Skip to main content
SpringerLink
Log in

Endodontic Microsurgery

  • Chapter
  • First Online:
Endodontic Treatment, Retreatment, and Surgery

Summary

Traditional endodontic surgery involves the surgical management of a tooth with a periapical lesion that cannot be resolved by conventional non-surgical endodontic treatment/retreatment. The main objective of peri-radicular surgery is to promote tissue regeneration. Indications for surgery include complex root canal anatomy, irretrievable materials in the root canal, procedural accidents requiring surgery, persistent symptomatic cases, refractory lesions and where biopsy may be needed. This can be achieved by the surgical removal of periapical pathological tissue (surgical curettage) and by removing/occluding irritants within the confines of the apical portion of the root canal system and isthmuses (retrograde root resection, root end preparation and retrograde obturation). Endodontic microsurgery combines unsurpassed magnification and illumination using a dental operating microscope and specific micro-instruments that significantly affects case selection, predictability and post-operative healing sequelae. These major advances in surgical technique, instrumentation and materials have occurred over the last twenty years. Supported by research they have not only led to the overall improvement in treatment success but the ability to save what were once considered hopeless teeth

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39:921–30.

    Article  Google Scholar 

  2. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germfree and conventional laboratory rats. J South Calif Dent Assoc. 1966;34:449–51.

    PubMed  Google Scholar 

  3. Bergenholtz G. Micro-organisms from necrotic pulp of traumatized teeth. Odontol Revy. 1974;25:347–58.

    PubMed  Google Scholar 

  4. Sundqvist G. Bacteriological studies of necrotic dental pulps. Umea University Odontological Dissertation No.7. Umea: University of Umea; 1976.

    Google Scholar 

  5. Friedman S, Mor C. The success of endodontic therapy – healing and functionality. J Calif Dent Assoc. 2004;32(6):493–503.

    PubMed  Google Scholar 

  6. Nair PNR. Pathogenesis of apical periodontitis and the cause of endodontic failures. Crit Rev Oral Biol Med. 2004;15:348–81.

    Article  PubMed  Google Scholar 

  7. Sjogren U, Happonen RP, Kahnberg KE, Sundqvist G. Survival of Arachnia propionica in periapical tissue. Int Endod J. 1988;21:277–82.

    Article  PubMed  Google Scholar 

  8. Nair PNR, Sjogren U, Krey G, Sundqvist G. Therapy- resistant foreign-body giant cell granuloma at the periapex of a root-filled human tooth. J Endod. 1990;16:589–95.

    Article  PubMed  Google Scholar 

  9. Nair PNR, Sjogren U, Schumacher E, Sundqvist G. Radicular cyst affecting a root-filled human tooth: a long-term post-treatment follow-up. Int Endod J. 1993;26:225–33.

    Article  PubMed  Google Scholar 

  10. Cohen S. Treatment choices for negative outcomes with non-surgical root canal treatment: non-surgical retreatment vs. surgical retreatment vs. implants. Endod Top. 2005;11:4–24.

    Article  Google Scholar 

  11. Friedman S. Considerations and concepts of case selection in the management of post-treatment endodontic disease (treatment failure). Endod Top. 2002;1:54–78.

    Article  Google Scholar 

  12. Del fabbro M, Taschieri S, Testori T, Francetti L, Weinstein RL. Surgical versus non-surgical endodontic re-treatment for periradicular lesions (Review). Cochrane Database Syst Rev. 2007;3:CD005511.

    Google Scholar 

  13. Torabinejad M, Corr R, Handysideds R, Shabahang S. Outcomes of nonsurgical re-treatment and endodontic surgery: a systematic review. J Endod. 2009;35:930–7.

    Article  PubMed  Google Scholar 

  14. Martin MV, Nind D. Use of Chlorhexidine gluconate for preoperative disinfection of apicoectomy sites. Br Dent J. 1987;162:459–61.

    Article  PubMed  Google Scholar 

  15. Lindeboom JA, Frenken JW, Valkenburg P, van den Akker HP. The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study. Int Endod J. 2005;38(12):877–81.

    Article  PubMed  Google Scholar 

  16. Dionne RA, Campbell RA, Hall DL, Cooper SA, Buckingham B. Suppression of postoperative pain by preoperative administration of ibuprofen in comparison to placebo, acetaminophen, and acetaminophen plus codeine. J Clin Pharmacol. 1983;23:37–43.

    Article  PubMed  Google Scholar 

  17. Carr G. Microscopes in endodontics. J Calif Dent Assoc. 1992;11:55–61.

    Google Scholar 

  18. Kim S, Pecora G, Rubenstein R. Color atlas of microsurgery in endodontics. Philadelphia: WB Saunders; 2001. p. 21–2.

    Google Scholar 

  19. Pecora G, Andreana S. Use of the dental operating microscope in endodontic surgery. Oral Surg Oral Med Oral Pathol. 1993;75:751–8.

    Article  PubMed  Google Scholar 

  20. Rubenstein R. Magnification and illumination in apical surgery. Endo Top. 2005;11:56–77.

    Article  Google Scholar 

  21. Hargreaves K, Khan A. Surgical preparation: anaesthesia and haemostasis. Endo Top. 2005;11:32–55.

    Article  Google Scholar 

  22. Velva rt P, Peters CI. Soft tissue management in endodontic surgery. J Endod. 2005;31:4–16.

    Article  Google Scholar 

  23. Velva rt P. Surgical retreatment. In: Bergenholtz G, Horsted-Bindslev P, Reit C, editors. Textbook of Endodontology. Oxford: Blackwell Munksgaard; 2003. p. 311–26.

    Google Scholar 

  24. Velva rt P, Ebner-Zimmermann U, Ebner JP. Papilla healing following sulcular full thickness flap in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:365–9.

    Google Scholar 

  25. Velva rt P. Papilla base incision: a new approach to recession free healing of the interdental papilla after endodontic surgery. Int Endod J. 2002;35:453–60.

    Article  Google Scholar 

  26. Harrison JW, Jurosky KA. Wound healing in the tissues of the periodontium following peri-radicular surgery – 2. The dissectional wound. J Endod. 1991;17:544–52.

    Article  PubMed  Google Scholar 

  27. Peters LB, Wesselink PR. Soft tissue management in endodontic surgery. Dent Clin North Am. 1997;41:513–28.

    PubMed  Google Scholar 

  28. Mckenzie WS, Rosenberg M. Iatrogenic subcutaneous emphysema of dental and surgical origin: a literature review. J Oral Maxillofac Surg. 2009;67:1265–8.

    Article  PubMed  Google Scholar 

  29. Yacker MJ, Klein M. The effect of irrigation on osteotomy depth and bur diameter. Int J Oral Maxillofac Implants. 1996;11:634–8.

    PubMed  Google Scholar 

  30. Calderwood RG, Hera SS, Davies JR, Waite DE. A comparison of the healing rate of bone after the production of defects by various rotary instruments. J Dent Res. 1964;43:207–16.

    Article  PubMed  Google Scholar 

  31. Guttmann JL, Harrison JW. Surgical Endodontics. Boston: Blackwell Science; 1991. p. 203–77.

    Google Scholar 

  32. Arens DE, Torabinejad M, Chivian N, Rubenstein RA. Practical lessons in endodontic surgery. Chicago: Quintessence; 1988. p. 79–87.

    Google Scholar 

  33. PittFord TR. Surgical treatment of apical periodontitis. In: Orstavik D, Pitt Ford RT, editors. Essential endodontology. Prevention and treatment of apical periodontitis. Oxford: Blackwell Sciences; 1988. p. 278–307.

    Google Scholar 

  34. Khoury F, Hensher R. The bony lid technique for the apical root resection of lower molars. Int J Oral Maxillofac Surg. 1987;16:166–70.

    Article  PubMed  Google Scholar 

  35. Nevins A, Ruden S, Pruden P, Kerpel S. Metastatic carcinoma of the mandible mimicking periapical lesion of endodontic origin. Endod Dent Traumatol. 1988;4:238–9.

    Article  PubMed  Google Scholar 

  36. Hutchinson IL, Hooper C, Cooner HS. Neoplasia masquerading as periapical infection. Br Dent J. 1990;168:288–94.

    Article  Google Scholar 

  37. Abott P. Unusual periapical pathosis – adenoid cystic carcinoma. Aust Endod J. 2001;27:73–5.

    Article  Google Scholar 

  38. Selim HA, el Deeb ME, Messer HH. Blood loss during endodontic surgery. Endod Dent Traumatol. 1987;3:33–6.

    Article  PubMed  Google Scholar 

  39. Kim S, Rethnam S. Haemostasis in endodontic microsurgery. Dent Clin North Am. 1997;41:499–511.

    PubMed  Google Scholar 

  40. Jeonsonne BG, Boggs WS, Lemon RR. Ferric sulfate haemostasis: effect on osseous wound healing. II. With curettage and irrigation. J Endod. 1993;19:174–6.

    Article  Google Scholar 

  41. Lemon RR, Steele PJ, Jeansonne BG. Ferric sulfate hemostasis: effect on osseous wound healing. Left in situ for maximum exposure. J Endod. 1993;19:170–3.

    Article  PubMed  Google Scholar 

  42. Tidmarsh BG, Arrowsmith MG. Dentinal tubules at the root ends of apicected teeth: a scanning electron microscopic study. Int Endod J. 1989;22(4):184–9.

    Article  PubMed  Google Scholar 

  43. Vertucci F. Root canal anatomy of human permanent teeth. Oral Surg Oral Med Oral Pathol. 1984;58:589.

    Article  PubMed  Google Scholar 

  44. Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of the smear layer in endodontics: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:658–66.

    Article  PubMed  Google Scholar 

  45. Fogel HM, Peikoff MD. Microleakage of root end materials. J Endod. 2001;27:456–8.

    Article  PubMed  Google Scholar 

  46. Oynick J, Oynick T. A study of a new material for retrograde fillings. J Endod. 1978;4:203–6.

    Article  PubMed  Google Scholar 

  47. Dorn SO, Gartner AH. Retrograde filling materials: a retrospective success-failure study of amalgam. EBA and IRM. J Endod. 1990;16:391–3.

    Article  PubMed  Google Scholar 

  48. Jesslen P, Zetterqvist I, Hemidahl A. Long term results of amalgam verses glass ionomer cement as apical sealant after apicoectomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:101–3.

    Article  PubMed  Google Scholar 

  49. Chong BS, Pitt Ford TR, Hudson MB. A prospective clinical study of mineral trioxide aggregate and IRM when used as root-end filling materials in endodontic surgery. Int Endod J. 2003;36:520–6.

    Article  PubMed  Google Scholar 

  50. Rubenstein RA, Kim S. Short term observations of the results of endodontic surgery with the use of a surgical operating microscope and Super EBA as a root end filling material. J Endod. 1999;25:43–8.

    Article  Google Scholar 

  51. Rubenstein RA, Kim S. Long term follow-up of cases considered healed one year after apical microsurgery. J Endod. 2002;28:378–83.

    Article  Google Scholar 

  52. Regan JD, Gutmann JL, Witherspoon DE. Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues. Int Endod J. 2002;35:840–7.

    Article  PubMed  Google Scholar 

  53. Rud J, Munksgaard EC, Andreasen JO, Rud V, Amussen E. Root filling with composite and a dentine bonding agent: I-IV. Tandlaegebladet. 1989;93:156–160, 195–197, 223–229, 267–273, 343–345, 401–405.

    Google Scholar 

  54. Velvart P, Peters CI, Peters OA. Soft tissue management: suturing and wound closure. Endo Top. 2005;11:179–95.

    Article  Google Scholar 

  55. Friedman S. The prognosis and expected outcome of apical surgery. Endo Top. 2005;11:219–62.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCL-Eastman Dental Institute, 123 Gray’s Inn Road, London, WC1X 8WD, UK

    Roberto Sacco CDT, DDS, MSc, PG Cert Sed (Oral Surgery Specialist, Senior Clinical Teaching Fellow, Oral Surgery Specialist Dentist)

  2. King’s College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, UK

    Roberto Sacco CDT, DDS, MSc, PG Cert Sed (Oral Surgery Specialist, Senior Clinical Teaching Fellow, Oral Surgery Specialist Dentist)

  3. Oral and Maxillofacial Surgery, Pan Scotland Rotation, Honorary Lecturer at University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK

    Anthony Greenstein BM BS, MRCS, BDS, MFDS RCS (ED)

  4. Brindabella Specialist Centre, Canberra, ACT, Australia

    Bobby Patel BDS MFDS MClinDent MRD MRACDS (Specialist Endodontist)

Authors
  1. Roberto Sacco CDT, DDS, MSc, PG Cert Sed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony Greenstein BM BS, MRCS, BDS, MFDS RCS (ED)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bobby Patel BDS MFDS MClinDent MRD MRACDS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bobby Patel BDS MFDS MClinDent MRD MRACDS .

Editor information

Editors and Affiliations

  1. Forrest, Aust Capital Terr, Australia

    Bobby Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Sacco, R., Greenstein, A., Patel, B. (2016). Endodontic Microsurgery. In: Patel, B. (eds) Endodontic Treatment, Retreatment, and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-19476-9_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19476-9_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19475-2

  • Online ISBN: 978-3-319-19476-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation