1. The School of Dentistry Periapical Surgery Thomas Dietrich

2. Changes of periodontal parameters following apical surgery: a prospective clinical study of three incision techniques T. von Arx, T. Vinzens-Majaniemi, W. Bürgin & S. S. Jensen Int Endod J 2007; 40: 959-969.

3. Study design Longitudinal Prospective Observational Cohort study Patients with 238 teeth undergoing apical surgery from 2000 – 2004 Von Arx et al. Int Endod J 2007; 40: 959-969.

4. Study flowchart Number of teeth Numbers excludedReason for exclusion 238Initial number of treated teeth ⇓ 7Palatal access 231 ⇓ 19Apico-marginal lesions 212 ⇓ 27Multiple (adjacent) teeth treated in same patient 185 ⇓ 1Drop-outs (patients did not show up for 1-year control) 184Final number of evaluated teeth Von Arx et al. Int Endod J 2007; 40: 959-969.

5. Distribution of teeth per incision technique Teeth Intrasulcular incision Papilla base incision Submarginal incision n%n%n% Maxillary anterior2117.839.12678.8 Maxillary premolars2521.2927.3412.1 Maxillary molars1512.7824.213.0 Mandibular anterior10.813.026.0 Mandibular premolars 1210.213.000 Mandibular molars4437.31133.300 Total1181003310033100 Von Arx et al. Int Endod J 2007; 40: 959-969.

6. Distribution of teeth per restoration Von Arx et al. Int Endod J 2007; 40: 959-969. Teeth No restorationFillingCrown n%n%n% Maxillary anterior321.41336.13425.4 Maxillary premolars321.4513.93022.4 Maxillary molars642.9822.2107.5 Mandibular anterior0025.621.5 Mandibular premolars0025.6118.2 Mandibular molars214.3616.74735.1 Total1410036100134100

7. Changes (mean ± SD) of PD, GM, CAL by incision technique Von Arx et al. Int Endod J 2007; 40: 959-969. SiteIncision techniquePDGMCAL* Pooled buccalIntrasulcular incision −0.08 (±0.50)−0.42 (±0.69)x0.34 (±0.68)xΔ Papilla base incision−0.21 (±0.38)−0.31 (±0.49)0.10 (±0.62)Δ Submarginal incision −0.18 (±0.37)0.05 (±0.61)x−0.23 (±0.57)x

8. Conclusions The intrasulcular incision demonstrated greater changes in the levels of the GM and the clinical attachment than the other incision techniques, meaning more recession of the GM and greater loss of attachment. Von Arx et al. Int Endod J 2007; 40: 959-969.

9. Marginal incision Von Arx et al. Int Endod J 2007; 40: 959-969.

10. Papilla-base incision Von Arx et al. Int Endod J 2007; 40: 959-969.

11. Submarginal incision Von Arx et al. Int Endod J 2007; 40: 959-969.

12. Criteria for success For example (von Arx & Kurt 1999): –Pain score (0-3) –Clinical Score (0-3) –Healing classification: Success/complete healing (>90% regeneration of bone & pain/clinical scores = 0) Improvement/partial healing (50-90% regeneration of bone & pain/clinical scores = 0) Failure/incomplete/uncertain healing ( 0)

14. Clinical and Radiographic Assessment of Various Predictors for Healing Outcome 1 Year After Periapical Surgery T. von Arx, S.S. Jensen, S. Hänni J Endod 2007; 33: 123-128.

15. Study flowchart Von Arx et al. J Endod 2007; 33: 123-128. N TeethN ExcludedReason for Exclusion 266 (initial number of treated teeth) ↓21 No retrofilling (6 orthograde filling, 15 resection only) 245 ↓33 Lesion not limited to periapical area (10 tunnel lesions, 18 apicomarginal lesions, 8 lateral lesions) 212 ↓18Multiple teeth treated in same patient 194 ↓3 Dropouts (patients did not show up for 1-year control) 191 (final number of evaluated teeth)

16. Results (example) Von Arx et al. J Endod 2007; 33: 123-128. VariableOR90% CI SurgeryFirst vs. resurgery2.80.9, 9.1 Retrofilling material MTA vs. SuperEBA3.81.4, 10.9

17. “Conclusions” In conclusion, case selection for periapical surgery should consider the clinical significance of prognostic variables more studies are needed to evaluate the effect of multiple predictors on healing outcome after periapical surgery Von Arx et al. J Endod 2007; 33: 123-128.