[Comparative studies with apicoectomy using various surgical techniques and filling materials]

Follow-up examinations were made retrospectively on 799 apicoectomized teeth from a group of patients with a total of 3,524 apicectomies, the mean postoperative interval of observation being 4.2 years. An intraoperatively orthograde root-canal filling was performed in 51.3%, an intraoperatively retrograde in 23.7% and a preoperative filling in 25.0% of the patients. Apart from 126 teeth that had already been extracted, a further 160 teeth had been clinically and/or radiologically conspicuous, so that a total of 286 failures was to be recorded. The dentally related success graphs computed according to Kaplan and Meier (1958) showed a significantly worse success probability for the preoperative filling compared to the two other techniques. With regard to the different materials employed in orthograde application, the silver filling had a higher and the guttapercha filling a less favourable success quota compared to a titanium filling. Moreover, in the retrograde method, amalgam resulted in a significantly higher success probability than glass ionomer cement. With an attendant cyst there was a significantly improved success quota over apical parodontitis or a renewed operation. With regard to the localization of apicectomies, maxillary front teeth attained the highest success rate. The present results point unequivocally to an unfavourable outcome after preoperative endodontics and underscore the good prognosis of an intraoperatively orthograde filling. Due to the fact that biocompatibility is in the forefront today, time-tested materials, such as silver and amalgam, are clearly being used less.