As a result, the indications for endodontic surgery 7, 8 are reduced to the following: The idea that it is possible to contain microbes within the root canal system by carrying out endodontic surgery alone is not only untrue but dated and misguided ( Fig. 5, 6 Unless the root canal system is cleaned, shaped and filled, viable microorganisms may persist even after endodontic surgery constituting a potential risk factor for recurrence of periradicular pathosis. However, modern non-surgical retreatment techniques allow improved ability to gain coronal and radicular access coupled with a better understanding of the causes of treatment failure, the preference is to carry out non-surgical root canal retreatment before considering endodontic surgery. There used to be a plethora of indications for endodontic surgery much of which were related to difficulties in (re-)gaining access to the root canal system for non-surgical retreatment. It is beyond the scope of this article to provide exhaustive coverage, including comprehensive technical details of every endodontic surgical procedure therefore, it will focus primarily on the procedures most commonly performed - periradicular curettage, root-end resection, root-end cavity preparation and root-end filling previously also referred to as periapical curettage, apicectomy, retrograde cavity preparation and retrograde filling respectively. The aim of this article is to provide a contemporary and up-to-date overview of endodontic surgery. Indeed, contemporary micro-surgical techniques and newer root-end filling materials have reported a favourable healing outcome of 88–96%. ![]() These advances have helped improve the outcome of endodontic surgery, which was previously considered to be a rather unpredictable procedure, carried out in desperation and as a last resort. As a result, 'endodontic surgery' has evolved and is now often referred to as 'endodontic microsurgery'. ![]() There have been significant advances in endodontic surgery in the last two decades gone are the antiquated, mechanistic procedures to be replaced by biological approaches, newer materials, aided by enhanced illumination and magnification, micro-surgical armamentarium and techniques. However, if non-surgical root canal treatment is not possible or disease or symptoms persists following root canal treatment, endodontic surgery may be necessary in order to salvage a tooth. The biological aim of endodontic treatment is to prevent or resolve apical periodontitis by controlled asepsis or through decontamination of the root canal system so as to create an environment in which periradicular healing can occur.
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