Advertisement

Clinical Oral Investigations

, Volume 22, Issue 3, pp 1327–1335 | Cite as

Retention of molars after root-resective therapy: a retrospective evaluation of up to 30 years

  • Hermann Derks
  • Derk Westheide
  • Thorsten Pfefferle
  • Peter Eickholz
  • Bettina Dannewitz
Original Article
  • 332 Downloads

Abstract

Objectives

Long-term retention of teeth and especially molars in function is the ultimate goal of periodontal therapy. Root-resective therapy is a treatment option for molars with advanced furcation involvement, which has been questioned because of the heterogenous success rates published in literature. This study aimed to evaluate long-term results of root-resective treatment over a period of up to 30 years.

Methods

In this retrospective cohort, 90 root-resected molars in 69 patients were examined for 4–30 years (14.7 ± 6.8 years). The complete treatment sequence was performed by one of the authors in a general dental practice.

Results

Overall cumulative survival rate was 90.6% after 10 years, but then decreased considerably. Molars after root resection had a median survival time of 20 years. The incidence of endodontic complications leading to tooth extraction was only 26.7%, 50% were lost due to periodontal problems, and 16.7% because of caries. Mandibular molars had a significantly lower relative risk of loss than molars in the maxilla (HR 0.31, 95% CI 0.1–0.91, p = 0.033). Mandibular molars showed a survival probability of almost 80% even 20 years after root resection.

Conclusion

Root-resective therapy is a predictable treatment option, when care is administered at each phase of therapy.

Clinical relevance

This study provides important information about what is possible in daily practice under the outlines of public health care, when care is administered at each phase of resective therapy.

Keywords

Resective therapy Tooth loss Tooth survival Tooth retention Molar Long-term results 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent was not required.

References

  1. 1.
    McGuire MK, Nunn ME (1996) Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. J Periodontol 67:666–74lCrossRefPubMedGoogle Scholar
  2. 2.
    Dannewitz B, Krieger JK, Husing J, Eickholz P (2006) Loss of molars in periodontally treated patients: a retrospective analysis five years or more after active periodontal treatment. J Clin Periodontol 33:53–61lCrossRefPubMedGoogle Scholar
  3. 3.
    Salvi GE, Mischler DC, Schmidlin K, Matuliene G, Pjetursson BE, Bragger U, Lang NP (2014) Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy. J Clin Periodontol 41:701–77lCrossRefPubMedGoogle Scholar
  4. 4.
    Graetz C, Schutzhold S, Plaumann A, Kahl M, Springer C, Salzer S, Holtfreter B, Kocher T, Dorfer CE, Schwendicke F (2015) Prognostic factors for the loss of molars—an 18-years retrospective cohort study. J Clin Periodontol 42:943–50lCrossRefPubMedGoogle Scholar
  5. 5.
    Dannewitz B, Zeidler A, Husing J, Saure D, Pfefferle T, Eickholz P, Pretzl B (2016) Loss of molars in periodontally treated patients: results 10 years and more after active periodontal therapy. J Clin Periodontol 43:53–62lCrossRefPubMedGoogle Scholar
  6. 6.
    Carnevale G, Pontoriero R, Hürzeler MB (1995) Management of furcation involvement. Periodontol 2000 9:69–89lCrossRefGoogle Scholar
  7. 7.
    DeSanctis M, Murphy KG (2000) The role of resective periodontal surgery in the treatment of furcation defects. Periodontol 22:154–68lCrossRefGoogle Scholar
  8. 8.
    Livada R, Fine N, Shiloah J (2014) Root amputation: a new look into an old procedure. The New York state dental journal 80:24–8lPubMedGoogle Scholar
  9. 9.
    Huynh-Ba G, Kuonen P, Hofer D, Schmid J, Lang NP, Salvi GE (2009) The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol 36:164–76lCrossRefPubMedGoogle Scholar
  10. 10.
    Orstavik D, Kerekes K, Eriksen HM (1986) The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 2:20–34lCrossRefPubMedGoogle Scholar
  11. 11.
    Liang YH, Li G, Wesselink PR, Wu MK (2011) Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans. J Endod 37:326–31lCrossRefPubMedGoogle Scholar
  12. 12.
    Miller PD Jr (1985) A classification of marginal tissue recession. Int J Periodontics Restorative Dent 5:8–13lPubMedGoogle Scholar
  13. 13.
    Henderson R, Omar P (1999) Effect of frailty on marginal regression estimates in survival analysis. Journal of the Royal Statistical Society B61:367–379lCrossRefGoogle Scholar
  14. 14.
    Bergenholtz A (1972) Radectomy of multirooted teeth. J Am Dent Assoc 85:870–875CrossRefPubMedGoogle Scholar
  15. 15.
    Klavan B (1975) Clinical observations following root amputation in maxillary molar teeth. J Periodontol 46:1–5CrossRefPubMedGoogle Scholar
  16. 16.
    Hamp SE, Nyman S, Lindhe J (1975) Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol 2:126–135CrossRefPubMedGoogle Scholar
  17. 17.
    Langer B, Stein SD, Wagenberg B (1981) An evaluation of root resections. A ten-year study. J Periodontol 52:719–22lCrossRefPubMedGoogle Scholar
  18. 18.
    Erpenstein H (1983) A 3-year study of hemisectioned molars. J Clin Periodontol 10:1–10lCrossRefPubMedGoogle Scholar
  19. 19.
    Bühler H (1988) Evaluation of root-resected teeth. Results after 10 years. J Periodontol 59:805–10lCrossRefPubMedGoogle Scholar
  20. 20.
    Carnevale G, Di Febo G, Tonelli MP, Marin C, Fuzzi M (1991) A retrospective analysis of the periodontal-prosthetic treatment of molars with interradicular lesions. Int J Periodontics Restorative 11:189–205Google Scholar
  21. 21.
    Basten CH, Ammons WF, Persson R (1996) Long-term evaluation of root-resected molars: a retrospective study. Int J Periodontics Restorative Dent 16:206–219PubMedGoogle Scholar
  22. 22.
    Blomlöf L, Jansson L, Appelgren R, Ehnevid H, Lindskog S (1997) Prognosis and mortality of root-resected molars. Int J Periodontics Restorative Dent 17:190–201PubMedGoogle Scholar
  23. 23.
    Carnevale G, Pontoriero R, di Febo G (1998) Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study. J Clin Periodontol 25:209–14lCrossRefPubMedGoogle Scholar
  24. 24.
    Hou GL, Tsai CC, Weisgold AS (1999) Treatment of molar furcation involvement using root separation and a crown and sleeve-coping telescopic denture. A longitudinal study. J Periodontol 70:1098–1109CrossRefPubMedGoogle Scholar
  25. 25.
    Svärdström G, Wennström JL (2000) Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome. J Periodontol 71:579–585CrossRefPubMedGoogle Scholar
  26. 26.
    Vire DE (1991) Failure of endodontically treated teeth: classification and evaluation. J Endod 17:338–42lCrossRefPubMedGoogle Scholar
  27. 27.
    Alley BS, Kitchens GG, Alley LW, Eleazer PD (2004) A comparison of survival of teeth following endodontic treatment performed by general dentists or by specialists. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:115–18lCrossRefPubMedGoogle Scholar
  28. 28.
    de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S (2008) Treatment outcome in endodontics: the Toronto study—phase 4: initial treatment. J Endod 34:258–63lCrossRefPubMedGoogle Scholar
  29. 29.
    Lin PY, Huang SH, Chang HJ, Chi LY (2014) The effect of rubber dam usage on the survival rate of teeth receiving initial root canal treatment: a nationwide population-based study. J Endod 40:1733–177lCrossRefPubMedGoogle Scholar
  30. 30.
    Burry JC, Stover S, Eichmiller F, Bhagavatula P (2016) Outcomes of primary endodontic therapy provided by endodontic specialists compared with other providers. J Endod 42:702–75lCrossRefPubMedGoogle Scholar
  31. 31.
    Walter C, Weiger R, Dietrich T, Lang NP, Zitzmann NU (2012) Does three-dimensional imaging offer a financial benefit for treating maxillary molars with furcation involvement? A pilot clinical case series. Clin Oral Implants Res 23:351–38lCrossRefPubMedGoogle Scholar
  32. 32.
    Walter C, Dagassan-Berndt DC, Kuhl S, Weiger R, Lang NP, Zitzmann NU (2014) Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study. Clin Oral Implants Res 25:1352–138lCrossRefPubMedGoogle Scholar
  33. 33.
    Albrektsson T, Donos N, Working G (2012) Implant survival and complications. The Third EAO consensus conference 2012. Clin Oral Implants Res 23(Suppl 6):63–5lCrossRefPubMedGoogle Scholar
  34. 34.
    Corbella S, Taschieri S, Del Fabbro M (2015) Long-term outcomes for the treatment of atrophic posterior maxilla: a systematic review of literature. Clin Implant Dent Relat Res 17:120–32lCrossRefPubMedGoogle Scholar
  35. 35.
    Sousa V, Mardas N, Farias B, Petrie A, Needleman I, Spratt D, Donos N (2016) A systematic review of implant outcomes in treated periodontitis patients. Clin Oral Implants Res 27:787–844lCrossRefPubMedGoogle Scholar
  36. 36.
    Fugazzotto PA (2001) A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years. J Periodontol 72:1113–123lCrossRefPubMedGoogle Scholar
  37. 37.
    Micheelis W, Süßlin W (2012) Einstellung und Bewertung der Bevölkerung zur zahnärztlichen Versorgung in Deutschland. Ergebnisse einer bundesweiten Umfrage 2011. Book title. Institut der Deutschen Zahnärzte, KölnGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Private Dental PracticeEmmerich am RheinGermany
  2. 2.Private Dental PracticeBad BramstedtGermany
  3. 3.Section of Endodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial DiseasesUniversity Hospital HeidelbergHeidelbergGermany
  4. 4.Department of Periodontology, Center of Dentistry and Oral Medicine (Carolinum)Johann Wolfgang Goethe-University FrankfurtFrankfurtGermany
  5. 5.Private Dental PracticeWeilburgGermany

Personalised recommendations