Clinical Outcomes after Apical Surgery on the Palatal Root of the Maxillary First Molar Using a Palatal Approach

Clinicians are often reluctant to use the palatal approach in apical surgery for the maxillary first molar. This study aimed to investigate the outcomes and complications associated with apical surgery on the palatal root of the maxillary first molar by using a palatal approach.

We searched for patients who underwent apical surgery with a palatal approach on the palatal root of the maxillary first molar between March 2010 and September 2017 by a single operator. A total of 46 teeth from 46 subjects were included, and they were examined at 6 and 12 months after surgery and annually thereafter. To evaluate whether there was nerve damage on the surgical side, a pinprick test and cotton swab test were used with a 0-10 numerical rating scale, and the results were statistically compared by using the Wilcoxon signed-rank test.

Of the total 35 recall cases (recall rate, 76%; average follow-up time, 3.5 years), success was considered achieved in 32; 30 cases showed complete healing, and 2 had incomplete healing. Three cases resulted in failure, all occurring within 1 year after surgery. The pinprick test results showed that all the numerical rating scale scores were higher than 7, and the responses on the surgical site were not statistically different from those on the contralateral site (P = .109). All subjects showed normosensitivity to the cotton swab test.

Apical surgery on the palatal root of the maxillary first molar using a palatal approach was predictable and successful, and the number of complications resulting from artery and nerve damage was small.