Endodontic Surgery

During the past decade, endodontics has seen a dramatic shift in the application of periradicular surgery and the role it plays in endodontic treatment. With the introduction of enhanced magnification, periradicular ultrasonics and other associative technologies, teeth that might otherwise be extracted now have a chance for retention. This article describes the role of these advances in contemporary endodontic surgery. onsurgical root canal therapy is a highly successful procedure if diagnosis and technical aspects are carefully performed. There is a common belief that if root canal therapy fails, surgery is indicated for correction. This is not always true; most failures are best corrected by retreatment. Studies have shown that a majority of retreated cases are successful following retreatment.1-5 There are, however, situations in which surgery is necessary to retain a tooth that would otherwise be extracted. The purpose of this article is to briefly describe indications and contraindications as well as the steps involved and new advances in periradicular surgery. The details for this procedure can be found in surgical and nonsurgical endodontic text books.6-8 Indications and Contraindications for Periradicular Surgery The main indications for periradicular surgery are: complex root canal anatomy, procedural accidents (Figure 1), irretrievable materials in the root canal (Figure 2), symptomatic cases, horizontal apical fracture, biopsy (Figure 3) and corrective surgery (Figure 4). Contraindications are relatively few. There are four major categories: (1) anatomic factors, (2) medical or systemic complications, (3) indiscriminate use of surgery, and (4) unidentified cause of treatment failure. Steps in Periradicular Surgery The typical sequence of procedures used in periradicular surgery are flap design, incision and reflection, apical access, periradicular curettage, root-end resection, root-end cavity preparation, root-end filling, flap replacement and suturing, postoperative care and instructions, suture removal and evaluation. Recent Advances in Endodontic Surgery Many advances in surgical technique and instrumentation have occurred over the past decade. They include enhanced magnification and illumination, ultrasonic tips, microJUNE.2004.VOL.32.NO.6.CDA.JOURNAL 485 Contemporary Endodontic Surgery Richard Rubinstein, DDS, MS; and Mahmoud Torabinejad, DMD,