## 4 Discussion  
The current study was conducted to evaluate the effect of various preoperative factors such as age, gender, smoking, preoperative pain, and preoperative periapical lesion size on the outcome of surgical endodontic treatment. The results of the study showed a statistically significant relationship between periapical wound healing and age, smoking, and preoperative lesion size. Surgical endodontic retreatment is employed in managing recurrent secondary periapical lesions as a consequence of primary root canal treatment failure [19]. Surgical endodontic retreatment involves re-root canal treatment with subsequent sectioning of the apical end of the root followed by retrograde obturation and establishment of the apical seal of the root canal system. This apical seal facilitates healing of the periapical tissues by preventing the ingress of microbial irritants into the periapical area and concomitant tissue reaction [3]. It has now become clinically evident that even if the surgical endodontic treatment has been conducted using the same procedure, patients respond differently with respect to periapical wound healing [3,4]. This difference in periapical wound healing may be due to the presence of various preoperative factors such as pain, swelling, sinus tract, smoking, and size of the periapical lesion. However, evidence to support the influence of these preoperative factors on the outcome of periapical surgery are conflicting. In addition, most of the clinical studies that exist in the literature are retrospective [8,20,21]. The novelty \begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**Characteristics**} & \multicolumn{4}{c}{**Periapical Healing**} \\ \cline{2-5}  & **Yes** & **No** & **Total** & **_p_-Value** \\ \cline{2-5}  & **(_n_ = 29)** & **(_n_ = 11)** & **Total** & **_p_-Value** \\ \hline \multicolumn{5}{c}{**Age in years**} \\ \(<\)30 & 26 (81.3\%) & 6 (18.8\%) & 32 & 0.025 \(\char 67\) \\ \(>\)30 & 3 (37.5\%) & 5 (62.5\%) & 8 & \\ \multicolumn{5}{c}{**Gender**} \\ Male & 22 (78.6\%) & 6 (21.4\%) & 28 & \\ \multicolumn{5}{c}{Female} & 7 (58.3\%) & 5 (41.7\%) & 12 & 0.254 \(\char 67\) \\ \multicolumn{5}{c}{**Smoking**} \\ Nonsmoker & 22 (84.6\%) & 4 (15.4\%) & 26 & \\ \multicolumn{5}{c}{Smoker} & 7 (50.0\%) & 7 (50.0\%) & 14 & 0.029 \(\char 67\) \\ \multicolumn{5}{c}{**Preoperative**} \\ \multicolumn{5}{c}{pain} \\ Yes & 15 (68.2\%) & 7 (31.8\%) & 22 & \\ \multicolumn{5}{c}{No} & 14 (77.8\%) & 4 (22.2\%) & 18 & 0.723 \(\char 67\) \\ \multicolumn{5}{c}{**Periapical**} \\ \multicolumn{5}{c}{**lesion size**} \\ \(\leq\)6 mm & 20 (100\%) & 0 (0.0\%) & 20 & \\ \(>\)6 mm & 09 (45.0\%) & 11 (55.0\%) & 20 & \(<\)0.001 \(\char 67\) \\ \hline \hline \end{tabular} \({}^{\dagger}\) Chi-squared test, \({}^{\ast}\)Fisher’s Exact Test.  
\end{table} 
Table 2: Relationship of Periapical Healing with Age, Gender, Smoking, Preoperative pain, and Periapical lesion size on one year follow-up. of this study lies in following patients prospectively and opening an avenue for further research in this direction. Age is considered a prognostic indicator of outcome for many surgical procedures [4]. In this study, 81.3% healing was achieved in patients below 30 years of age. This finding is in agreement with [PERSON] et al. [22] They found a 95% success in patients between 21 to 40 years of age. Contrarily, [PERSON] et al. [23] reported 84% success in periapical healing in patients above 45 years of age, compared to 68% in patients below 45 years of age. This study observed no significant relationship between healing and gender. Similarly, a large number of studies did not find gender as a prognostic factor for periapical surgery [18; 24; 25]. However, [PERSON] et al. reported a higher success in males (60%) compared to females (40%) at 6 months [26]. The habit of smoking can influence the outcome of periapical surgery by several plausible biological mechanisms.