Root-end Surgery or Nonsurgical Retreatment: Are There Differences in Long-term Outcome?

Area of Science:

• Endodontics
• Dental Surgery
• Oral Health

Background:

• Secondary endodontic treatment decisions are complex and vary by clinician.
• Existing literature on the long-term survival of nonsurgical versus surgical retreatment is inconclusive.
• This study compares outcomes of nonsurgical retreatment and root-end surgery on teeth without prior retreatment.

Purpose of the Study:

• To compare the long-term tooth survival rates of nonsurgical retreatment versus root-end surgery.
• To investigate the influence of tooth type on treatment outcomes.
• To provide evidence for clinical decision-making in secondary endodontic therapy.

Main Methods:

• Retrospective analysis of insurance claims for 1021 teeth from 2008-2017.
• Survival analysis using Cox regression models, with untoward events defined as extraction or further surgery.
• Inclusion criteria limited procedures to those performed by endodontists.

Main Results:

• Nonsurgical retreatment survival rates were 90% (2yr), 86.8% (4yr), and 85% (6yr).
• Root-end surgery survival rates were 93.7% (2yr), 90.5% (4yr), and 88% (6yr).
• No statistically significant difference in survival was observed between nonsurgical retreatment and root-end surgery, irrespective of tooth type.

Conclusions:

• Clinicians may select either nonsurgical retreatment or root-end surgery for teeth with failed primary root canal therapy.
• Tooth location (anterior, premolar, molar) did not impact survival rates for either treatment modality.
• The findings support the use of both approaches in secondary endodontic treatment planning.