Apical Surgery Survival Hit 89% Regardless of Root-End Filling Material

Edited by Dentaltown staff

Teeth treated with apical surgery survived at a rate of 89.1% over a mean follow-up of 6.6 years, with no meaningful difference between intermediate restorative material and hydraulic calcium silicate cements, according to a study published Aug. 24 in Clinical Oral Investigations.

Surgery was performed between 2012 and 2020. Of 336 teeth initially treated, 137 met the final inclusion criteria, with a mean follow-up of 6.6 years plus or minus 2.7 years. Intermediate restorative material was used in 72 teeth, or 52.6%, and hydraulic calcium silicate cements in 65, or 47.4%.

Healing was classified in four categories. Complete healing occurred in 84 teeth, or 61.3%, incomplete healing in 13, uncertain healing in 21, and unsatisfactory healing in 19. Fifteen teeth were extracted.

Complete healing was significantly associated with both tooth survival and the absence of late failure, at P less than .001. Late failures occurred in 10 teeth that had initially appeared successful, split evenly between the two materials at five each.

The investigators also assessed radiographic erosion of the root-end filling using an Erosion Index scored from 0 to 4. Erosion was detected in 20 teeth, or 14.6%, affecting 11.1% of intermediate restorative material cases and 18.5% of calcium silicate cases, with no significant difference between materials.

Teeth showing any erosion were less likely to achieve complete healing than teeth with none, at an odds ratio of 2.7 with a 95% confidence interval of 0.8 to 8.1.

Omar Hussain and Sivakami Rethnam Haug conducted the study. They wrote that clinical erosion of root-end filling materials has not been extensively investigated and warrants further research.

Two limits deserve attention. The confidence interval around the erosion odds ratio crosses 1.0, so the association is suggestive rather than firmly established. And only 137 of the 336 originally treated teeth met inclusion criteria, which leaves room for the surviving sample to differ from the full treated cohort.

Sources:
Clinical Oral Investigations, “Outcome and erosion of root-end filling materials following endodontic apical surgery: a minimum follow-up of 4 years,” published online Aug. 24, 2026: link.springer.com/10.1007/s00784-026-07090-5