Endodontic microsurgery − A technique for the 21st century
The present editorial appears in the Journal of Orofacial Sciences.

Apical or endodontic surgery has traditionally been viewed as a last resort to save a tooth, often after failed primary root canal treatment and endodontic retreatment. As a clinical technique applied by both oral surgeons and endodontists, it has not had the best reputation, largely due to great variations in techniques used over decades.

For the endodontist, apical surgery is now endodontic microsurgery, the most advanced method of executing this procedure. Endodontic microsurgery, featuring the triad of high magnification, ultrasonic root-end preparation, and biocompatible root-end filling materials, was introduced in the 1990s and firmly established over the past decade.

The primary objective of apical surgery is to eliminate and prevent microbial leakage from the root canal system into the periradicular tissues with subsequent healing of existent apical periodontitis. Traditional techniques involved large osteotomies with either just apical resection or retrograde amalgam fillings, after cavity preparation with round burs at an acute bevel angle. This traditional approach, albeit still encountered today, has a success rate of 59% explaining negative reports for the procedure in general.

In contrast, endodontic microsurgery utilizes a surgical microscope with enhanced magnification and illumination throughout the clinical operation. This allows for atraumatic access, including more precise incision and flap elevation, as well as a smaller osteotomy compared to the traditional procedures.

Hemostasis is achieved by the presurgical injection of anesthetic solutions with 1:50,000 epinephrine and intraoperatively by using epinephrine containing cotton pellets and ferric sulfate. Microinstruments are used for inspection, curettage, and root-end filling. Using the microsurgical approach, roots can be resected at a shallow bevel angle, almost perpendicular to the long axis of the tooth, sacrificing less tooth structure, and exposing less dentinal tubules.

Continue reading here: http://www.jofs.in/article.asp?issn=0975-8844;year=2018;volume=10;issue=1;spage=1;epage=2;aulast=Setzer
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