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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
Fig. 3 Fig. 4a Fig. 4b Fig. 5 Fig. 6 Fig. 3 A failed previous nonsurgi- cal retreatment and apical surgery done on tooth #36. A pre-op radiograph showing persistence of the periradicular lesion. Apical surgery using a microsurgi- cal protocol was determined to be the treatment of choice. Figs. 4a & b Inspection of the resected mesial and distal roots under 12× magnification of the microscope revealed (a) a gap in the filling on the mesiobuccal canal and (b) the untreated isthmus between the distal canals. Fig. 5 Post-op radiograph show- ing root end filling with mineral trioxide aggregate. Fig. 6 Radiographic examina- tion at one year. Complete healing was evident. after apicoectomy has been performed. In this way, perforations, missed canals, microfractures and multiple apical foramina can be identified.13 In the case of apical transportation, perforation near the apex, file separation in the apical part of the canal, deep intracanal posts and previous failed apical sur- gery performed with the traditional surgical tech- nique, the microsurgical technique is the treatment of choice and offers a predictable outcome (Figs. 3–6).13, 19, 20 An important aid in making a decision on retreat- ment or apical microsurgery is cone beam com- puted tomography (CBCT), which provides useful information on the anatomy of the tooth and the periradicular tissue.21 This imaging modality reveals signs of periradicular pathology or parts of the root canal system that were not filled and were not visible in the 2-D periapical radiographs.21 The literature supports the combination of endo dontic retreatment followed by apical surgery as a treatment option, as the success rate increases by 22%.12 The combination of proper endodontic treatment and the microsurgical technique allows the clinician to successfully address almost all cases with a lesion of endodontic origin.13 Conclusion The microsurgical technique based on the operat- ing microscope, microsurgical instruments, ultra- sonic root end tips and root end filling materials that are more biocompatible provides a predictable, minimally invasive solution and is often more favorable than endodontic retreatment. The choice between endodontic retreatment or apical micro- surgery is a decision that is based on three pillars: the tooth in question, the patient and the dentist. Editorial note: A list of references is available from the publisher. 46 — issue 2018 Endodontics Article