Surgical Intervention in Teeth with Obstructed Root Canals: 10-Year-Survival

Stagnating or progressing periapical pathosis in teeth with root canal fillings is conventionally treated by orthograde access. In cases of coronal obstruction due to post restorations a technique of surgical access and lateral obturation of the root canal is described. Root canal preparation is performed by cutting a slot into the tooth root to gain access to the unfilled part of the root canal. For this type of endodontic surgery there are no long time studies of survival and failure reasons available. Objectives: Therefore, the aim of this study was to evaluate the indication, survival time over a 10 year period and cause of failure of teeth which have undergone this type of endodontic surgery. Material and Methods: After surgical intervention according to the described technique 18 teeth in 15 patients were followed up clinically and radiographically over 10 years. All teeth were maxillary incisors and canines. When the endodontic surgery was performed, the average age of the patients was 37 years. In all cases, indication for surgical intervention was due to a periapical inflammation demanding revision of the unfilled segment of the root canal apical to a cast post. Results: There was a drop out of one case. Two teeth were removed within the 10 year period because of a subsequent root fracture. One restoration needed refixation. All complications occurred within the first 5 years. Probing depth, tooth mobility and other periodontal parameters were similar to contra lateral untreated teeth. Patients did not describe restrictions in function, fistulation or other clinical symptoms of inflammation. Conclusions: Due to an acceptable survival rate the lateral access technique is an alternative to apicectomy in endodontically compromised teeth. Case selection is determined by tooth morphology and bone structure to minimise the risk of root fracture.