J Korean Acad Conserv Dent.  2011 Nov;36(6):465-476. 10.5395/JKACD.2011.36.6.465.

Success and failure of endodontic microsurgery

• Song M
• Kim E

• KMID: 2176598
• DOI: http://doi.org/10.5395/JKACD.2011.36.6.465

Abstract

In current endodontic practice, introduction of operating microscope, ultrasonic instruments, and microinstruments has induced a big change in the field of surgical retreatment. In this study, we aimed to offer key steps of endodontic microsurgery procedure compared with traditional root-end surgery, and to evaluate factors influencing success and failure based on published articles. Endodontic microsurgery is a surgical procedure performed with the aid of a microscope, ultrasonic instruments and modern microsurgical instruments. The microscope provides magnification and illumination - essential for identifying minute details of the apical anatomy. Ultrasonic instruments facilitate the precise root-end preparation that is within the anatomical space of the canal. Modern endodontics can therefore be performed with precision and predictability, thus eliminating the disadvantages inherent in traditional periapical surgery such as large osteotomy, beveled apicoectomy, inaccurate root-end preparation and the inability to observe isthmus. Factors influencing the outcomes of endodontic microsurgery may be diverse, but standardization of procedures can minimize its range. Among patient and tooth-related factors, periodontal status and tooth position are known to be prognostic, but there are only few articles concerning this matter. High-evidence randomized clinical trials or prospective cohort studies are needed to confirm these findings.

Keyword

Endodontic microsurgery; Periodontal involvement; Prognostic factor; Success and failure; Surgical retreatment; Tooth position

MeSH Terms

Apicoectomy
Cohort Studies
Endodontics
Humans
Lighting
Microsurgery
Osteotomy
Retreatment
Tooth
Ultrasonics

Figure

• 

  Figure 1 Example of each category of the cause of endodontic failure. Note the arrows. (a) Missing canal, MB2 with an isthmus in maxillary molar; (b) Leaky canal, gap between the gutta-percha and dentin; (c)-1 & (c)-2 apical calculus, calculus deposition due to chronic sinus tract; (c)-3 Scanning electron microscopic image of apical calculus (×30K); (d) Anatomical complexity, accessory canals that has not been touched; (e) Underfilling; (f) Crack, apical crack at lingual side of root; (g) Iatrogenic problem, broken file in mesial root in mandibular molar; (h) Overfilling, over-extended gutta-percha.9

• 

  Figure 2 Typical failure case of endodontic surgery. (a) Preoperative radiograph with periradicular radiolucency showing a root-end filling apart from the filled canal; (b) Coronal surface of the resected apical fragment. Note the missing canal (arrow) that had not been touched, even after both nonsurgical and surgical retreatments. G, Gutta-percha canal filling of nonsurgical retreatment; R, Root-end filling of surgical retreatment; (c) Immediate postoperative radiograph. Super EBA was used for the root-end filling; (d), (e), and (f) Seven-year follow-up radiographs with 3 different angles showing complete healing.10

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