Results of apicoectomy of maxillary canines, premolars and molars with special reference to oroantral communication as a prognostic factor.

-_At total of 276 patients with 314 apicoectomized canines, premolars and molars from the maxilla were reviewed. Oroantral communication (OAC) was noted in 4J(13 %) of the cases. All patients were followed-up clinically and radiographically. The results of the operatior~ proved successful in 54 %, uncertain in 25 % and unsuccessful in 21%. No difference was found between the results in the OAC group and the rest of the material. The best results were noted for the canines, while the frequency of success was lowest for the first premolars. Such factors as retrograde root filling, the quality of the erthograde root filling, preoperative root resorption and the extent of periapical destruction had no demonstrable effect on the later course. In the group where the periapical lesion was a radicular cyst, the frequency of success was 25 % higher. I~ four o.f 26 cases the tomograms showed no bony partition between the apical region and the maxillary sinus. In three of these cases the result was regarded as successful on the basis of conventional radiographs. (Received for publication 27 March, accepted 30 June 1974) Various factors presumably capable of influencing the outcome of apicoectorny have been analyzed. Such factors are, for example, age and sex of the patient, tooth group, quali ty of the orthograde root filling, time of root filling in relation to operation, retrograde root filling, periodontal status, size of the periapical destruction, experience of the oral surgeon, etc.7,s,0,10,t2,18,14,15, I~, 1~,t8. However, oroantral communication (OAC) has not previously been studied for its effect on the prognosis. The results of apicoectomy of canines, premolars and molars in the maxilla were therefore studied with special reference to the effect of OAC on the prognosis. The effect of OAC on the status of the maxillary sinus was also studied. Material and methods NUMBER OF PATIENTS AND TEETH A total of 293 patients underwent apicoectomy of one or more teeth in the canine region and APICOECTOMY OF M A X I L L A R Y T E E T H Table 1. Survey of the material according to tooth group 387 No. of teeth (percentage) Tooth group Tota l Without OAC With OAC 3 [ 3 143 (92.3) 12 (7.7) 155 (100) 4 [ 4 73 (91.3) 7 (8.8) 80 (100) 5 ] 5 51 (73.9) 18 (26.1) 69 (100) 7 6] 6 7 6 (60.0) 4 (40.0) 10 (100) t o t a l 273 (86.9) 41 (13.1) 314 (100) distally in the maxilla at the Depar tment of Oral Surgery, Universi ty of Ume~ during the period 1958-1972. The series does not include reoperated eases. Seventeen patients had to be excluded because they could not be traced. This left 276 (97 men, 179 women) with 314 operated teeth. OAC was noted in 41 teeth (13%). The ages of the patients at operat ion varied between 12 and 71 years (mean 38.3 years). Table i gives the distribution of the material according to operated tooth and OAC. OAC is here to be unders tood as including not only those cases with distinct rupture of the sinus mucosa with communicat ion between the apical region and the maxillary sinus (n = 24), but also patients where the mucosa was intact ( n= 17). Patients with O A C underwent comple te sinus radiography, including tomography, in association with collection of the mater ia l ~t. T o m o graphy was done to obtain a more detai led picture of the regeneration of the bone in the region of the operation and of the re la t ion between the borders of the maxi l la ry sinus and the root of the operated tooth. F o u r tomographic sections were exposed at a distance of 2 ram. Altogether, 26 patients were examined in this way. The reasons why no t all of the patients with OAC were examined (n = 41, see "Material") were: a) the pa t ien t had moved away from the a rea (n = 3) and b) the tooth had been reoperated or extracted (n = 12) and thus the periapical status at the review was not related to the p r imary apicoectomy. S U R G I C A L P R O C E D U R E The operation was done in a conventional waylS, ze. The retrograde root filling material consisted of silver amalgam (n = 133), guttapercha (n = 11) or Cavit| (n = 8).