In this study, we compared outcomes of traditional
apicoectomy versus modern apicoectomy, by means of a controlled
clinical trial with a 5-year follow-up. The study investigated 938
teeth in 843 patients. On the basis of the procedure performed, the
teeth were grouped in 3 groups. Differences between the groups were
the method of osteotomy (type of instruments used), type of preparation
of retrograde cavity (different apicoectomy angles and instruments
used for root-end preparation), and root-end filling
material used (gray mineral trioxide aggregate or silver amalgam).
Outcome (tooth healing) was estimated after 1 and 5 years,
postoperatively. Clinical success rates after 1 year were 67% (306
teeth), 90% (186 teeth), and 94% (256 teeth) according to traditional
apicoectomy (group 1), modern microsurgical apicoectomy using
burns for osteotomy (group 2) or using piezo-osteotomy (group 3),
respectively. After 1 year, group comparison results were statistically
significant (P G 0.0001). Linear trend test was also statistically
significant (P G 0.0001), pointing out larger healing from group 1 to
group 3. After 5 years, teeth were classified into 2 groups on the basis
of root-end filling material used. Clinical success was 90.8% (197
teeth) in the silver amalgam group versus 96% (309 teeth) in the
mineral trioxide aggregate group (P G 0.00214). Multiple logistic
regression analysis found that surgical technique was independently
associated to tooth healing. In conclusion, modern apicoectomy
resulted in a probability of success more than 5 times higher (odds
ratio, 5.20 [95% confidence interval, 3.94Y6.92]; P G 0.001) compared
with the traditional technique