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Abstract

Objectives: Endodontic microsurgery (EMS) is a treatment modality indicated when conventional endodontic treatment and nonsurgical retreatment fail to eradicate periapical pathology or when a biopsy is required. Certain factors are associated with the prognosis of EMS and the outcome predictors. This study aimed to (i) assess the level of EMS success; (ii) examine the association between the two radiographic methods (CBCT and PA) used and the EMS outcome; and (iii) investigate the associations between each prognostic factor and the success of the EMS outcomes obtained based on information gained from the periapical radiographs (PA) and cone beam computed tomography (CBCT) scans. Methods: Fifty-one patients (78 teeth) who received EMS at the University of British Columbia (UBC) between 2010-2021 were included. Clinical and radiographic examinations assessed the long-term treatment outcome and its potential determinants. Different prognostic factors were collected retrospectively and prospectively. Two calibrated Endodontists assessed the radiographic healing outcomes (success, failure, and survival) using PA and CBCT indices. The analyzed prognostic factors were age, gender, tooth location, tooth type, medical condition(s), quality of the coronal restoration, preoperative pulpal diagnosis, preoperative periapical diagnosis, presence of preoperative clinical symptoms, quality of RCT, untreated anatomy, maxillary sinus perforation, retro-filling material, biopsy, grafting, and sequence of the treatment. Univariate, bivariate, and logistic regression analyses were used to determine the prognostic factors affecting the EMS outcomes. Results: The survival rate was 91.02%. The success rate was 80.8% using CBCT and 83.3% using PA when cases with vertical root fracture (VRF) were included; and 82.9% using CBCT, and 85.5% using PA when VRF cases were excluded. The inter-examiner agreement was almost perfect using CBCT, and moderate agreement using PA (P