Prognostic Factors Affecting the Outcome of Surgical Root Canal Treatment—A Retrospective Cone-Beam Computed Tomography Cohort Study

Abstract

Aim: To assess the association between demographic and clinical variables and the outcome of root-end surgery using digital periapical radiographs (PA) and cone-beam computed tomography (CBCT). Methodology: One hundred and fifty teeth that received endodontic microsurgery were clinically and radiographically examined (PA and CBCT scans) after 1 and 2 years. Two calibrated endodontists evaluated the radiographic healing based on a six-point outcome classification. The outcome was classified using both strict (healed) and loose (healing) criteria. The success rates were calculated, and several outcome prognostic factors were assessed. Results: One hundred and fifty teeth were assessed with both radiographic systems. When “loose” success criteria were applied using PA, 90% (n = 135) of teeth were assessed as having had a favourable outcome (90%; 95% CI: 85.2–94.8%), whereas 90.7% (n = 136) of teeth showed a successful outcome when assessed with CBCT (90.7%; 95% CI: 86.0–95.3%). When “strict” success criteria were applied, there was a statistically significant difference (p = 0.018) between the success rates of mineral trioxide aggregate (MTA) (63.7%) and Biodentine (95.5%). Conclusions: Within the limitations of this study, endodontic microsurgery showed a high success rate. Among all the demographic and clinical variables assessed, in the multiregression analysis, only the use of Biodentine was associated with a higher proportion of “complete” healings compared to MTA or Intermediate Restorative Material (IRM) when assessed using CBCT. MTA and Biodentine performed similarly when “incomplete” healings were regarded as successful outcomes.