Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals

Key Points Molar apicectomy with amalgam root-end filling attracted an overall 5-year 'complete healing' rate of 57%. The results were best with mandibular first molars and worst with mandibular second molars. The prognosis was also better if there was 'good' orthograde root filling in situ at the outset, an associated radicular cyst rather than apical granulomatous change and where the buccal sulcus was deep rather than shallow. It was worse when orthograde root filling was absent and when there was disease at the furcation. The apical ends of the roots were commoner sites of failure than the furcation. Purely lateral failure was not seen. The significant complication was impaired sensation in the lower lip following mandibular molar apicectomy. This occurred for a variable period in 20–21% of cases. A permanent deficit followed in 1%. There was a three-fold increase in the frequency of the latter after second molar apicectomy compared with first molar apicectomy. 'Complete healing' at 1 year was maintained in 75% of cases at 5 years. Aim To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. Design Multicentre, prospective study. Setting The departments of oral and maxillo-facial surgery in two district general hospitals. Method One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974–1995. A five-year review of each operated tooth was carried out or attempted between 1979–2000. Results Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the abs