Long-term Follow-up for Apical Microsurgery of Teeth with Core and Post Restorations

Abstract

Introduction: Orthograde retreatment was recommended before apical surgery to achieve high success rates. The aim of this study was to determine the success rates of apicoectomy of core and post-restored teeth without prior root canal retreatment followed for up to 13 years.

Methods: Seventy-three patients with 87 teeth with apical periodontitis underwent apical microsurgery from 2004 to 2006 at the Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria. After 1.5-5 years and 10-13 years, 85 and 49 teeth, respectively, were followed up by 4 independent, calibrated examiners. Absolute and relative frequencies of the dichotomous outcome (healed vs nonhealed) were analyzed considering patient-, tooth-, and treatment-related factors. The significance of the obtained values was determined with the chi-square and Fisher exact tests.

Results: All of the 85 (100%) investigated teeth were in situ 1.5-5 years after surgery, whereas only 49 of 62 analyzed teeth (79%) remained after 10-13 years. Radiologically documented periapical healing was 97.6% (83/85 teeth) for the first follow-up period but decreased to 75.8% (47/62 teeth) by the second follow-up. Smokers showed significantly worse results after 10-13 years. None of the other investigated potential influencing factors significantly affected results.

Conclusions: This clinical study showed that apical microsurgery on teeth with core and post restoration using Intermediate Restorative Material (Dentsply Caulk, Milford, DE) as filling material achieves excellent results after 1.5-5 years (97.6%) and still shows good results after 10-13 years (75.8%). Accordingly, it is a reliable alternative to root canal retreatment, eliminating the risk of post removal-related complications.

Keywords: Apical microsurgery; chronic apical periodontitis; core and post restoration; follow-up; radiograph.