Radiographic evaluation of cases referred for surgical endodontics

The aim of this study is to test the hypothesis that more patients with failed root-canal treatment or other endodontic problems are referred for periradicular surgery rather than nonsurgical re-treatment.

Three sets of 100 periapical radiographs representing typical cases referred for surgical treatment were collected in three departments of oral and maxillo-facial surgery situated in different parts of the Netherlands. Of these, a total of 278 radiographs were evaluated to determine whether endodontic surgery was indicated or whether the primary endodontic treatment or endodontic re-treatment was a realistic option. An oral and maxillo-facial surgeon, an endodontist and a general dental practitioner viewed the radiograph independently under standard conditions.

Overall, orthograde root-canal (re-)treatment was considered possible in 63% of the cases. The results differed between the three examiners with the oral surgeon reporting that 41% of cases were amenable to conventional treatment, for the general dental practitioner and the endodontists the figures were 67 and 80%, respectively.

Based on these observations, it is concluded that most of the teeth referred for surgical treatment to an oral surgeon could be treated by orthograde nonsurgical root-canal treatment.