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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
Fig. 1a Fig. 1b Figs. 1a & b Root canal system complexity demonstrated in clinical cases. Lateral canals and ramifications are evident on the post-op radiographs. Fig. 2 Tooth-related factors for decision making on nonsurgical or surgical retreatment. Fig. 2 cavity freely. This results in a significant reduction of postoperative symptoms of pain and swelling and faster healing. According to the literature particu larly of the previous decades, nonsurgical endo dontic retreatment is still the treat- ment of choice for the elimination of in- tracanal bacteria, while apical surgery comes in second as an alternative option.16, 17 In the case of a failed endodontic treat- ment, the decision for endodontic retreatment or apical surgery is based on a number of factors concerning the clin- ical and radiographic status of the tooth, as well as the dentist’s clinical dexterity.18 The quality of the permanent restoration, the ability to access the root canals, the quality of the root canal filling, iatrogenic errors, and intraradicular or extraradicular infection are factors that must be taken into consideration for the final treatment plan (Fig. 2).6, 18 If coronal microleakage has occurred or inadequate, open-margin restorations have been placed, nonsurgi- cal endodontic retreatment is the treat- ment of choice.6 In the case of intracanal infection, apical surgery blocks the micro- organisms inside the root canals, while endo dontic retreatment eliminates them. In contrast, in the case of extraradicular infection, apical surgery eliminates bacterial infection, while endodontic retreatment isolates bacteria in the peri- radicular tissue.1 However, the main factor that affects the treatment plan is communication with the patient.1 Modern treatment dictates that the clinician should inform the patient of the benefits and risks of each treatment option in a detailed manner and then pro- vide the treatment that the patient selects.1 In the case of a failed endo dontic treatment with an esthetically very successful pros- thetic restoration, if endo dontic retreat- ment is considered to be time- consuming or even when the patient is unable to afford the cost of the procedure, apical surgery may be the treatment of choice.1 The high magnification of the operating microscope provides the ability to see iatro- genic errors during apical microsurgery Article Endodontics issue 2018 — 45