Authors: Rubinstein RA, Kim S.
Title: Short-Term Observation of the Results of Endodontic Surgery with the Use of a Surgical Operation Microscope and Super-EBA as Root-End Filling Material.
Journal: J Endod
Date: Jan 1999
Citation: 25(1): 43-48
Category: Endodontic Surgery
Evidence-based Ranking: 2
Purpose/Objectives: To determine the clinical success of endodontic surgery in anteriors, premolars, and molars using microsurgical techniques and Super-EBA.

Materials & Methods: 94 cases of strict endodontic origin were treated (31 molars, 31 premolars, 32 anteriors). The surgery techniques were performed with microscopic magnification, microscalpels, 2%lidocaine w/1:50k epi and 21% Stasis-Ferric Sulfate when needed, an Impact Air 45 handpiece, curettes and scalers, a 90-degree prep with a 170K tapered fissure bur, a Stropko Irrigator/Drier, and a piezo-ultrasonic with CT tips were used for apical preparation. Fast set Super-EBA mixed to a putty was used for all cases and condensed into the preps then carved with a cleoid discoid or curette and finished with a fluted finishing bur. The crypts were irrigated and flaps closed with 4-0 Supramid sutures (removed 24-48hrs post op). Recall radiographs were taken every 3 months for 1 year 2 months. Successful diagnosis was made when the lamina dura was restored or the case healed with a scar. Failures were those cases not fitting these criteria.

Results: The overall healing after 1 year and 2 months was 96.8%, with 6.38% healing by scar. One molar, premolar and anterior failed. The average healing time was 7.2 months. A healing time was dependent upon lesion size (larger lesions took longer to heal). 15% of lesions were cysts and 85% were granulomas – the time for healing slightly favored granulomas.

Author’s Conclusion: The potential reasons for success include: 1) strict selection criteria 2) conservative microsurgical osteotomy size was 4-5mm 3) curettes and scalers reduced surgical trauma 4) magnification allows better visualization of fins, isthmuses, accessory canals and canaliculi 5) ultrasonics allow axial preps within the anatomic pulp space 6) micromirrors 7) drying with a Stropko allows better visualization 8) Super-EBA. The authors attribute healing success primarily to the microsurgical techniques rather than the material used. The authors plan to follow-up the cases after a minimum of 5 years.

Validity of Conclusion: The results seem valid.

Reviewer’s Comments: This is a good article presenting microsurgical techniques.