Abstract：
Surgical endodontic treatment encompasses a broad spectrum of procedures, amongst which root-end cavity preparation and filling, retrograde root canal treatment and through-and-through endodontic surgery, may be classified under the umbrella term \'Root-end surgery\'. This narrative review considers the available data on periapical healing, soft tissue healing, tooth survival and oral health-related quality of life (OHRQoL), following root-end surgery and the factors that affect its outcomes. The pooled periapical healed rate for the studies published up to 2021 was 69% (95% CI: 65%, 73%) but increased to 76% (95% CI: 66%, 86%) when only data from the 2020\'s studies were analysed. The prognostic factors consistently reported for periapical healing have included: pre-operative periapical lesion with complete loss of buccal plate, quality of root-end preparation, remaining thickness of apical root dentine and restorative status. Soft tissue healing of the reflected flap was found to have a positive association with periapical healing. The survival rates following root-end surgery range from 48% to 93%, with failure of periapical healing associated with root and crown fracture, being the predominant reasons for tooth extraction. The factors influencing impact of root-end surgery on patients\' quality of life could not be adequately evaluated due to design flaws in the available studies. In conclusion, if root canal treatment failure due to leakage through cracks, fractures or restoration margin are excluded, the remaining cases may represent localized residual infection and inflammation at the periapex that should be amenable to predictable management with the aid of modern root-end surgery.
摘要：
外科牙髓治疗包括广泛的手术，其中根端空腔的准备和填充，逆行根管治疗,通过牙髓手术，可以归类为“根端手术”。这篇叙述性综述考虑了关于根尖周愈合的现有数据，软组织愈合，牙齿生存和口腔健康相关生活质量（OHQoL），根端手术后及其影响预后的因素。截至2021年发表的研究的合并根尖周愈合率为69%(95%CI：65%，73%)，但增加到76%(95%CI：66%，86%)，当仅分析2020年研究的数据时。持续报道的根尖周愈合的预后因素包括：术前根尖周病变伴颊板完全丢失，根端制剂的质量，根尖牙本质的剩余厚度和修复状态。发现反射皮瓣的软组织愈合与根尖周愈合呈正相关。根端手术后的存活率从48%到93%不等，与根和冠骨折相关的根尖周愈合失败，是拔牙的主要原因。由于现有研究的设计缺陷，无法充分评估影响根端手术对患者生活质量影响的因素。总之,如果根管治疗失败由于泄漏通过裂缝，排除骨折或修复边缘，其余病例可能表现为局部残余感染和周围炎症,在现代根端手术的帮助下,应适用于可预测的治疗.
