TITLE:
Apicoetomy Practice Patterns and Diagnostic Accuracy in Periapical Lesions: Insights from a Fifteen-Year Review at the University of Port Harcourt Teaching Hospital
AUTHORS:
Ayamma Udo Umanah, Efetobo Victor Orikpete
KEYWORDS:
Apicoectomy, Periapical Lesions, Histopathology, Diagnostic Concordance, Root-End Surgery, Nigeria
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.3,
March
20,
2026
ABSTRACT: Background: Apicoectomy is a surgical endodontic procedure performed for teeth with persistent periapical infections, failed root canal treatments, or anatomical complexities that make the tooth unsuitable for non-surgical retreatment. Histopathological examination of excised periapical tissues is essential for definitive diagnosis, but this practice is often neglected in low- and middle-income countries. Limited data exist from Nigeria regarding histopathology submission rates and diagnostic concordance following apicoectomy. Objective: To determine the frequency of apicoectomy procedures at the University of Port Harcourt Teaching Hospital (UPTH) over a fifteen-year period, evaluate the proportion of specimens submitted for histopathological analysis, and assess the degree of concordance between clinical and histopathological diagnoses. Methods: A retrospective cross-sectional study was conducted at the Departments of Restorative Dentistry and Oral Pathology/Oral Diagnosis, UPTH. Clinical and histopathological records of all apicoectomy procedures performed between January 2010 and December 2024 were reviewed. Data on patient demographics, tooth type, clinical diagnosis, histopathology submission, and histopathological diagnosis were extracted. Concordance between clinical and histopathological diagnoses was analyzed using Cohen’s kappa statistics. A p-value Results: A total of 25 apicoectomy procedures were recorded during the study period. The mean patient age was 30.5 ± 13.9 years, with a slight male (52.0%) predominance. Maxillary central incisors were the most frequently treated teeth (70.8%). Only 56% of specimens were submitted for histopathological analysis. Among these, 50% were periapical granulomas and 50% periapical cysts. Diagnostic concordance was observed in 57.1% of cases. Cohen’s Kappa [κ = 0.20; (p = 0.33)], showed only slight agreement between clinical and histopathological diagnoses. Conclusion: The study revealed a low frequency of apicoectomy and suboptimal utilization of histopathological analysis. The slight agreement between clinical and histopathological diagnoses highlights the need for mandatory submission of all apicoectomy specimens for histopathological evaluation.