Effectiveness of root resection techniques compared with root canal retreatment or apical surgery for the treatment of apical periodontitis and tooth survival: A systematic review
Stefano Corbella, Clemens Walter, Igor Tsesis
Surgical removal of a root has been proposed as a treatment for multi-rooted teeth with apical periodontitis, usually in cases of advanced, combined endodontic-periodontal lesions or severe periodontal disease affecting a single root. It may also be indicated in cases of horizontal or vertical root fracture, or in cases where non-surgical or surgical endodontic treatment of the affected root is impractical or unfeasible.
The aim of this systematic review was to analyze the effectiveness of root resection as a treatment for apical periodontitis, compared with non-surgical root canal retreatment or apical surgery. The focus was on studies with at least one-year follow-up after treatment, and studies which included both clinical and patient-reported outcomes. Although it could be argued that removal of the affected root would eliminate apical periodontitis, the review sought to analyze how this treatment compared with alternatives (non-surgical or surgical endodontic treatment) in terms of a range of outcomes including tooth survival, pain, swelling and tooth mobility.
The systematic review was performed using strict inclusion criteria, considering both comparative and non-comparative studies, and a systematic extraction of data from the included studies, followed by a quantitative synthesis of the results. Only three studies complied with the inclusion criteria and were coherent with the objectives of the review (Alassadi et al., 2020, Derks et al., 2018, El Sayed et al., 2020).
All three papers were based on retrospective cohort studies, two from Germany and one from the United States. Two were performed in an academic setting and one in a private dental office. In all studies, root resection was performed after non-surgical root canal treatment, in most cases for periodontal reasons. None of the studies presented comparative data on the effectiveness of different methods for the treatment of apical periodontitis but showed data only on the outcome of the procedure and the survival of the tooth.
Root resection was performed for endodontic reasons in 27.1% (n=23) of cases reported by Alassadi et al. (2020), 13.6% (n=11) reported by Derks et al. (2018), and 6.2% (n=8) reported by El Sayed et al. (2020). Tooth survival over time was reported in all studies, with follow-up ranging from 1 to 30 years.
Due to the heterogeneity of the studies and to the scarcity of data regarding the objective of the review, a narrative presentation of the results was chosen.
Survival of the root-resected multi-rooted teeth with localised advanced apical periodontitis ranged from 33-57% (Alassadi et al., 2020, Derks et al., 2018, El Sayed et al., 2020). Two of the studies reported separate information on the survival of teeth that had been root-resected for endodontic reasons, and the results indicated no difference in the survival of teeth that had received root resection for different reasons (Alassadi et al 2020, El Sayed et al., 2020)
The results of this systematic review indicate that evidence on the outcomes of root resection performed on multi-rooted teeth with localised advanced apical periodontitis is lacking and unclear. Recommendations cannot therefore be made on the choice of this intervention compared to alternatives including non-surgical and surgical endodontic retreatment. Further research is needed to longitudinally assess the effectiveness of root resection in terms of tooth survival, pain and mobility compared with alternative treatments. Future studies should include a more comprehensive assessment of the endodontic status of the tooth/root before intervention, more focus should be given to patient-reported outcomes and outcome data should be presented after a minimum one year of follow-up.
Stefano Corbella & Lise-Lotte Kirkevang
ESE Benefits of Endodontics Committee
Alassadi, M., Qazi, M., Ravidà, A., Siqueira, R., Garaicoa-Pazmiño, C. & Wang, H.L. (2020). Outcomes of root resection therapy up to 16.8 years: A retrospective study in an academic setting. Journal of Periodontology 91(4) 493-500.
Corbella, S., Walter, C., Tsesis, I. (2022). Effectiveness of root resection techniques compared with root canal retreatment or apical surgery for the treatment of apical periodontitis and tooth survival: A systematic review. International Endodontic Journal Aug 3. Doi: 10.1111/iej.13808.
Derks, H., Westheide, D., Pfefferle, T., Eickholz, P. & Dannewitz, B. (2018). Retention of molars after root-resective therapy: a retrospective evaluation of up to 30 years. Clinical Oral Investigations 22(3) 1327-1335.
Dommisch, H., Walter, C., Dannewitz, B. & Eickholz, P. (2020). Resective surgery for the treatment of furcation involvement: A systematic review. Journal of Clinical Periodontology 47 Suppl 22 375-391.
El Sayed, N., Cosgarea, R., Rahim, S., Giess, N., Krisam, J. & Kim, T.S. (2020). Patient-, tooth-, and dentist-related factors influencing long-term tooth retention after resective therapy in an academic setting-a retrospective study. Clinical Oral Investigations 24(7) 2341-2349.