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Aims: The aim of this retrospective clinical trial was to evaluate and compare the upper and lower first molar apicectomy procedures in terms based on certain clinical criteria selected. Materials and Methods: This clinical trial was conducted at the Department of Oral and Maxillofacial Surgery / College of Dentistry / University of Mosul. The sample recruited was composed of forty healthy subjects who required apicectomy procedures on either an upper or lower fist molar. The sample was subdivided into two groups of twenty subjects each. The first group comprised those patients where root end resection ( apicectomy ) on an upper first molar tooth was required. The second group included those patients who required an apicectomy procedure on one of their lower first molar tooth . Criteria that were evaluated and compared included pain, swelling and trismus which were evaluated on the first operative day, second, third and seventh postoperative day. Results: A significant difference was observed between recall visits in regard to the pain level of mandibular procedures and was also observed in maxillary procedures. In regard to pain level assessment between mandibular and maxillary procedures, a significant difference was observed with pain levels higher in mandibular procedures for the second and third day when compared to maxillary procedures. A significant difference was observed between recall visits in regard to swelling of soft tissue of mandibular and maxillary procedures. Concerning grade of swelling assessment between mandibular and maxillary procedures, a significant difference was observed with swelling of soft tissue higher in mandibular procedures on the second and third day when compared to maxillary procedures. A significant difference was observed for limitation of mouth opening in mandibular procedures between recall visits specifically on the first and second day but was not observed in maxillary procedures. When comparing between upper and lower surgical procedures, a significant difference was observed in trismus specially on the second and third post-operative day and which was more pronounced in mandibular procedures. Conclusions: It seems that complications following root end resection on lower first molar teeth are more evident when compared to the upper first molar region, but only in the first few days following surgery. However, such complications were tolerable to the patient and can be overcome by medications and exercise. Such complications should not hinder the oral surgeon from performing endodontic surgery on posterior teeth when indicated. Al – Rafidain Dent J Vol. 11, No2, 2011 www.rafidaindentj.net A clinical comparative evaluation between upper and lower first molar apicectomy procedures (A retrospective trial). ISSN: 1812–1217