Endodontic surgery has an established record of success. Modern materials and equipment (microsurgery) make it even more successful. It has become more commonplace for those who market implants to downplay the benefits of endodontic surgery, and perhaps misinform patients regarding the benefits of endodontic surgery.
In a recent updated meta-analysis of the literature regarding endodontic surgery (Tsesis et. al.),
a successful outcome of endodontic surgery was seen in 89% of patients
at 1 year. It also pointed out that modern materials and equipment (MTA
and microscopes) are associated with better outcomes. While this is a short term study, the benefits of endodontic surgery are the preservation of the periodontium. The periodontium is what gives teeth their natural appearance, form and function.
The following case shows the benefit of endodontic surgery, use of CBCT
in surgical planning, and the surgical correction of endodontic
overfill.
CASE #1
This root canal was done by her general dentist 3 months earlier. As
you can see it is overfilled, post placed, crown prepped and ready for
new crown, but patient continues to have symptoms with the tooth.
CBCT taken to evaluate the root morphology. It is clear that this is a
single root/canal. (The canal has an oblong shape) It was chosen to
treat this tooth with apical surgery to preserve the restorative work
that has been completed and assure that the overextened gutta percha is
removed.
Apicoectomy completed with MTA retrofill.
9 month recall show complete healing of the periapical lesion, tooth is
fully functional and asymptomatic. This procedure saves the patient
significant time and money over extraction and implant placement.
CASE #2
This patient has crowns on #6-#11. Tooth #6 is causing a localized
ache, affected by pressure and chewing. #6 is sensitive to percussion
with normal probings. DX: Prior RCT with Symptomatic Apical
Periodontitis (SAP). The margins are suspicious, but apical surgery was
chosen to address the infection without disturbing the existing crown.
Apicoectomy completed, no root fractures seen with microscope. MTA retrofill.
9.5 year recall. Tooth is fully functional, asymptomatic with
radiographic healing. Apicoectomy has preserved the tooth and the
periodontium for an extended period of time.
SOURCES:
Outcomes of Surgical Endodontic Treatment Performed by a Modern Technique: An Updated Meta-analysis of the Literature
Igor Tsesis, Eyal Rosen, Silvio Taschieri, Yoel Telishevsky Strauss, Valentina Ceresoli, Massimo Del Fabbro
Journal of endodontics 1 March 2013 (volume 39 issue 3 Pages 332-339 DOI: 10.1016/j.joen.2012.11.044)