A clinical study on treatment results of apicoectomy

In this study, the treatment results of apicoectomy with orthograde filling were compared with those of apicoectomy with retrograde gutta-percha filling and retrograde sponge gold filling. The long-term follow-up results of the teeth treated by apicoectomy are presented, and the possible prognostic factors are discussed. The healing process of the apical bone cavity was analyzed with standard X-ray techniques and image analysis system. One hundred nineteen teeth were apicoectomized with orthograde filling, 196 teeth with retrograde gutta-percha root filling and 42 teeth with sponge gold filling. There was no significant correlation between the treatment results and the sex or age of the patients, kinds of teeth, preoperative radiolucent areas, the number of operations or histopathological diagnosis of apical lesion. The success rate of apicoectomy with orthograde filling or apicoectomy with retrograde gutta-percha root filling was significantly higher than that with retrograde sponge gold filling. The filling materials and the operation method were considered to be the most important factors for a successful outcome. Bone reconstruction was found to start from the periphery of the bone cavity and the bone defect became gradually reduced in a star-like pattern. At 4 months after operation, in the successful cases, the area of bone cavity decreased 46-64% compared with before operation, but in the unsuccessful cases, the area did not change or increased 75-120%. Thus at 4 months after operation, it is possible to determine whether or not apicoectomy is successful.