A study of suitability of referrals for periradicular surgery

Objective To determine if the clinical and radiographic presentation of patients referred by their general dental practitioner requesting periradicular surgery fulfilled a set of predetermined guidelines as to the appropriateness of the procedure. Design Multicentre prospective study. Setting Maxillofacial departments of district general hospitals. Method Consecutive analysis of referrals within four hospitals over a 1-year period between 1995 and 1996. Results From 205 referrals, mostly of patients in the 30 to 40 years age group, 79.5% (n = 163) of referrals failed to meet the criteria, mainly because of an unsatisfactory root canal filling, but also due to obvious coronal microleakage and adjacent teeth contributing to the disease process not yet having received endodontic treatment. In only 6.3% (n = 13) of patients had there been an attempt to retreat the pulp space infection by conventional means. Conclusion The majority of referrals in this study did not fulfil the guideline criteria on the provision of periradicular surgery. The factors influencing failure in endodontics and periradicular disease did not appear to have been appreciated, or were not acted upon. Conventional retreatment of the pulp space needs to be considered or attempted prior to referral for surgery.