dental pulp. Arch Oral Biol 1960; 2: 177–189.
Lowman JV, Burke RS, Pelleu GB . Patent accessory canals: incidence in the molar furcation region. Oral Surg 1973; 36: 580–584.
Gutmann JL . Prevalence, location and patency of accessory canals in the furcation region of molars. J Periodontol 1978; 49: 21–26.
Vertucci FJ, Anthony RL . A scanning electron microscopic investigation of accessory foramina in the furcation and pulp chamber floor of molar teeth. Oral Surg 1986; 62: 319–326.
Niemann RW, Dickinson GL, Jackson CR, Wearden S, Skidmore AE . Dye ingress in molars: furcation to chamber floor. J Endod 1993; 19: 293–296.
Pineda F, Kuttler Y . Mesio-distal and bucco-lingual roentgenographic investigation of 7,275 root canals. Oral Surg 1972; 33: 101–110.
De Deus QD . Frequency, location and direction of the lateral, secondary, and accessory canals. J Endod 1975; 1: 361–366.
Kirkham DB . The location and incidence of accessory pulpal canals in periodontal pockets. J Am Dent Assoc 1975; 91: 353–356.
Hession RW . Endodontic morphology: A radiographic analysis. Oral Surg 1977; 44: 610–620.
Welch JD, Anderson RW, Pashley DH, Weller N, Kimbrough WF . An assessment of the ability of various materials to seal furcation canals in molar teeth. J Endod 1996; 22: 608–611.
Saunders WP, Saunders EM . Assessment of leakage in the restored pulp chamber of endodontically treated multi-rooted teeth. Int Endod J 1990; 23: 28–33.
Chong BS, Pitt Ford TR, Kariyawasam SP . Tissue response to potential root-end filling materials in infected root canals. Int Endod J 1997; 30: 102–114.
Peters LB, Wesselink PR, Buijs JF, Van Winkelhoff AJ . Viable bacteria in root dentinal tubules of teeth with apical periodontitis. J Endod 2001; 27: 76–81.
Gilheany PA, Figdor D, Tyas MJ . Apical dentine permeability and microleakage associated with root-end resection and retrograde filling. J Endod 1994; 20: 22–26.
Pitt Ford TR, Andreasen JO, Dorn SO, Kariyawasam SP . Effect of IRM root-end fillings on healing after replantation. J Endod 1994; 20: 381–385.
Skoner JR, Wallace JA, Fochtman F, Moore PA, Zullo T, Hoffman RD . Blood mercury levels with amalgam retroseals: a longitudinal study. J Endod 1996; 22: 140–141.
Chong BS, Pitt Ford TR, Karyawasam SP . Short-term response to potential root-end filling materials in infected root canals. Int Endod J 1997; 30: 240–249.
Berry TG, Summitt JB, Chung AKH, Osborne JW . Amalgam at the new millennium. J Am Dent Assoc 1998; 129: 1547–1556.
Ghafouri SN, Ball PC, Fitch RK . The in-depth sealing properties of amalgam and composite restorative materials. Br Dent J 1982; 153: 400–403.
Thirawat J, Edmunds DH . The sealing ability of materials used as retrograde root fillings in endodontic surgery. Int Endod J 1989; 22: 295–298.
Chong BS, Pitt Ford TR, Watson TF, Wilson RF . Sealing ability of potential retrograde root filling materials. Endod Dent Traumatol 1995; 11: 264–269.
Friedman S, Lustmann J, Shaharabany V . Treatment results of apical surgery in premolar and molar teeth. J Endod 1991; 17: 30–33.
Kersten HW, Wesselink PR, Van Velzen T . The diagnostic reliability of the buccal radiograph after root canal filling. Int Endod J 1987; 20: 20–24.
Rud J, Andreasen JO . A study of failures after endodontic surgery by radiographic, histologic and stereomicroscopic methods. Int J Oral Surg 1972; 1: 311–328.
Pitt Ford TR, Roberts GJ . Tissue response to glass ionomer retrograde root fillings. Int Endod J 1990; 23: 233–238.
Rud J, Andreasen JO, Möller Jensen E . A multivariate analysis of the influence of various factors upon healing after endodontic surgery. Int J Oral Surg 1972; 1: 258–271.
Grung B, Molven O, Halse A . Periapical surgery in a Norwegian county hospital; follow-up findings in 477 teeth. J Endod 1990; 16: 411–417.
Harty FJ, Parkins BJ, Wengraf AM . The success rate of apicectomy. Br Dent J 1970; 129: 407–413.
Rud J, Rud V, Munksgaard EC . Effect of root canal contents on healing of teeth with dentine-bonded resin composite retrograde seal. J Endod 1997; 23: 535–541.
Danin J, Linder LE, Lundqvist G, Ohlsson L, Ramsköld LO, Strömburg T . Outcome of periradicular surgery in cases with apical pathosis and untreated canals. Oral Surg Oral Med Oral Path 1999; 87: 227–232.
Nordenram A, Svärdström G . Results of apicectomy. Swed Dent J 1970; 63: 593–604.
Hirsch JM, Ahlstrom U, Henrikson P, Heyden G, Peterson L . Periapical surgery. Int J Oral Surg 1979; 8: 173–185.
Lustmann J, Friedman S, Shaharabany V . Relation of pre- and intra-operative factors to prognosis of posterior apical surgery. J Endod 1991; 17: 239–241.
McCall JO, Wald SS . Clinical Dental Roentgenology. 3rd ed. Philadelphia: W B Saunders Co. 1952, p.192.
Mattila K, Altonen M . A clinical and roentgenological study of apicoectomised teeth. Odontol Tidskr 1968; 76: 389–407.
Ericson S, Finne K, Persson G . Results of apicectomy of maxillary canines, premolars and molars with special reference to oro-antral communication as a prognostic factor. Int J Oral Surg 1974; 3: 386–393.
Persson G, Lennartson B, Lundström I . Results of retrograde root filling with special reference to Amalgam and Cavit as root filling materials. Swed Dent J 1974; 67: 123–134.
Mikkonen M, Kullaa-Mikkonen A, Kotilainen R . Clinical and radiologic re-examination of apicoectomised teeth. Oral Surg Oral Med Oral Pathol 1983; 55: 302–306.
Rahbaran S, Gilthorpe NS, Harrison SD, 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 Path 2001; 91: 700–709.
Nair PNR, Sjögren U, Schumacher E, Sundqvist G . Radicular cyst affecting a root-filled human tooth; a long-term post-treatment follow-up. Int Endod J 1993; 26: 225–233.
Nair PNR, Pajarola G, Schroeder HE . Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81: 93–102.
Nair PNR . Review: new perspectives on radicular cysts: do they heal? Int Endod J 1998; 31: 155–160.
Nair PNR, Sjögren U, Figdor D, Sundqvist G . Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments and periapical scars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87: 617–627.
Simon JHS . Incidence of periapical cysts in relation to the root canal. J Endod 1980; 6: 845–848.
Priebe WA, Lazansky JP, Wuehrmann AH . The value of the roentgenographic film in the differential diagnosis of periapical lesions. Oral Surg Oral Med Oral Pathol 1954; 7: 979–983.
Bhaskar SN . Periapical lesions: types, incidence and clinical features. Oral Surg Oral Med Oral Pathol 1966; 21: 657–671.
Lalonde ER . A new rationale for the management of periapical granulomas and cysts: an evaluation of histopathological and radiographic findings. J Am Dent Assoc 1970; 80: 1056–1059.
Skoglund A, Persson G . A follow-up study of apicectomised teeth with total loss of the buccal bone plate. Oral Surg Oral Med Oral Pathol 1985; 59: 78–81.
Safavi KE, Dowden WE, Langeland K . Influence of delayed coronal permanent restoration on endodontic prognosis. Endod Dent Traumatol 1987; 3: 187–191.
Ray HA, Trope M . Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J 1995; 28:12–18
Acknowledgements
This work was partly supported by funding from the NHS Executive Eastern Region. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive Eastern Region. The authors would like to thank Professor T. R. Pitt Ford for his valued critique of the manuscript together with his numerous suggestions for improvement. They would also like to express their appreciation to Dr I. R. Harris for his helpful advice and to acknowledge the important assistance of those dental colleagues who provided follow-up data for some of the patients. Finally, they would like to record their gratitude to Joanne Spatz for the word-processing. In addition to the first author the surgery was carried out by Ms E. Rapaport, Drs. R. Chauhan, M. Kumar, S. Bass, A. G. Buchanan, T. Cudmore, M. Goodliffe, I. R. Harris, S. C. Jack, J. Munns, S. Pinto, T. Rajah and S. Rashid.
Author information
Authors and Affiliations
Corresponding author
Additional information
Refereed Paper
Rights and permissions
About this article
Cite this article
Wesson, C., Gale, T. Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals. Br Dent J 195, 707–714 (2003). https://doi.org/10.1038/sj.bdj.4810834
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.4810834
This article is cited by
-
Anatomical analysis of mandibular posterior teeth for endodontic microsurgery: a cone-beam computed tomographic evaluation
Clinical Oral Investigations (2021)
-
Outcome of nonsurgical retreatment and endodontic microsurgery: a meta-analysis
Clinical Oral Investigations (2015)
-
Trigeminal nerve injuries after mandibular oral surgery in a university outpatient setting—a retrospective analysis of 1,559 cases
Clinical Oral Investigations (2015)
-
Endodontic surgery prognostic factors
Evidence-Based Dentistry (2011)
-
Surgical endodontic treatment under magnification has high success rates
Evidence-Based Dentistry (2010)
