title: 5-year results comparing mineral trioxide aggregate and adhesive resin composite for root-end sealing in apical surgery. A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Prognostic factors of clinical outcomes in endodontic microsurgery: a prospective study. [Periotest-analysis in penradicular surgery: preliminary results of a clinical-prospective study]. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery. Endoscopic endodontic microsurgery: 2-year evaluation of healing and functionality. Treatment outcome in endodontics: the Toronto study--phases 3, 4, and 5: apical surgery. Endoscopic periradicular surgery: a prospective clinical study. A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery. A prospective clinical study of polycarboxylate cement in periapical surgery A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery. Dentine-bonded resin composite (Retroplast) for root-end filling: a prospective clinical and radiographic study with a mean follow-up period of 8 years. [An endodontic ultrasonic system for apical endodontic surgery]. Endodontic surgery with ultrasonic retrotips: one-year follow-up. Endodontic surgery using 2 different magnification devices: preliminary results of a randomized controlled study. [Periradicular surgery with and without endoscopy: a prospective clinical comparative study]. Randomized clinical trial of root-end resection followed by root-end filling with mineral trioxide aggregate or smoothing of the orthograde gutta-percha root filling--1-year follow-up. Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study. Outcomes of periradicular surgery of maxillary first molars using a vestibular approach: a prospective, clinical study with one year of follow-up. Clinical outcome in periradicular surgery: effect of patient- and tooth-related factors--a multicenter study. A prospective, randomized, comparative clinical study of resin composite and glass ionomer cement for retrograde root filling [Periradicular surgery with endoscopy--a clinical prospective study]. Comparative evaluation of platelet-rich plasma and guided tissue regeneration membrane in the healing of apicomarginal defects: a clinical study. A Randomized Controlled Study of Mineral Trioxide Aggregate and Super Ethoxybenzoic Acid as Root-end Filling Materials in Endodontic Microsurgery: Long-term Outcomes. Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth. Effect of Platelet-rich Fibrin on Healing of Apicomarginal Defects: A Randomized Controlled Trial. The effectiveness of compomer as a root-end filling: a clinical investigation. Retrograde root filling with dentin-bonded modified resin composite. Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite. Correlation of bone defect dimensions with healing outcome one year after apical surgery. Quasi-likelihood estimation for relative risk regression models. Microscope versus endoscope in root-end management: a randomized controlled study. Periapical microsurgery: the effect of root dentinal defects on short- and long-term outcome.
abstract: INTRODUCTION Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design ed to re-examine a large sample of teeth treated with apical surgery after 5 years . METHODS Patients were recalled 5 years after apical surgery , and treated teeth were classified as healed or not healed based on clinical and radiographic examination . ( The latter was performed independently by 3 observers ) . Two different methods of root-end preparation and filling ( primary study parameters ) were to be compared ( mineral trioxide aggregate [ MTA ] vs adhesive resin composite [ COMP ] ) without r and omization . RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years ( dropout rate = 20.1 % ) . The overall rate of healed cases was 84.5 % with a significant difference ( P = .0003 ) when comparing MTA ( 92.5 % ) and COMP ( 76.6 % ) . The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories ( ie , sex , age , type of tooth treated , post/screw , type of surgery ) . CONCLUSIONS The results from this prospect i ve nonr and omized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing OBJECTIVE R and omized clinical prospect i ve study to evaluate the application of MTA and IRM as retro grade sealers in surgical endodontics . STUDY DESIGN One hundred single-rooted teeth were surgically treated . After r and omization , MTA or IRM was used as a retrosealer . Radiographs were taken 1 week , 3 months , and 1 year postoperatively . Assessment was performed by 2 independent assessors 1 year after surgery . Both treatment groups were homogeneous in their composition , and clinical features and radiographic findings were classified according to Rud 's classification . RESULTS Complete healing was observed in 64 % of the MTA-treated teeth vs 50 % of the IRM-treated teeth . Incomplete healing was seen in 28 % ( MTA ) vs 36 % ( IRM ) , and unsatisfactory in 6 % ( MTA ) vs 14 % ( IRM ) . Only 1 failure was seen ( MTA ) . No statistically significant differences were found between the 2 retrofilling material s. CONCLUSION As root-end filling material s in this clinical prospect i ve r and omized design on single rooted teeth , MTA and IRM had the same clinical effectiveness INTRODUCTION This prospect i ve study examined the potential prognostic factors of endodontic microsurgery and compared the predictors of an isolated endodontic lesion with those of both an isolated endodontic lesion and an endodontic-periodontal lesion . METHODS Data were collected from the Microscope Center of the Department of Conservative Dentistry at the Dental College of Yonsei University , Seoul , Korea , between March 2001 and March 2011 . A total number of 584 teeth were included , and all clinical procedures were performed by a single operator ( E.K. ) . The evaluation was performed at least 1 year after surgery . For statistical analysis of the predisposing factors , the chi-square test and logistic regression were performed . RESULTS Of the 584 cases treated , 431 cases came for recall after a period of at least 12 months . Sex ( female ) , tooth position ( anterior ) , arch type ( maxilla ) , and lesion type ( isolated endodontic lesion ) were found to have a positive effect on surgical outcome . With regards to isolated endodontic lesions , the tooth position ( anterior ) , arch type ( maxilla ) , and type of restoration ( single/splinted crown , short bridge , and removable partial denture abutment ) were found to be pure positive predictors . CONCLUSIONS In endodontic microsurgery , it is likely that preoperative factors , particularly the tooth position and arch type , have a greater influence on the healing outcome than intra- and post-operative factors The two objectives of the present study were : to assess the healing after periradicular surgery  using the Periotest device , and to compare the recorded Periotest values with the healing category determined after a one-year follow-up using radiographic and clinical criteria . In 43 patients with periradicular surgery ,  Periotest values  could be recorded pre- and postoperatively , as well as after six and twelve months . Cases with a successful healing , as determined at the one-year follow-up , demonstrated a continuous decrease of the Periotest values over time , whereas one-year failures showed increasing Periotest values over the study period . In control teeth , the Periotest values remained unchanged for the whole study period . It appears that the Periotest measurements correlate with the postoperative healing mode following periradicular surgery , and therefore , allow an additional assessment of the healing outcome OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review This clinical study prospect ively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery .  The study cohort included 194 teeth in an equal number of patients . Three teeth were lost for the follow-up ( 1.5 % drop-out rate ) .  Clinical and radiographic measures were used to determine the healing outcome . For statistical analysis , results were dichotomized ( healed versus nonhealed ) . The overall success rate was 83.8 % ( healed cases ) . The only individual predictors to prove significant for the outcome were pain at initial examination ( p=0.030 ) and other clinical signs or symptoms at initial examination ( p=0.042 ) , meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms . Logistic regression revealed that pain at initial examination ( odds ratio=2.59 , confidence interval=1.2 - 5.6 , p=0.04 ) was the only predictor reaching significance . Several predictors almost reached statistical significance : lesion size ( p=0.06 ) , retrofilling material ( p=0.06 ) , and postoperative healing course ( p=0.06 ) This prospect i ve clinical study aim ed to evaluate the benefits of the endoscope as an aid to root-end management , and to assess the treatment outcome during 2 years following surgery . Forty-three endodontic surgical procedures in 30 patients were performed with the aid of an endoscope and followed for a period of 2 years . Radiographic criteria and clinical evaluation were used to assess the outcome . All cases were evaluated in terms of healing and functionality . 91.1 % and 90.7 % of the teeth evaluated after 1 and 2 years , respectively , were classified as successful . We found no statistically significant differences for both healing and functionality between the 1- and 2-year evaluations . No difference related to tooth type or tooth location was found at the 2-year follow-up . Fisher 's exact test was used to statistically assess the difference between successful and unsuccessful cases for each of the variables considered . The endoscope can be an aid for endodontic surgical procedures in terms of both periapical healing and functionality up to 2 years follow-up INTRODUCTION The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate ; therefore , current evidence is required to support the prognosis of this important procedure . The objectives of this study were ( 1 ) to assess the long-term outcome of apical surgery and ( 2 ) to identify significant outcome predictors in Phases 3 - 5 of the Toronto Study , pooled with the previously reported Phases 1 and 2 . METHODS The 4- to 10-year outcome of apical surgery was prospect ively assessed by a blinded , independent , calibrated examiner and dichotomized as " healed " ( periapical index score < or=2 or scar ; no signs or symptoms ) or " diseased . " Teeth presenting without signs or symptoms were classified as " functional . " Multivariate analysis was performed to investigate outcome predictors , pooling Phases 3 - 5 ( n = 40 ) with Phases 1 and 2 ( n = 94 ) for improved power . RESULTS Of 261 treated teeth in the pooled sample , 96 were lost to follow-up , and 31 were extracted . Of the remaining 134 teeth ( 85 % recall , excluding 66 teeth that could not be recalled ) examined for outcome , 99 teeth ( 74 % ) were healed , and 126 teeth ( 94 % ) were functional . Three significant ( P < .05 ) outcome predictors were identified : age ( odds ratio [ OR ] , 2.5 ; confidence interval [ CI ] , 1.01 - 6.00 ; healed : > 45 years , 84 % , < or=45 years , 68 % ) , preoperative root-filling length ( OR , 3.4 ; CI , 1.34 - 8.76 ; healed : inadequate , 84 % ; adequate , 68 % ) , and size of the surgical crypt ( OR , 1.9 ; CI , 1.19 - 3.16 ; healed : < or=10 mm , 80 % ; > 10 mm , 53 % ) . CONCLUSIONS In this 4- to 10-year cohort study , the outcome was better in subjects > 45 years old , teeth with inadequate root-filling length , and crypt size of < or=10 mm We  did apicectomies  of 30 teeth with periradicular lesions in 23 patients , using a 3 mm endoscope . Two patients failed to attend for postoperative assessment and of the remaining 21 patients who had 28 teeth treated the operation was judged after 1 year to be a success in 26 ( 93 % ) INTRODUCTION The purpose of the present study was to evaluate the clinical outcomes of endodontic microsurgery when super ethoxy-benzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) and mineral trioxide aggregate ( MTA ) were used as root-end filling material s in a prospect i ve r and omized controlled study . METHODS Of the 388 teeth eligible for endodontic microsurgery , 128 teeth were excluded from the study , and 260 teeth were r and omly assigned to either the Super EBA group or the MTA group with equal numbers using the " minimization method . " Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study and were carried out by a single operator . The patients were followed up at 3 , 6 , and 12 months . The primary outcome measure was the change in the apical bone density at 12 months , and the secondary outcome measures were the presence of clinical symptoms or abnormal findings at 12 months . RESULTS A total of 192 teeth were examined at the 12-month follow-up ; 102 teeth were in the Super EBA group , and 90 were in the MTA group . The overall success rate was 94.3 % , with a success rate of 95.6 % ( 86/90 teeth ) for MTA and 93.1 % ( 95/102 teeth ) for Super EBA . The statistical analysis of the success rate results did not show any significant difference between the groups ( P = .472 ) . CONCLUSIONS In this prospect i ve r and omized controlled study , there was no significant difference in the clinical outcomes of endodontic microsurgery when Super EBA and MTA were used as root-end filling material Objective : To evaluate the clinical efficacy of polycarboxylate cement as retro grade filling material . Design : A prospect i ve clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes , in which polycarboxylate cement was used as retro grade filling material . Measurements were made of the area and diameter of the lesions pre- and postoperatively , and 6 and 12 months after the operation . The apical resection and retro grade filling areas were also measured , and the prognosis following surgery was recorded . Results : A total of 23 patients with 31 apicoectomized teeth were studied ( 2 patients being lost to follow-up ) . The mean area of the periapical lesions before surgery was 52.25 mm2 , with a mean major diameter of 6.1 mm and a mean lesser diameter of 4.8 mm . The success rate after 12 months was 54.7 % , according to the criteria of Von Arx and Kurt . The prognosis was poorer in females , in larger lesions , and in cases with larger retro grade filling areas . Conclusions : Polycarboxylate cement offers good results , with important bone regeneration after periapical surgery . Key words : Periapical surgery , endodontic treatment , polycarboxylate cement AIM To assess the success rate of the root-end filling material , Mineral Trioxide Aggregate ( MTA ) . METHODOLOGY Referred adult patients were recruited using strict entry criteria and r and omly allocated to receive MTA or IRM . A st and ardized surgical technique was employed : the root end was resected perpendicularly and a root-end cavity was prepared ultrasonically and filled . A radiograph taken immediately after surgery was compared with those taken at 12 and 24 months . Customised film holders and the paralleling technique were used ; radiographs were assessed by two trained observers using agreed criteria . The results from 122 patients ( 58 in IRM group , 64 in MTA group ) after 12 months and 108 patients ( 47 in IRM group , 61 in MTA group ) for the 24-month review period were analysed using the chi2 test . RESULTS The highest number of teeth with complete healing at both times was observed when MTA was used . When the numbers of teeth with complete and incomplete ( scar ) healing , and those with uncertain and unsatisfactory healing were combined , the success rate for MTA was higher ( 84 % after 12 months , 92 % after 24 months ) compared with IRM ( 76 % after 12 months , 87 % after 24 months ) . However , statistical analysis showed no significant difference in success between material s ( P > 0.05 ) at both 12 and 24 months . CONCLUSIONS In this study , the use of MTA as a root-end filling material result ed in a high success rate that was not significantly better than that obtained using IRM AIM To evaluate treatment outcome after using a resin composite ( Retroplast , RP ) in combination with a dentine-bonding agent ( GLUMA ) as root-end filling material after 1 year as well as after more than 5 years ( final examination ) . Also , the influence of various pre- , intra- and postoperative factors on the treatment outcome was studied . METHODOLOGY All patients ( 87 ) undergoing root-end resection consecutively treated by root-end filling with RP on an incisor , canine , pre-molar , or first molar ( 87 teeth , 118 roots ) were initially enrolled in the study .  RP was applied on the entire resected surface that was prepared to a slightly concave shape and after conditioning with EDTA and GLUMA . The treatment outcome involving subjective , clinical and radiographic parameters was evaluated after 1 year and at the final examination . A total of 27 patients ( 36 roots ) were excluded from the study because of unavailability of follow-up ( 19 ) and extraction of the operated tooth for reasons other than failed surgery ( 8) . Consequently , 60 patients ( 82 roots ) were included in the final material . The mean follow-up period at the final examination was 8 years ( range : 6.5 - 9 years ) . RESULTS The radiographic evaluation at the final examination revealed that 77 % , 5 % , 7 % and 11 % of the treated roots were characterized by complete , incomplete , uncertain and unsatisfactory healing , respectively . A total of 95 % of the roots classified as completely healed at the 1-year control were also completely healed at the final examination . Two roots ( 5 % ) showing complete healing at the 1-year control revealed unsatisfactory healing at the final examination because of displaced or lost RP-filling . Moreover , 60 % of the roots with uncertain healing at the 1-year control demonstrated complete or incomplete healing at the final examination . The classification according to subjective , clinical and radiographic parameters revealed that 78 % of the teeth were characterized by a successful treatment outcome at the final examination . Evaluation of the influence of various pre- , intra- and postoperative factors on the treatment outcome revealed that the radiographic classification at the final examination was exclusively influenced by the radiographic classification at the 1-year control ( P < 0.001 ) . CONCLUSIONS The present long-term study indicates that RP can be used for root-end filling with a successful treatment outcome Apical endodontic surgery is applied frequently following a failed conventional endodontic treatment . The apical preparation can be carried out conventionally using a round bur or using an endodontic ultrasonic system . The purpose of this study was to compare the outcome of the 2 treatment options by a r and omized prospect i ve clinical study . Patients ( n=399 ) were at r and om allocated to treatment using a conventional round bur or using an ultrasonic system ( P-max Newtron ) according to a for the rest similar treatment protocol . One year post treatment , the treatment outcomes were determined by 2 oral and maxillofacial surgeons , blinded for the treatment option . Adequate follow-up data were obtained from 290 patients . The overall success rate was 71 % in the patients treated conventionally and 81 % in the patients treated using the ultrasonic system . In molar teeth , the difference in success rate was statistically significant OBJECTIVE The purpose of this prospect i ve clinical study was to monitor the outcome of ultrasonic root-end preparation , in relation to tooth type and location , presence of post restoration and type of retrotip . STUDY DESIGN Teeth treated surgically showed a periradicular lesion of strictly endodontic origin . Fifty teeth were included in the study , according to specific selection criteria . Cases were followed for a period of 1 year and then classified in 3 groups ( success , uncertain healing , and failure ) according to radiographic and clinical criteria . RESULTS Of the 46 teeth evaluated at 1-year follow-up , 42 teeth ( 91.3 % ) successfully healed , 1 tooth had uncertain healing , and 3 failed . We found no statistically significant differences in treatment results related to the type of tooth , tooth location , post restoration , and type of retrotip .  CONCLUSION Adherence to a strict endodontic surgical protocol and the use of contemporary techniques and material s can lead to a predictable outcome PURPOSE The introduction of microsurgical instruments and magnification devices has brought advantages in root-end management and the application of root-end filling material s. The main purpose of this prospect i ve clinical study was to monitor the outcome of ultrasonic root-end preparation using magnification loupes or an endoscope . Tooth location and the presence of post restoration were also examined as potentially affecting the outcome . MATERIAL S AND METHODS Teeth treated surgically showed a periradicular lesion of strictly endodontic origin . A total of 59 patients were included in the study , according to specific selection criteria . Following the reflection of a full mucoperiosteal tissue flap , residual soft tissues were curetted , root ends were resected , and root-end cavities were prepared ultrasonically with a zirconium nitrate tip , and zinc oxide EBA-reinforced cement root-end fillings were placed . Thirty-two root-end management procedures were performed using magnification loupes and 39 using an endoscope . All cases followed for a period of 1 year were classified into 3 groups ( success , uncertain healing , and failure ) according to radiographic and clinical criteria . RESULTS Of the 71 teeth evaluated at 1-year follow-up , 67 teeth ( 92.95 % ) successfully healed , 3 teeth had uncertain healing , and 2 failed . In the group using endoscopy , 94.9 % of successful healing was achieved , while for the other group , 90.6 % was recorded . We found no statistically significant differences in treatment results related to the arch ( P = .20 ) , post restoration ( P = .21 ) , or type of magnification device ( P = .08 ) . CONCLUSIONS In the present study , adherence to a strict endodontic surgical protocol and the use of modern surgical endodontic procedures , together with visual magnifications , result ed in an overall high success rate A total of 129 teeth with periradicular surgeries ( apicoectomies ) were analyzed in a prospect i ve clinical study . In the test group including 62 teeth , an endoscope ( Tele-Otoscope with a 70 degrees viewing angle ) was used as an intraoperative visualization aid to monitor the following surgical steps : root-end resection , root-end cavity preparation and retro grade root-canal obturation . In the control group including 67 teeth , intraoperative diagnostics were carried out using micromirrors . Fifty-four and 61 teeth could be re-examined after one year . Based on the clinical and radiographic findings they were categorized as success , uncertain healing or failure . In the test group with endoscopy , the success rate was 88.9 % , whereas in the control group it was only 75.4 % . However , statistically no significant difference was found between the two groups . Additional experimental and clinical studies will show if endoscopy will improve the success rates in periradicular surgery any further AIM To compare healing after root-end resection with a root-end filling of mineral trioxide aggregate ( MTA ) or smoothing of the ortho grade gutta-percha ( GP ) root filling . METHODOLOGY Forty-four patients ( consisting of 52 teeth with periapical infection ) , average age of 54.6 years ( range 30 - 77 ) participated in a r and omized clinical trial ( RCT ) comparing the MTA and GP treatment methods . Radiographs produced 1-week and 12 months post-operatively were compared after blinding for treatment method , and healing was assessed as complete , incomplete , uncertain , or unsatisfactory . RESULTS Six teeth were not available for the 12-month follow-up : three teeth ( GP ) had been re-operated because of pain and two teeth ( one GP , one MTA ) had been extracted because of root fracture ( these five teeth were classified as failures ) . One patient ( GP ) was not available for recall . In the GP group , seven teeth ( 28 % ) showed complete healing , six teeth ( 24 % ) incomplete healing , six teeth ( 24 % ) uncertain healing and two teeth ( 8 % ) unsatisfactory healing after 1 year . In the MTA group , 22 teeth ( 85 % ) showed complete healing , three teeth ( 12 % ) incomplete healing , and none were scored as uncertain or unsatisfactory healing after 1 year . The difference in healing between the GP and the MTA groups was significant ( P < 0.001 ) . CONCLUSIONS The results from this RCT emphasize the importance of placing a root-end filling after root-end resection . Teeth treated with MTA had significantly better healing ( 96 % ) than teeth treated by smoothing of the ortho grade GP root filling only ( 52 % ) OBJECTIVE The aim of this study was to evaluate the healing outcome after periapical surgery with an ultrasonic cleaning technique in conjunction with the use of either of 2 different retro grade root-filling material s in teeth with apical periodontitis . STUDY DESIGN One hundred sixty teeth in 139 consecutive patients were r and omly allocated into 2 groups receiving either IRM or thermoplasticized gutta-percha ( GP ) with AH Plus sealer as a retro grade root-end seal . The patients were review ed 12 months after surgery . The results were analyzed with Fisher exact test . RESULTS One hundred forty-seven teeth in 131 patients were review ed . Radiologic evaluation and clinical examination showed an 85 % success rate for the IRM group and 90 % for GP group . There was no statistical significance between the 2 groups . CONCLUSION Both tested material s , IRM and GP , are suitable as retro grade root-end filling material s in conjunction with ultrasonic root-end preparation according to the results of the healing outcome after 12 months follow-up PURPOSE The aim of the present prospect i ve , r and omized , controlled , clinical study was to compare the outcomes of periradicular surgery of the maxillary first molar tooth using the vestibular approach between 2 preoperative radiologic evaluation methods : cone beam computed tomography ( CBCT ) and conventional radiography . PATIENTS AND METHODS Periradicular surgery was applied to the maxillary first molar tooth in 40 patients . The patients were divided into 2 groups . The patients in group 1 underwent examination and preoperative planning with CBCT , and the patients in group 2 underwent examination and preoperative planning with conventional radiography . The outcomes of the treatment were evaluated radiographically and clinical ly , and the data were analyzed statistically . RESULTS The mean operative time was significantly shorter in group 1 than in group 2 . According to the radiographic and clinical healing criteria used in the present study , the healing of patients in group 1 was rated as a success in 35 % , an improvement in 40 % , and a failure in 25 % . In the group 2 patients , healing was rated as a success in 42.1 % , an improvement in 31.6 % , and a failure in 26.3 % . Sinus membrane elevation was performed in 92.3 % of all patients . Sinus membrane perforation occurred in 20 % of the patients in group 1 and 36.8 % of the patients in group 2 . CONCLUSIONS Periradicular surgery of maxillary first molars using a vestibular approach is a viable treatment method with a low complication rate . Preoperative CBCT examination demonstrated positive contributions to the treatment outcomes OBJECTIVE To evaluate the effect of patient- and tooth-related factors on the outcome of apical surgery in a multicenter study . METHOD AND MATERIAL S A total of 281 teeth in 255 patients undergoing periradicular surgery  were investigated clinical ly and radiographically 6 to 12 months postoperatively . RESULTS The overall success rate was 88.0 % . Sex was a significant ( P = .024 ) predictor , with a success rate of 89.8 % in females and 84.0 % in males . The success rate was significantly higher in patients 31 to 40 years of age . The treatment of premolars result ed in a significantly higher success rate ( 91.9 % ) than the treatment of anterior teeth ( 86.1 % , P = .042 ) and molars ( 86.4 % , P = .026 ) . The loss of the buccal bone plate and the extension of apical osteolysis to the furcation area in molars result ed in a considerably lower success rate . Lesion size , preoperative pain , tenderness to percussion , fistula , and resurgery were significant factors . CONCLUSION There are several factors influencing the success rate of apical surgery that must be taken into account when considering apical surgery as a treatment alternative Abstract Objective . To compare the clinical and radiographic treatment outcome of retro grade root filling with either dentin-bonded resin composite ( Retroplast , RP ) or glass ionomer cement ( Chelon-Silver , CS ) . Study design . A prospect i ve , r and omized clinical study of 134 consecutive patients with indication of retro grade root filling of an incisor , canine , premolar , or first molar . Either RP or CS was chosen at r and om as retro grade filling material . Either material was applied onto the entire resection surface after prepared slightly concave . This preparation technique makes a sealing of the entire resection surface possible and prevents marginal contraction gaps during polymerization . A total of 122 patients were available for 1-year follow-up . Results . After 1 year the proportion of successful cases was significantly higher in the RP group ( 73 % ) than in the CS group ( 31 % ) ( p<0.001 ) . Doubtful healing with a need for a longer observation period was seen in 17 % of the RP cases and 19 % of the CS cases . The proportion of failures in the RP group ( 10 % ) was significantly lower than that in the CS group ( 50 % ) ( p<0.001 ) . Most of the unsuccessful  CS cases failed due to loosening of the retro grade filling . Conclusions . Dentin-bonded RP applied onto the entire , slightly concave resection surface is a predictable apical sealant characterized by a high success rate . In contrast , retro grade root filling with CS results in an unacceptably high failure rate due to insufficient bonding strength to the concave resection surface Using an endoscope in periradicular surgery provides an impressive optical enlargement and may lead to better clinical diagnostics and a high rate of success . Aims of this investigation were examining this hypothesis as well as detecting influencing factors . In 2002 and 2003 , 114 teeth of 91 patients were root-end resected using endoscope .  Before surgery , the tooth , number of resected root-ends , content of root channels , clinical diagnosis and moment of surgery were recorded . Patients were controlled one year after surgery and success was evaluated as a summary of clinical and radiological findings . Four patients did not reappear for the control examination . Out of 110 teeth , treatment was successful in 91.8 % and failed in 7.3 % . 0.9 % could not be classified . Statistically , more failures were noted after periradicular surgery in molars . The rate of success increased during the study by means of a learning curve . The results confirm the hypothesis that where using an endoscope periradicular surgery is highly successful INTRODUCTION The aim of the study was to compare the healing responses of platelet-rich plasma ( PRP ) , PRP + a collagen sponge , and a collagen membrane used as guided tissue regeneration ( GTR ) material s for the treatment of apicomarginal defects . METHODS Thirty patients with suppurative chronic apical periodontitis and apicomarginal communication were selected and allocated r and omly into three groups according to the barrier technique to be used during periradicular surgery : the collagen membrane group , the PRP group , and the PRP + collagen sponge group .  Clinical and radiographic measurements were determined at baseline and every 3 months after surgery up to 1 year . Cases were defined as healed when no clinical signs or symptoms were present , and radiographs showed complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The PRP and PRP + collagen sponge groups depicted 83.33 % and 88.89 % healing , respectively , in terms of combined clinical -radiographic healing as compared with 80 % in the collagen membrane group . All the three treatments showed highly significant ( P < .05 ) reductions in the periodontal pocket depth ( PD ) , the clinical attachment level ( CAL ) , the gingival margin position ( GMP ) , the size of the periapical lesion , the percentage reduction of the periapical rarefactions , and periapical healing . No significant differences between the three groups were evident for these parameters ( P > .05 ) . CONCLUSIONS GTR applied to apicomarginal defects using PRP or PRP + collagen sponge lead to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing , gain of periodontal support , PD reduction , and PRP may be an alternative treatment for GTR membrane in the treatment of apicomarginal defects INTRODUCTION The purpose of the present study was to evaluate the long-term clinical outcome of endodontic microsurgery when mineral trioxide aggregate ( MTA ) and super ethoxybenzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) were used as root-end filling material s. Additionally , this study aim ed to compare the clinical outcome of endodontic microsurgery at the 1-year follow-up with that at the 4-year follow-up . METHODS Two hundred sixty teeth were r and omly assigned to either the MTA or Super EBA group in equal numbers using the minimization method . Endodontic microsurgery was performed according to the Yonsei protocol . The previous study of 192 teeth examined at the 1-year follow-up revealed a success rate of 95.6 % for MTA and 93.1 % for Super EBA . Patients were recalled 4 years after surgery , and treated teeth were classified as successes or failures with Molven 's criteria . The Pearson chi-square test and the McNemar test were conducted to analyze and compare the success rates . RESULTS A total of 182 teeth were examined at the 4-year follow-up . The success rate was 91.6 % for MTA and 89.9 % for Super EBA . Statistical analysis of the success rate did not show any significant difference between the 2 material s ( P = .8 ) . The overall success rate at the 4-year follow-up was 89.5 % , which was slightly lower compared with 94.3 % at the 1-year follow-up . However , there was no significant difference between the follow-up periods ( P = .063 ) . CONCLUSIONS This study identified no significant difference in the 4-year success rates of MTA and Super EBA as root-end filling material s in endodontic microsurgery . Additionally , compared with short-term outcomes , long-term follow-up outcomes were not significantly different OBJECTIVE This study evaluated the treatment outcome after periapical surgery with the use of 2 different retro grade root-filling material s and the influence of 3 pre- and perioperative variables on the periapical healing . STUDY DESIGN Two hundred six teeth in 164 patients were r and omly allocated to receive either IRM or Super-EBA as a retro grade root-end seal . The teeth were review ed 12 months after surgery . The influence of lesion size , lesion type , and ortho grade root filling quality on healing was analyzed . RESULTS One hundred ninety-four teeth in 153 patients were review ed . Radiologic evaluation and clinical examination revealed 91 % success rate for the IRM group and 82 % for the Super-EBA group . There was no statistical significance in the healing outcome between the 2 groups ( Fisher exact test ) . The analyzed pre- and perioperative variables had no significant influence on the treatment outcome ( Z test ) . CONCLUSIONS Both retro grade material s tested in this study can serve as a root-end seal in periapical infected teeth , according to the results of the healing outcome after 12 months ' follow-up INTRODUCTION The purpose of this prospect i ve , r and omized controlled trial was to evaluate the healing outcomes of platelet-rich fibrin ( PRF ) in periapical surgeries involving apicomarginal defects and to compare these results with surgeries not using any guided tissue regeneration techniques . METHODS Thirty patients with suppurative chronic apical periodontitis and apicomarginal communication were r and omly assigned to either the PRF or the control group .  Clinical and radiographic parameters including pocket depth ( PD ) , clinical attachment level , gingival marginal position , size of periapical lesion , and percentage reduction of the periapical radiolucency were recorded at baseline and at an interval of 3 months for a period of 12 months . RESULTS The overall success rate was 83.33 % , with a success rate of 86.66 % ( 13 of 15 teeth ) for PRF group and 80 % ( 12 of 15 teeth ) for control group . Both the groups exhibited a significant reduction in PD , clinical attachment level , gingival marginal position , and size of periapical lesion at 12-month period . No significant differences were observed between the 2 groups for these parameters except PD , which showed a statistically significant reduction in the PRF group ( P < .05 ) . CONCLUSIONS The adjunctive use of regenerative techniques may not promote healing of apicomarginal defects of endodontic origin OBJECTIVE This study investigates the treatment outcome of a root-end filling technique that uses a light-cured compomer combined with a light-cured dental adhesive . STUDY DESIGN The study used 34 single-rooted teeth restored with post , core , and crowns . A shallow concave apical preparation was filled with a light-cured compomer with a light-cured dental adhesive . As a control , a chemically cured glass ionomer was used with a conventional root-end preparation . A follow-up clinical and radiographic evaluation of the treatment result was conducted after 1 year . RESULTS A significantly higher success rate ( P<.015 ) was observed in the treatment group that used a compomer ( 89 % complete healing ) compared to glass ionomer ( 44 % complete healing ) . CONCLUSIONS When used as a retro grade root filling in a shallow concave preparation , a light-cured compomer and a dental adhesive improves healing regardless of the quality of the remaining root filling A  retro grade root-end cover with a special resin composite ( Retroplast ) combined with the dentin bonding agent Gluma ( Bayer AG ) has been used since 1984 by the authors . Its content of silver , added to promote radiopacity , has been found to lower the working time and storage stability of the composite and might cause discolorations . Since 1990 , silver has therefore been replaced with ytterbium trifluoride , which eliminates these side effects . The purpose of this study was to compare the clinical results obtained with these two resin composites and to evaluate the healing results after several years in function . Apical fillings ( 351 ) with the modified Retroplast  showed the following radiographic healing pattern 1 yr after surgery : 80 % complete healing , 2 % scar tissue , 12 % uncertain healing , and 6 % failure . No significant difference in this healing pattern was found , compared with that obtained with the silver-containing Retroplast . Cases with ytterbium trifluoride classified as scar tissue and uncertain healing at 1 yr when examined at 2 to 4 yr postoperatively showed 89 % complete healing . 0 % scar tissue , 1 % uncertain healing , and 9 % failure . This result is significantly different from that obtained 1 yr after surgery . Based on calculations , it was predicted that with time 90 % will become complete healing , whereas 10 % will become failure INTRODUCTION The aim of apical surgery is to hermetically seal the root canal system after root-end resection , thereby enabling periradicular healing . The objective of this nonr and omized prospect i ve clinical study was to report results of 2 different root-end preparation and filling methods , ie , mineral trioxide aggregate ( MTA ) and an adhesive resin composite ( Retroplast ) . METHODS The study included 353 consecutive cases with endodontic lesions limited to the periapical area . Root-end cavities were prepared with sonic microtips and filled with MTA ( n = 178 ) , or alternatively , a shallow concavity was prepared in the cut root face , with subsequent placement of an adhesive resin composite ( Retroplast ) ( n = 175 ) . Patients were recalled after 1 year . Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The overall rate of healed cases was 85.5 % . MTA-treated teeth demonstrated a significantly ( P = .003 ) higher rate of healed cases ( 91.3 % ) compared with Retroplast-treated teeth ( 79.5 % ) . Within the MTA group , 89.5%-100 % of cases were classified as healed , depending on the type of treated tooth . In contrast , more variable rates ranging from 66.7%-100 % were found in the Retroplast group . In particular , m and ibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast . CONCLUSIONS MTA can be recommended for root-end filling in apical surgery , irrespective of the type of treated tooth . Retroplast should be used with caution for root-end sealing in apical surgery of m and ibular premolars and molars This clinical study prospect ively 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 mm(3 ) ) were compared with non-healed cases ( 554 mm(3 ) ) . 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 For a prospect i ve r and omized clinical trial with two groups , the relative risk can be used as a measure of treatment effect and is directly interpretable as the ratio of success probabilities in the new treatment group versus the placebo group . For a prospect i ve study with many covariates and a binary outcome ( success or failure ) , relative risk regression may be of interest . If we model the log of the success probability as a linear function of covariates , the regression coefficients are log-relative risks . However , using such a log-linear model with a Bernoulli likelihood can lead to convergence problems in the Newton-Raphson algorithm . This is likely to occur when the success probabilities are close to one . A constrained likelihood method proposed by Wacholder ( 1986 , American Journal of Epidemiology 123 , 174 - 184 ) , also has convergence problems . We propose a quasi-likelihood method of moments technique in which we naively assume the Bernoulli outcome is Poisson , with the mean ( success probability ) following a log-linear model . We use the Poisson maximum likelihood equations to estimate the regression coefficients without constraints . Using method of moment ideas , one can show that the estimates using the Poisson likelihood will be consistent and asymptotically normal . We apply these methods to a double-blinded r and omized trial in primary biliary cirrhosis of the liver ( Markus et al. , 1989 , New Engl and Journal of Medicine 320 , 1709 - 1713 ) The purpose of this prospect i ve , r and omized , clinical study was to monitor the outcome of periradicular surgery , in which either a surgical microscope or an endoscope was used as a magnification device . A total of 113 teeth in 70 patients were included in the study , according to specific selection criteria . The choice of endoscope or surgical microscope was made using a r and omized table . One hundred cases were followed for at least 2 years . Of these , 59 root-end management procedures were performed using a microscope and 41 using an endoscope . At the 2-year follow-up they were classified into three groups ( success , uncertain healing and failure ) according to radiographic and clinical criteria . After a 2-year follow-up , 91 teeth ( 91 % ) healed successfully . In the group using an endoscope 90 % of successful healing was achieved , while 92 % of success was recorded for the group using a microscope . No statistically significant difference was found in the treatment results relating to the type of magnification device . The type of magnification device used did not seem to affect the outcome of endodontic surgery INTRODUCTION The purpose of this prospect i ve clinical study was to evaluate the clinical outcome of endodontic microsurgery on roots exhibiting the presence or absence of dentinal defects at 1-year and 3-year follow-up period . METHODS One hundred fifty-five teeth were treated with periapical microsurgery  using a modern microsurgical protocol in a private practice setting . The root apices were resected and inspected for dentinal defects with a surgical operating microscope and a 0.8-mm head diameter light-emitting diode microscope diagnostic probe light . After inspection , root-end preparations were performed using ultrasonic tips , and root-end fillings were placed . Follow-up visits occurred at 1 year and 3 years postoperatively . The primary outcome measure used was the change in the radiographic apical bone density , and the secondary outcome measure used was the absence of clinical symptoms . RESULTS Of the 155 treated teeth , a total of 134 teeth were assessed at the 1-year follow-up and 127 teeth at the 3-year evaluation . In the " intact " group , 94.8 % healed at 1 year , and 97.3 % healed at 3 years . In the " dentinal defect " group , 29.8 % healed at 1 year , and 31.5 % healed at 3 years . The baseline root condition of either " dentinal defect " or " intact " showed a statistical difference in the healing outcome at both 1 and 3 years . CONCLUSIONS This prospect i ve periapical microsurgery study showed a significant superior clinical outcome for intact roots when compared with roots with dentinal defects at both 1 year and at 3 years postoperatively
target: Conclusions : The probability for success for EMS proved to be significantly greater than the probability for success for RES , providing best available evidence on the influence of cavity preparation with ultrasonic tips and /or SuperEBA ( Keystone Industries , Gibbstown , NJ ) , IRM ( Dentsply Sirona , York , PA ) , MTA , or silicate cements as root‐end filling material instead of a shallow cavity preparation and placement of a resin‐based material .
  HIGHLIGHTSEndodontic microsurgery ( EMS ) with the use of high‐magnification ultrasonic root‐end preparation and root‐end filling with SuperEBA , IRM , MTA , or other calcium silicate cements has a high probability of success .
  Resin‐based endodontic surgery with the use of high‐magnification preparation of a shallow concave root‐end cavity with bonded resin‐based root‐end filling material performed less favorably than EMS
background: Introduction : The aim of the present study was to investigate the influence of root‐end preparation and filling material on endodontic surgery outcome .