Endodontic surgery : a Critical review

Aim: The main objective of periapical surgery is to obtain periradicular tissue regeneration, including the formation of a new attachment apparatus by exclusion of any noxious agent within the physical confines of the affected root. Consequently one of the target of root-end preparation techniques during endodontic surgery is to create a well cleaned and shaped cavity to be filled, in order to seal the apical terminus of the root canal system. Methods: A review of the literature was performed by using electronic and hand-searching methods for the endodontic bone lesion, root-end management and periradicular surgery healing criteria. Results: There are many published reports regarding endodontic surgery. Our search showed that the main benefit considered in evaluating the outcome of surgical treatment is the probability of healing. Adherence to a strict endodontic surgical protocol, a minimally invasive surgical technique, a careful root-end preparation using contemporary techniques, visual magnification, proper materials and a correct case selection might be key factors to the success of treatment. Conclusions: long-term outcome of the surgical and non-surgical approach for the re-treatment of periapical lesions is very similar. Even if a faster healing rate was observed for surgical cases, there are no scientific data that support the concept of a systematic difference in healing potential between surgical and non-surgical re-treatment.