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The influence of an isthmus on the outcomes of surgically treated molars: A retrospective study

 Sunil Kim  ;  Hoiin Jung  ;  Sooyun Kim  ;  Su-Jung Shin  ;  Euiseong Kim 
 JOURNAL OF ENDODONTICS, Vol.42(7) : 1029-1034, 2016 
Journal Title
Issue Date
Adult ; Aged ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Microsurgery ; Middle Aged ; Molar/anatomy & histology* ; Molar/surgery* ; Retrograde Obturation/methods* ; Retrospective Studies ; Surface Properties ; Treatment Outcome
Clinical outcome ; endodontic microsurgery ; isthmus ; root canal anatomy ; success rate
INTRODUCTION: The purpose of this study was to investigate the effects of an isthmus on the success rate of surgically treated molars. METHODS: The study included 106 maxillary and mandibular first molars with endodontic lesions limited to the periapical area. Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study. When an isthmus was observed after a high-magnification inspection, it was included in the retrograde preparation design. When an isthmus was not observed, only the main root canal space was prepared. The patients were followed up periodically every year after treatment. Success was defined as the absence of clinical signs and symptoms and radiographic evidence of complete or incomplete healing. RESULTS: Of the 106 teeth included in the study, 72 teeth had an isthmus, and 34 did not. Kaplan-Meier analysis revealed that the cumulative survival rate after surgery was 61.5% and 87.4% for 4 years when an isthmus was present and absent, respectively. A multivariate Cox proportional hazards regression analysis showed that the adjusted hazard ratio for failure was 6.01 times higher for the isthmus-present teeth than for the isthmus-absent teeth (P < .05). CONCLUSIONS: In this study, the success rate for endodontic microsurgery on isthmus-absent teeth was higher than that for isthmus-present teeth. Considering the success rate and potential risk of weakening the root after preparation, the techniques of isthmus preparation need to be improved.
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2. College of Dentistry (치과대학) > Dept. of Conservative Dentistry (보존과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Il(김선일) ORCID logo https://orcid.org/0000-0002-8889-9844
Kim, Soo Yun(김수연)
Kim, Eui Seong(김의성) ORCID logo https://orcid.org/0000-0003-2126-4761
Shin, Su Jung(신수정) ORCID logo https://orcid.org/0000-0001-5795-3919
Jung, Hoi In(정회인) ORCID logo https://orcid.org/0000-0002-1978-6926
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