Endodontic Surgery: A Review of Postoperative and Healing Outcome

Review Article

Austin J Surg. 2021; 8(1): 1260.

Endodontic Surgery: A Review of Postoperative and Healing Outcome

Gomes LCL1,2* and Dutra JC3

¹Department of Restorative Dentistry, Endodontic Division, Sao Paulo State University (Unesp), Institute of Science and Technology, Sao Jose dos Campos, Brazil

²Department of Dental Materials and Prosthodontics, Sao Paulo State University (Unesp), Institute of Science and Technology, Sao Jose dos Campos, Brazil

³Department of Endodontics, Sao Paulo University, School of Dentistry, Brazil

*Corresponding author: Gomes LCL, Department of Dental Materials and Prosthodontics, Sao Paulo State University (Unesp), Sao Jose dos Campos, Brazil

Received: December 01, 2020; Accepted: February 02, 2021; Published: February 09, 2021

Abstract

The purpose of this review was to give the reader an update about the postoperative period and healing outcome after surgical endodontic retreatment. Endodontic surgery has become a standard of care for dental maintenance if conventional endodontic retreatment is not able to eliminate the infection, it is important to know how to manage the post-surgical care; due it might directly interfere in the healing outcome after the surgical procedure. Based on the results of the present review, the postoperative period after the surgery treatment is very mild, without any complications, being similar to any dental surgical discomfort, as swelling, bleeding and pain, which could be easily controlled with simple medicine. Regarding the repair after endodontic surgery, the length of follow-up time and the healing evaluation criteria affect the outcome, and 1-year follow-up periods might be insufficient to predict a long-term healing.

Keywords: Apicoectomy; Endodontics; Postoperative Care; Postoperative Period; Wound Healing

Introduction

Initial root canal therapy has been shown to be a predictable procedure with a high degree of success [1-4], although, failures can occur after treatment. Some publications reported failure rates of 14%-16% for initial root canal treatment [1,5]. Lack of healing is attributed to persistent intraradicular infection residing in previously uninstrumented canals, dentinal tubules, or in the complex irregularities of the root canal system [6-9].

Typically, when conventional root canal treatment fails in clinical situations, the preferred subsequent option in most cases is nonsurgical retreatment. However, in some instances, other factors, such as a complex root canal system or previous accidents, may interfere with the success of non-surgical retreatment. In such cases, periradicular surgery is the treatment of choice in order to save the tooth [10].

Periradicular belongs to the field of endodontic surgery, and its aims to solve a periapical inflammatory process by surgical access followed by lesion enucleation and root filling. In order to preserve the dental element, in these cases, apicectomy is considered one of the best options [11]. Furthermore, the main objective of an endodontic surgery is to surgically maintain a tooth that has an endodontic lesion which cannot be resolved by non-surgical retreatment [12].

Regarding the success of endodontic surgery, it depends on the condition of the tooth. The prognosis of periradicular surgery is directly affected by the existing bone portion attached to the root framework. It is therefore important to know that the likelihood of success depends on the condition of the dental element [13].

The postoperative period of an endodontic surgery should occur as optimally as possible, so that repair of the periapical region could happen. As a surgical procedure, some discomfort may occur after the surgery, as swelling, pain, discoloration of the soft tissues and bleeding. The post-surgical management of the patient is important as the surgical management of the patient. Patients who do not receive adequate post-surgical instructions or who ignore these instructions are predisposed to untoward sequelae [14].

This literature review aims to give the reader an update about the postoperative period and healing outcome after a surgical endodontic treatment. The present paper is divided into three sections: Endodontic surgery definition and its indication, postoperative management and healing outcome.

Review

Endodontic Surgery: Definition and its Indication

If conservative therapy does not lead to healing after a reasonable follow-up, this failure indicates that the periapical lesion remained unchanged because the canal was not adequately treated and filled. If periapical pathology persists and/or treatment through the orthograde route is impracticable or exhausted, the endodontic surgery is indicated [15].

Endodontic surgery has become a standard of care for dental maintenance if conventional endodontic retreatment is not feasible or associated with risks. However, in certain situations, the outcome of endodontic surgery may be compromised or uncertain due to the extent or location of periapical or periradicular lesions [16].

The first endodontic surgery report was performed by Farrar & Brophy (1880) [17,18] who made the apicectomy (root resection) in the United States. Since then, his technique has been refined and this procedure has been practiced by both the general dentist and the special tyone [19,20].

Torabinejad et al. (1995) [15] report that if conservative therapy does not lead to healing after a reasonable follow-up, this failure indicates that the periapical lesion remained unchanged because the root canal was not adequately treated and filled. If periapical pathology persists and/or treatment through the orthograde route is impracticable or exhausted, endodontic surgery is indicated [15].

The work done by El Swiah and Walter (1996) [21] evaluated the clinical factors involved in the decision to perform an apicectomy, they concluded that a sum of technical and biological factors lead to 60% of apicectomies. The most common biological factors are: persistent symptoms, continuous presence of root lesions and persistent exudate (2%). Therefore, these factors must be taken into consideration when indicating the case for surgery [21].

Nishiyama et al. (2002) [22] state that parendodontic surgery (belongs to the field of endodontic surgery) is indicated when signs and/or symptoms remain after all possibilities of solution by endodontic treatments have been exhausted. The promotion of tissue repair through the elimination of the periapical pathological process is the goal of this surgery.

Von Arx (2011) [16] concluded that the evaluation of a case referred for apical surgery must always include a careful weighing of the advantages and disadvantages of surgical and non-surgical intervention. The indication for apical surgery must be based on a careful and thorough clinical and radiographic examination [16].

The endodontic surgery indications were recently updated by the European Society of Endodontics (ESE) (2006) [23] and include the following:

1. Radiological findings of apical periodontitis and/or symptoms associated with an obstructed canal (obstruction proved not to be removable, displacement did not seem feasible, or the risk of damage was very large).

2. Extruded material with clinical or radiological findings of apical periodontitis and/or persistent symptoms over a prolonged period.

3. Persistent or emerging disease after root canal treatment when root canal retreatment is inadequate.

4. Perforation of the root or pulp chamber floor, where treatment by the pulp cavity is impossible.

Kim and Kratchman (2006) [24] argue that a surgical approach is more conservative than a non-surgical treatment for certain cases. A common example is a tooth with acceptable endodontics and a new restoration with root retainer and crown, but a persistent or enlarged periapical lesion. Breaking or disassembling the crown, removing the retainer and retracting the channels would be more dramatic, longer, more expensive and less predictable than a root microsurgical approach. The indications for endodontic surgery in the articles included in this review are shown in Table 1.