Surgical management of endodontic failures: indications and treatment results

Two-hundred and twenty-four teeth with failures after conventional endodontic treatment were treated by periapical surgery by one surgeon and followed up for 1-8 years. Indications for surgery were: inaccessibility to the apical part of the root by a coronal approach due to posts, calcifications or procedural accidents. Cysts, a few acute cases and wide-open apices were also treated surgically. Healing was judged radiographically and classified into one of four healing groups: (1) complete healing, (2) incomplete healing (scar tissue); (3) uncertain healing, and (4) unsatisfactory healing. The grouping was performed separately by the oral surgeon and an endodontist. Deviating cases were then evaluated jointly, difficult cases and borderline cases were judged by an oral radiologist. Complete healing was observed for 76.6 per cent and incomplete healing (scar tissue) for 8.1 per cent of the teeth. The size of the latter group was strongly influenced by the number of cases with large preoperative rarefaction. A success/failure grouping of the material (success = complete and incomplete healing) revealed that 27 per cent of the retrofilled cases failed compared with 3.6 per cent in the orthograde group. The main conclusion is that retrofills should be avoided whenever possible.