Does apical root resection in endodontic microsurgery jeopardize the prosthodontic prognosis?

Area of Science:

• Endodontics
• Prosthodontics
• Periodontics

Background:

• Apical surgery involves resecting the root apex, potentially creating an unfavorable crown-to-root ratio.
• The crown-to-root ratio is traditionally used to assess prognosis in periodontally compromised teeth.
• Apical root resection differs significantly from periodontal bone loss in its impact on tooth support.

Purpose of the Study:

• To critically evaluate the validity of the crown-to-root ratio in assessing the prognosis of apically resected teeth.
• To compare the effects of apical root resection with periodontal bone loss on tooth stability.

Main Methods:

• Review of existing literature on crown-to-root ratio, apical surgery, and biomechanics.
• Analysis of root morphology and stress distribution during mastication.
• Evaluation of endodontic microsurgery techniques and their impact on bone preservation.

Main Results:

• Conical root morphology means apical resection removes less surface area than linear length suggests.
• Masticatory stress is concentrated cervically, with minimal stress in the apical third, making apical resection less detrimental than periodontal bone loss.
• Osteotomy for apical resection can compromise buccal bone, increasing endo-perio communication risk.

Conclusions:

• The crown-to-root ratio is not a valid metric for evaluating the prosthodontic prognosis of apically resected teeth.
• Precise endodontic microsurgery, minimizing osteotomy width and preserving buccal bone, is crucial for successful outcomes and avoiding endo-perio communication.