Apical surgery may cause gingival recession

Two hundred forty-two subjects were treated with apical surgery from 2000 to 2004. All subjects were operated on by the same clinician. One hundred eighty-six subjects were later reevaluated. The study consisted of 102 female and 84 male patients. The mean age of the patients was 49.7 years (range, 9-81 years). Most of the 56 cases lost to follow-up did not want to participate at the follow-up exam (n = 23) or the treated tooth was extracted before the follow-up exam (n = 15).

Key study factors included gender, age, smoking status, treated tooth type, restoration presence, apical surgery incision procedure (intrasulcular, papilla-base, or submarginal), and healing status. Healing status was evaluated clinically and radiographically.

The main outcome measures were the evaluation of probing depth, clinical attachment level, and recession in patients who were treated with apical surgery for endodontic periapical lesions. Measurement of these periodontal parameters was taken at time of the surgery and 1 and 5 years after the initial treatment. The most relevant change was recession on the facial and lingual surfaces of the teeth that had been operated on.

Relevant changes were seen only for gingival recessions that had a mean value of about 0.3 mm. These changes were present at the 1-year postoperative exam and did not modify until the 5-year follow-up. Probing depth was not affected by the apical surgery procedure. Clinical attachment level (probing depth + recession) was affected as a consequence of the apically displaced gingival margin. Age, sex, smoking habit, and periapical healing had influence on the periodontal parameters. The most important factor, however, was the kind of incision used for the periapical surgery. Overall, baseline to 5-year changes in gingival recession for the facial aspect of treated teeth observed for intrasulcular, papilla-base, and submarginal incision procedures were 0.47 mm, 0.31 mm, and 0.12 mm, respectively.

The authors conclude that periapical surgery may cause gingival recession.