Outcomes of root resection therapy up to 16.8 years: A retrospective study in an academic setting

The survival of periodontally treated molars in long-term maintenance: A systematic review and meta-analysis

AIM

This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated with molar loss among patients with periodontitis who received professional periodontal therapy and maintenance.

MATERIALS AND METHODS

Longitudinal studies with a minimum follow-up duration of 5 years published until 28 August 2023 were retrieved from the following databases: the Cochrane Library, Embase, MEDLINE and Web of Science. All included studies reported data on molar retention. Meta-analysis was performed using Review Manager 5.4. A modified version of the Newcastle-Ottawa Scale was used to evaluate the study quality. Statistical results of analyses of the overall survival rate and molar loss are presented as estimated standardized mean differences, whereas the results of the analyses of risk factors are presented as risk ratios with 95% confidence intervals (95% CIs).

RESULTS

From among the 1323 potentially eligible reports, 41 studies (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The pooled survival rate of the molars during maintenance therapy was 82% (95% CI: 80%-84%). The average loss of molars was 0.05 per patient per year (95% CI: 0.04-0.06) among the patients receiving long-term periodontal maintenance (PM) therapy. Fifteen factors were examined in this meta-analysis. Six patient-related factors (older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance) and five tooth-related factors (maxillary location, high probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality) were identified as risk factors for molar loss during maintenance therapy.

CONCLUSIONS

The findings of the present study suggest that the long-term retention of periodontally compromised molars can be achieved. The average number of molars lost per decade was <1 among the patients receiving long-term PM therapy. Older age, noncompliance, smoking, bruxism, diabetes, lack of private insurance coverage, maxillary location, furcation involvement, higher mobility, increase in the probing pocket depth and loss of pulpal vitality are strong risk factors for the long-term prognosis of molars.

Maxillary root amputation: Case report with a 14-year-follow-up and updated mini review

Root resection is performed to create a maintainable furcation area in teeth with advanced periodontitis. However, the long-term feasibility of this treatment remains controversial. We present a case in which distal root resection in a maxillary molar successfully preserved the form and function of the dentition for approximately 14 years.

Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline

BACKGROUND

The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease.

AIM

To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss.

METHODS

This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders.

RESULTS

The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed.

CONCLUSION

The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Effectiveness of root resection techniques compared with root canal retreatment or apical surgery for the treatment of apical periodontitis and tooth survival: A systematic review

BACKGROUND

To manage apical periodontitis in root filled maxillary and mandibular molars, root resection techniques may be employed to avoid the loss of the tooth.

OBJECTIVES

The objectives of the study were to systematically analyse the effectiveness of root resection techniques (root resection/crown resection/root amputation) for the management of apical periodontitis with non-surgical root canal retreatment or apical surgery by the evaluation of clinical and patient-related outcomes (PROMS), in human experimental studies and longitudinal studies.

METHODS

An electronic literature search in PubMed, MEDLINE via OVID interface, EMBASE and Cochrane Central, supplemented by a manual hand search of the grey literature, was performed up to 25th September 2021. Randomized controlled trials, comparative clinical trials and observational studies reporting on the outcome (tooth survival and patient-reported outcome measures with a minimum follow-up of 1 year) of root resection techniques for treating apical periodontitis were identified. The risk of bias was evaluated using the Newcastle-Ottawa scale.

RESULTS

From a total of 2098 reports, 36 were considered for further screening. Three retrospective studies, published between 2018 and 2020, were included in this systematic review. A high heterogeneity in terms of protocols, study design and the reported outcomes were observed. The risk of bias was scored as low to moderate. These three studies consisted of data from 305 resected teeth, from 254 patients, with a follow-up period of 1-16.8 years. Overall, 151 teeth were extracted during the follow-up period. In these studies, root resection treatment was carried out on 42 teeth exclusively for endodontic reasons. One of these studies reported 12 out of 23 teeth lost at follow-up. None of the studies reported on PROMS.

DISCUSSION

Although root resection techniques may be used for treating teeth with apical periodontitis, the data are limited. Furthermore, the studies are very heterogeneous and associated with high risk of bias.

CONCLUSIONS

Given the current level of available evidence, it is not possible to recommend, or dismiss, root resection techniques for managing apical periodontitis.

REGISTRATION

PROSPERO database (CRD42021260306).

Survival analysis of root-resected molars from 1 to 13.4 years: A retrospective cohort study

STATEMENT OF PROBLEM

While root resective therapy may extend the longevity of a molar, data on patient selection and outcomes of root resection are scarce.

PURPOSE

The purpose of this retrospective cohort study was to analyze the survival of root-resected molars and investigate factors affecting the decision and outcomes of the therapy.

MATERIAL AND METHODS

Patient- and tooth-related data from participants who had received root resection between 1999 and 2022 were collected. Cox regression was used to build predictive models for time-to-tooth loss based on predictors-initial diagnoses (carious, endodontic, periodontal, or endodontic-periodontal lesions), the presence of a complete-coverage crown, and the location of the tooth in the arch (P<.001).

RESULTS

Of 60 teeth, all from different participants, 31 molars were resected because of endodontic lesions. The failure rate was 35% with 21 teeth extracted. At 5 years, the survival probability was 0.58, considering all predictors. The survival of molars resected because of carious or endodontic lesions was significantly lower than those because of periodontal or endodontic-periodontal lesions (P<.05). The hazard ratio for tooth loss in the resected teeth was 15.6, 95% confidence interval (CI) (3.7 to 83.2) without complete-coverage crowns and 8.6, 95% CI (2.2 to 43.2) at the most posterior location.

CONCLUSIONS

Root resection provided to manage a localized periodontal lesion had the highest prognosis. The absence of a crown and the location as the most posterior tooth in the arch were associated with poor survival following resection.

Multivariate outcome evaluation of furcation-involved molars treated with non-surgical mechanical therapy alone or combined with open flap debridement: A retrospective study

BACKGROUND

This retrospective study assessed the effect of non-surgical and surgical mechanical therapy for furcation-involved molars.

METHODS

Furcation defects treated and followed for at least 1 year were selected. Data relative to the clinical outcomes were recorded. The immediate (3- to 6-month) clinical outcomes and the long-term survival of the treated molars were assessed. The potential variables influencing the treatment outcomes through multi-level regression analysis, and Cox Proportional-Hazards Models were also analyzed.

RESULTS

One hundred and eighty-four molars were included with an average follow-up of 7.52 years. At the 3- to 6-month re-evaluation 1.39 ± 0.99 mm pocket depth reduction, 0.88 ± 1.29 mm clinical attachment gain, and a 0.51 ± 1.13 mm increase in recession was observed. The 5- and 10-year survival rates were 88.3% and 61.3%, respectively. The horizontal and vertical extent of furcation involvement, baseline probing depth, mucoperiosteal flap elevation, and the frequency of supportive periodontal therapy influenced the clinical outcomes and tooth survival.

CONCLUSION

Non-surgical and surgical mechanical root debridement is a viable treatment for the management of furcation involved molars with shallow horizontal and vertical components.

Prognostic Factors of Grade 2-3 Endo-Periodontal Lesions Treated Nonsurgically in Patients with Periodontitis: A Retrospective Case-Control Study

Background

Endo-periodontal lesions are bacterial infectious diseases involving both the periodontal and pulp tissues with poor outcomes. It is hard for clinicians to predict their prognosis. The aim of this study is to investigate the factors affecting the prognosis of endo-periodontal lesions.

Methods

A total of 140 teeth diagnosed with grade 2-3 endo-periodontal lesions in patients with periodontitis were recruited in this study. They were divided into high and low responder groups, according to the clinical symptoms and parameters of the teeth involved after nonsurgical treatment of both the endodontic and periodontal components. Clinical parameters and symptoms were compared before and after treatment, and gender, age, smoking, and all clinical parameters were compared between high and low responder groups using univariate analyses. Logistic regression was applied to evaluate the independent effects on endo-periodontal lesion prognosis.

Results

Compared with the clinical parameters at baseline, the values of tooth mobility (TM), periapical index (PAI), and discomfort when chewing were decreased after endodontic therapy, and the values of periodontal probing depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI), TM, simplified oral hygiene index (OHI-S), full-mouth periodontitis severity, PAI, and discomfort when chewing were decreased after periodontal therapy. Univariate analysis revealed that smoking, PD, CAL, TM, PAI, clinical crown-root ratio (CR), full-mouth periodontitis severities, and the number of root canals were significantly different between the high and low responder groups (P < 0.05). The logistic regression analysis showed that smoking, PD, CAL, full-mouth periodontitis severities, and the number of root canals remained significantly associated with grade 2-3 endo-periodontal lesions in patients with periodontitis (P < 0.05). The logistic regression analysis showed that smoking, PD, CAL, full-mouth periodontitis severities, and the number of root canals remained significantly associated with grade 2-3 endo-periodontal lesions in patients with periodontitis (

Conclusions

and Practical Implications. High PD and CAL, multirooted teeth, smoking, and serious full-mouth periodontitis indicated a poor prognosis for teeth with grade 2-3 endo-periodontal lesions.