Outcome of orthograde retreatment after failed apicoectomy: use of a mineral trioxide aggregate apical plug

Johannes Mente; Meltem Leo; Annemarie Michel; Holger Gehrig; Daniel Saure; Thorsten Pfefferle

doi:10.1016/j.joen.2015.01.002

Outcome of orthograde retreatment after failed apicoectomy: use of a mineral trioxide aggregate apical plug

J Endod. 2015 May;41(5):613-20. doi: 10.1016/j.joen.2015.01.002. Epub 2015 Feb 18.

Authors

Johannes Mente¹, Meltem Leo², Annemarie Michel², Holger Gehrig², Daniel Saure³, Thorsten Pfefferle²

Affiliations

¹ Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. Electronic address: johannes.mente@med.uni-heidelberg.de.
² Division of Endodontics and Dental Traumatology, Department of Conservative Dentistry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.
³ Institute of Medical Biometry and Informatics, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.

PMID: 25702855
DOI: 10.1016/j.joen.2015.01.002

Abstract

Introduction: This controlled, single-center historic cohort study project evaluates treatment outcomes of a nonsurgical treatment approach after failed apicoectomy.

Methods: The treatment outcomes of nonsurgical retreatment after a failed apicoectomy were evaluated clinically and radiographically. The study cohort consisted of teeth that had received primary root canal treatment and subsequent apicoectomy elsewhere before the patients presented with post-treatment disease. Orthograde retreatment and obturation using an apical mineral trioxide aggregate plug was performed by postgraduate students and endodontic specialists in 25 cases between 2004 and 2012. Pre-, intra-, and postoperative information and the potential effect on the retreatment outcome were evaluated and statistically analyzed using the chi-square test.

Results: Twenty-two patients with 23 teeth attended the follow-up examinations (recall rate = 92%). The follow-up periods ranged from 12 to 102 months (median = 35 months). Twenty teeth (87%) were classified as "success," and 3 teeth were considered (17%) "failure." The chi-square test confirmed that the preoperative factor "number of roots" had a statistically significant effect on treatment outcome (odds ratio = 0.08; 95% confidence interval, 0-1.76; P = .03). The factor "tooth location" was of borderline significance (odds ratio = 0.1; 95% confidence interval, 0-2.14; P = .05).

Conclusions: The results of the present study suggest that orthograde retreatment combined with orthograde placement of an apical mineral trioxide aggregate plug is a promising long-term treatment option for teeth with postsurgical pathosis. The success rates were higher for single-rooted teeth. The use of cone-beam computed tomographic imaging in cases of inconclusive periapical radiographs is recommended to minimize the risk of misinterpretation when assessing treatment outcome.

Keywords: Failed apicoectomy; mineral trioxide aggregate; orthograde retreatment; treatment outcome.

MeSH terms

Adult
Aluminum Compounds*
Apicoectomy*
Calcium Compounds*
Drug Combinations
Female
Humans
Male
Middle Aged
Oxides*
Reoperation
Retrograde Obturation / methods*
Root Canal Filling Materials*
Silicates*
Treatment Failure
Treatment Outcome
Young Adult

Substances

Aluminum Compounds
Calcium Compounds
Drug Combinations
Oxides
Root Canal Filling Materials
Silicates
mineral trioxide aggregate