Evaluating Outcomes and Prognostic Factors in Endodontic Microsurgery: A Retrospective Cohort Study

Outcome studies are essential for evidence-based endodontics. This study evaluates rates of radiographic periapical healing and survival to reintervention in endodontic microsurgery (EMS), along with the prognostic factors associated with these outcomes.

Dental records were reviewed to identify teeth treated with EMS at the University of Toronto between 1999 and 2021. Each tooth was tracked until the final follow-up (minimum of 1 year) or an untoward event. Radiographic periapical healing, survival, and their prognostic factors were analyzed using logistic and Cox regression, respectively. Median (interquartile range [IQR]), odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated (P < .05).

A total of 128 teeth met the criteria for radiographic periapical healing analysis, and 186 teeth were included in the survival analysis. The median follow-up time for radiographic periapical healing was 41.5 months (IQR: 27.8-72.9). At the latest follow-up, the overall radiographic periapical healing rate was 82.8%, and it was significantly associated with the absence of periodontal involvement (OR: 2.8, 95% CI: 1.1-7.7, P = .045) and root-end filling depth >2 mm (OR: 3.5, 95% CI: 1.2-9.6, P = .014). Median survival follow-up time was 37.5 months (IQR: 22.3-61.6); 86.6% of teeth survived without reintervention, 1.6% required treatment, and 11.8% were extracted. Age ≤45 (HR: 3.0, P = .036) and root-end filling ≤2 mm (HR: 4.3, P = .004) increased the risk of intervention.

Both radiographic periapical healing and survival rates following EMS are high. Prognostic factors were identified, which require confirmation in future studies.