Traditional Endodontic Surgery Versus Modern Technique: A 5-Year Controlled Clinical Trial

In this study, we compared outcomes of traditionalapicoectomy versus modern apicoectomy, by means of a controlledclinical trial with a 5-year follow-up. The study investigated 938teeth in 843 patients. On the basis of the procedure performed, theteeth were grouped in 3 groups. Differences between the groups werethe method of osteotomy (type of instruments used), type of preparationof retrograde cavity (different apicoectomy angles and instrumentsused for root-end preparation), and root-end fillingmaterial used (gray mineral trioxide aggregate or silver amalgam).Outcome (tooth healing) was estimated after 1 and 5 years,postoperatively. Clinical success rates after 1 year were 67% (306teeth), 90% (186 teeth), and 94% (256 teeth) according to traditionalapicoectomy (group 1), modern microsurgical apicoectomy usingburns for osteotomy (group 2) or using piezo-osteotomy (group 3),respectively. After 1 year, group comparison results were statisticallysignificant (P G 0.0001). Linear trend test was also statisticallysignificant (P G 0.0001), pointing out larger healing from group 1 togroup 3. After 5 years, teeth were classified into 2 groups on the basisof root-end filling material used. Clinical success was 90.8% (197teeth) in the silver amalgam group versus 96% (309 teeth) in themineral trioxide aggregate group (P G 0.00214). Multiple logisticregression analysis found that surgical technique was independentlyassociated to tooth healing. In conclusion, modern apicoectomyresulted in a probability of success more than 5 times higher (oddsratio, 5.20 [95% confidence interval, 3.94Y6.92]; P G 0.001) comparedwith the traditional technique.