An update on endodontic microsurgery – a literature review

Abstract

Surgical endodontic treatment has long been the last resort for saving previously root canal treated teeth with persistent
chronic apical periodontitis. Surgical endodontic treatment could be indicated when nonsurgical retreatment seems impractical
or unlikely to improve the previous results or when a biopsy is needed. Traditional surgical endodontic treatment
is performed with root-end resection with a 45-degree bevel, retrograde preparation of the canal with bur, and root-end
filling leading to only a moderate success rate with this technique. This changed with the introduction of the microscope,
microinstruments, ultrasonic tips, and more biologically acceptable root-end filling materials (e.g. mineral trioxide aggregate
(MTA), bioceramics). By the utilisation of the above mentioned improvements during the procedure, the achieved
success rate can be significantly higher (93,5%) compared to the traditional surgical endodontic procedure (59%). Nevertheless
it must be emphasized that this increased success rate can only be obtained if all steps with key importance
(i.e. root tip resection, retrograde cavity preparation and retrograde obturation) are performed according to the modern,
evidence-based methods. The aim of this article is to impart the advancements in this field in the used materials, techniques
and theories, providing a contemporary perspective of modern „endodontic microsurgery”.