Modern endodontic surgery concepts and practice: a review.

Endodontic surgery has now evolved into endodontic microsurgery. By using state-of-the-art equipment, instruments and materials that match biological concepts with clinical practice, we believe that microsurgical approaches produce predictable outcomes in the healing of lesions of endodontic origin. In this review we attempted to provide the most current concepts, techniques, instruments and materials with the aim of demonstrating how far we have come. Our ultimate goal is to assertively teach the future generation of graduate students and also train our colleagues to incorporate these techniques and concepts into everyday practice.

[1]  P. Velvart,et al.  Papilla healing following sulcular full thickness flap in endodontic surgery. , 2004, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[2]  R. Rubinstein,et al.  Long-term follow-up of cases considered healed one year after apical microsurgery. , 2002, Journal of endodontics.

[3]  S. Friedman,et al.  Relation of pre- and intraoperative factors to prognosis of posterior apical surgery. , 1991, Journal of Endodontics.

[4]  R. Curtis,et al.  The constitution of mineral trioxide aggregate. , 2005, Dental materials : official publication of the Academy of Dental Materials.

[5]  Evans Be.  Local hemostatic agents. , 1977 .

[6]  K. Kerekes,et al.  Long-term results of endodontic treatment performed with a standardized technique. , 1979, Journal of endodontics.

[7]  C. Eduardo,et al.  The use of Er:YAG, Nd:YAG and Ga-Al-As lasers in periapical surgery: a 3-year clinical study. , 2001, Journal of clinical laser medicine & surgery.

[8]  F. Pineda.  Roentgenographic investigation of the mesiobuccal root of the maxillary first molar. , 1973, Oral surgery, oral medicine, and oral pathology.

[9]  D. Goldstein,et al.  Plasma epinephrine levels and cardiovascular response to high administered doses of epinephrine contained in local anesthesia. , 1987, Anesthesia progress.

[10]  F. Marshall,et al.  Molar endodontic surgery. , 1983, Journal.

[11]  E. Kaminski,et al.  A comparative study of the wound healing of three types of flap design used in periapical surgery. , 1984, Journal of endodontics.

[12]  H. Dunn.  Studies on implantation of anorganic bone in cystic jaw lesions , 1970 .

[13]  G. Hartwell,et al.  Leakage in vitro with IRM, high copper amalgam, and EBA cement as retrofilling materials. , 1989, Journal of endodontics.

[14]  M. Somerman,et al.  Cementoblasts maintain expression of osteocalcin in the presence of mineral trioxide aggregate. , 2003, Journal of endodontics.

[15]  J. Simon,et al.  Incidence of periapical cysts in relation to the root canal. , 1980, Journal of endodontics.

[16]  S. Friedman,et al.  Treatment outcome in endodontics-The Toronto Study. Phases I and II: apical surgery. , 2004, Journal of endodontics.

[17]  A. Walmsley,et al.  Cutting ability of an ultrasonic retrograde cavity preparation instrument. , 1995, Endodontics & dental traumatology.

[18]  M. Torabinejad,et al.  Cytotoxicity of four root end filling materials. , 1995, Journal of endodontics.

[19]  J. W. Harrison,et al.  Posterior endodontic surgery: anatomical considerations and clinical techniques. , 1985, International endodontic journal.

[20]  Welch Jt,et al.  The use of epinephrie in local anesthetics for dental patients with cardiovascular disease: a review of the literature. , 1960 .

[21]  B. Jeansonne,et al.  Ferric sulfate hemostasis: effect on osseous wound healing. Left in situ for maximum exposure. , 1993, Journal of endodontics.

[22]  J. Simon,et al.  Human saliva penetration of root canals obturated with two types of mineral trioxide aggregate cements. , 2005, Journal of endodontics.

[23]  H. S. Selden,et al.  Bone wax as an effective hemostat in periapical surgery. , 1970, Oral surgery, oral medicine, and oral pathology.

[24]  J. Gutmann,et al.  Osteoblasts and MG-63 osteosarcoma cells behave differently when in contact with ProRoot MTA and White MTA. , 2003, International endodontic journal.

[25]  P. Nair,et al.  Radicular cyst affecting a root-filled human tooth: a long-term post-treatment follow-up. , 1993, International endodontic journal.

[26]  D Green,et al.  Double canals in single roots. , 1973, Oral surgery, oral medicine, and oral pathology.

[27]  M. Eghbal,et al.  Chemical differences between white and gray mineral trioxide aggregate. , 2005, Journal of endodontics.

[28]  P. Boyne,et al.  The effects of osseous implant materials on regeneration of alveolar cortex , 1961 .

[29]  M. Torabinejad,et al.  Bacterial leakage of mineral trioxide aggregate as a root-end filling material. , 1995, Journal of endodontics.

[30]  G. Carr.  Ultrasonic root end preparation. , 1997, Dental clinics of North America.

[31]  L. A. Morgan,et al.  A scanning electron microscopic study of in vivo ultrasonic root-end preparations. , 1999, Journal of endodontics.

[32]  R. Holland,et al.  Reaction of rat connective tissue to implanted dentin tube filled with mineral trioxide aggregate, Portland cement or calcium hydroxide. , 2001, Brazilian dental journal.

[33]  M. Torabinejad,et al.  Tissue reaction to implanted super-EBA and mineral trioxide aggregate in the mandible of guinea pigs: a preliminary report. , 1995, Journal of endodontics.

[34]  R. Weller,et al.  The mental forman: Part I. Size, orientation, and positional relationship to the mandibular second premolar , 1990 .

[35]  P. Velvart.  Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery. , 2002, International endodontic journal.

[36]  S. Andreana,et al.  Use of dental operating microscope in endodontic surgery. , 1993, Oral surgery, oral medicine, and oral pathology.

[37]  P. Velvart,et al.  Comparison of long-term papilla healing following sulcular full thickness flap and papilla base flap in endodontic surgery. , 2004, International endodontic journal.

[38]  R. Rubinstein,et al.  Short-term observation of the results of endodontic surgery with the use of a surgical operation microscope and super-EBA as root-end filling material , 1999 .

[39]  Y. Hsu,et al.  The resected root surface. The issue of canal isthmuses. , 1997, Dental clinics of North America.

[40]  F. Vertucci.  Root canal anatomy of the human permanent teeth. , 1984, Oral surgery, oral medicine, and oral pathology.

[41]  P. Nair,et al.  Pathogenesis of apical periodontitis and the causes of endodontic failures. , 2004, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[42]  R. Weller,et al.  RS 36 The canal isthmus in mesiobuccal roots of maxillary first molars , 1995 .

[43]  S. Dorn,et al.  Retrograde filling materials: a retrospective success-failure study of amalgam, EBA, and IRM. , 1990, Journal of endodontics.

[44]  J. J. Legan,et al.  In vitro evaluation of effects of ultrasonic root-end preparation on resected root surfaces. , 1997, Journal of endodontics.

[45]  D. Goldstein,et al.  Effects of Diazepam Premedication and Epinephrine‐Containing Local Anesthetic on Cardiovascular and Plasma Catecholamine Responses to Oral Surgery , 1984, Anesthesia and analgesia.

[46]  E. Besner.  Systemic effects of racemic epinephrine when applied to the bone cavity during periapical surgery. , 1972, Virginia dental journal.

[47]  S. Friedman,et al.  Ultrasonic root end cavity preparation assessed by an in situ impression technique. , 1998, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[48]  M. Maddalone,et al.  Periapical endodontic surgery: a 3-year follow-up study. , 2003, International endodontic journal.

[49]  C. E. Brown,et al.  An analysis of success and failure of apicoectomies. , 1991, Journal of endodontics.

[50]  Paul A. Rosenberg,et al.  A comparison of the apical seals achieved using retrograde amalgam fillings and the Nd:YAG laser. , 1994, Journal of endodontics.

[51]  A. F. Paghdiwala.  Root resection of endodontically treated teeth by erbium: YAG laser radiation. , 1993, Journal of endodontics.

[52]  R. Weller,et al.  The mental foramen: 1. Size, orientation, and positional relationship to the mandibular second premolar. , 1990, Journal of endodontics.

[53]  N. Yarom,et al.  A retrospective radiographic study of root-end surgery with amalgam and intermediate restorative material. , 2003, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[54]  J. Priestley.  Scarlatina and Small-Pox , 1892 .

[55]  P. Nair.  Non‐microbial etiology: foreign body reaction maintaining post‐treatment apical periodontitis , 2003 .

[56]  R. Holland,et al.  Reaction of rat connective tissue to implanted dentin tubes filled with a white mineral trioxide aggregate. , 2002, Brazilian dental journal.

[57]  T von Arx,et al.  Root-end cavity preparation after apicoectomy using a new type of sonic and diamond-surfaced retrotip: a 1-year follow-up study. , 1999, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[58]  J. Camilleri,et al.  Biocompatibility of two commercial forms of mineral trioxide aggregate. , 2004, International endodontic journal.

[59]  T. Strömberg,et al.  Outcomes of periradicular surgery in cases with apical pathosis and untreated canals. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[60]  A. Halse,et al.  Surgical management of endodontic failures: indications and treatment results. , 1991, International dental journal.

[61]  L. A. Morgan,et al.  Evaluation of cracks associated with ultrasonic root-end preparation. , 1995, Journal of endodontics.

[62]  C. Reit,et al.  Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment. , 2000, Endodontics & dental traumatology.

[63]  K. Mattila,et al.  Follow-up study of apicoectomized molars. , 1976, International journal of oral surgery.

[64]  D. August.  Long-term, postsurgical results on teeth with periapical radiolucencies. , 1996, Journal of endodontics.

[65]  J. Andreasen,et al.  Incomplete bone healing of experimental cavities in dog mandibles. , 1971, The British journal of oral surgery.

[66]  S. Ciancio,et al.  Efficacy of epinephrine concentration in local anesthesia during periodontal surgery. , 1984, The Journal of Periodontology.

[67]  M. Gilthorpe,et al.  Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study. , 2001, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[68]  R. L. Cooley,et al.  Endodontic flap design: analysis and recommendations for current usage. , 1984, Oral surgery, oral medicine, and oral pathology.

[69]  H. Steiman,et al.  Preliminary investigation of ultrasonic root end preparation. , 1995, Journal of endodontics.

[70]  J. Baumgartner,et al.  Perforation repair comparing two types of mineral trioxide aggregate. , 2004, Journal of endodontics.

[71]  U. Lekholm,et al.  Retreatment of endodontic fillings. , 1979, Scandinavian journal of dental research.

[72]  R. Weller,et al.  The mental foramen: Part II. Radiographic position in relation to the mandibular second premolar , 1992 .

[73]  T. Komori,et al.  Clinical application of the erbium:YAG laser for apicoectomy. , 1997, Journal of endodontics.

[74]  R. Holland,et al.  Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. , 2001, Dental traumatology : official publication of International Association for Dental Traumatology.

[75]  P. Nair,et al.  Types and incidence of human periapical lesions obtained with extracted teeth. , 1996, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[76]  V. Horsley.  Antiseptic Wax , 1892 .

[77]  Merriam-Webster.  Merriam-Webster's Collegiate Dictionary , 1998 .

[78]  T. Testori,et al.  Success and failure in periradicular surgery: a longitudinal retrospective analysis. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[79]  N. Hardt,et al.  Periradicular surgery of molars: a prospective clinical study with a one-year follow-up. , 2001, International endodontic journal.

[80]  M. Torabinejad,et al.  A comparison between two root end preparation techniques in human cadavers. , 1994, Journal of endodontics.

[81]  B. P. Austin,et al.  Osseous reactions to three hemostatic agents. , 1985, Journal of endodontics.

[82]  J. Gutmann,et al.  Management of the resected root end: a clinical review. , 1993, International endodontic journal.

[83]  E. Munksgaard,et al.  Periapical healing of mandibular molars after root-end sealing with dentine-bonded composite. , 2001, International endodontic journal.

[84]  M. Torabinejad,et al.  Root end filling materials: a review. , 1996, Endodontics & dental traumatology.

[85]  S. Dorn,et al.  Effect of IRM root end fillings on healing after replantation. , 1994, Journal of endodontics.

[86]  J. Andreasen,et al.  A study of failures after endodontic surgery by radiographic, histologic and stereomicroscopic methods. , 1972, International journal of oral surgery.

[87]  J. Yagiela,et al.  Vasoconstrictors and local anesthesia: a review and rationale for use. , 1983, Journal of the American Dental Association.

[88]  J. Gutmann,et al.  Prognosis in periradicular surgery: a clinical prospective study. , 2000, International endodontic journal.

[89]  R. Asa.  Endodontic microsurgery. , 1994, CDS review.

[90]  A. Halse,et al.  Follow-up after periapical surgery: the value of the one-year control. , 1991, Endodontics & dental traumatology.

[91]  J. Gutmann.  Parameters of achieving quality anesthesia and hemostasis in surgical endodontics. , 1993, Anesthesia & pain control in dentistry.

[92]  R. A. Uchin.  Surgical endodontics. , 1979, Dental clinics of North America.

[93]  R. Holland,et al.  Histomorphological response of dogs' dental pulp capped with white mineral trioxide aggregate. , 2004, Brazilian dental journal.

[94]  W. Maillet,et al.  Connective tissue response to root surfaces resected with Nd:YAG laser or burs. , 1996, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[95]  P. Poikkeus,et al.  Clinical and radiographic study of pulpectomy and root canal therapy. , 1978, Scandinavian journal of dental research.

[96]  Stephen Cohen,et al.  Pathways of the Pulp , 1976 .

[97]  P. Wesselink,et al.  Soft tissue management in endodontic surgery. , 1997, Dental clinics of North America.

[98]  I. Tsesis,et al.  Analysis of postoperative symptoms following surgical endodontic treatment. , 2003, Quintessence international.

[99]  Carruthers Gb.  Ultrasonic root end preparation. , 1997 .

[100]  J. Nör,et al.  Effect of ProRoot MTA on pulp cell apoptosis and proliferation in vitro. , 2005, Journal of endodontics.

[101]  Marshall Fj,et al.  Molar endodontic surgery. , 1983 .

[102]  S. Lejeune,et al.  Prospective study of two retrograde endodontic apical preparations with and without the use of CO2 laser. , 1998, Endodontics & dental traumatology.

[103]  A. E. Zaki,et al.  A comparison of the sealing properties of different retrograde techniques: an autoradiographic study. , 1985, Oral surgery, oral medicine, and oral pathology.

[104]  S. Kim.  Principles of endodontic microsurgery. , 1997, Dental clinics of North America.

[105]  J. Marshall,et al.  Cardiovascular effects and efficacy of a hemostatic agent in periradicular surgery. , 2004, Journal of endodontics.

[106]  P. Nair,et al.  New perspectives on radicular cysts: do they heal? , 2002, International endodontic journal.

[107]  E. Saunders,et al.  Coronal leakage as a cause of failure in root-canal therapy: a review. , 1994, Endodontics & dental traumatology.

[108]  S. Dorn,et al.  Effect of super-EBA as a root end filling on healing after replantation. , 1995, Journal of endodontics.

[109]  Syngcuk Kim.  Color Atlas of Microsurgery in Endodontics , 2000 .

[110]  S. Friedman,et al.  Treatment results of apical surgery in premolar and molar teeth. , 1991, Journal of endodontics.

[111]  T. M. Gale,et al.  Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals , 2003, British Dental Journal.

[112]  F. Harty,et al.  The success rate of apicectomy. A retrospective study of 1, 016 cases , 1970, British Dental Journal.

[113]  M. Gagliani,et al.  The outcome of endodontic retreatment: a 2-yr follow-up , 2004, Journal of endodontics.

[114]  M. Torabinejad,et al.  Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys. , 1997, Journal of endodontics.

[115]  Stanley F. Malamed,et al.  Handbook of local anesthesia , 1996 .

[116]  Syngcuk Kim,et al.  Hemostasis in endodontic microsurgery. , 1997, Dental clinics of North America.

[117]  H. Plenk,et al.  Periapical tissue responses and cementum regeneration with amalgam, SuperEBA, and MTA as root-end filling materials. , 2005, Journal of endodontics.

[118]  Stephen William Navarre,et al.  Root-end fracture during retropreparation: a comparison between zirconium nitride-coated and stainless steel microsurgical ultrasonic instruments. , 2002, Journal of endodontics.

[119]  L. A. Morgan,et al.  Evaluation of diamond-coated ultrasonic instruments for root-end preparation. , 1999, Journal of endodontics.

[120]  Gutmann Jl.  Parameters of achieving quality anesthesia and hemostasis in surgical endodontics. , 1993 .

[121]  D. B. Jenkins,et al.  Quality of root-end preparations using ultrasonic and rotary instrumentation in cadavers. , 2000, Journal of endodontics.

[122]  J. Gutmann,et al.  Ultrasonic root-end preparation, Part 2. Microleakage of EBA root-end fillings. , 1994, International endodontic journal.

[123]  B. Chong,et al.  A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery. , 2003, International endodontic journal.

[124]  A. L. Frank,et al.  Long-term evaluation of surgically placed amalgam fillings. , 1992, Journal of endodontics.

[125]  J. Gutmann,et al.  Haemostasis in periradicular surgery. , 1996, International endodontic journal.

[126]  O. Peters,et al.  An in vitro study comparing root-end cavities prepared by diamond-coated and stainless steel ultrasonic retrotips. , 2001, International endodontic journal.

[127]  R. Weller,et al.  Incidence and position of the canal isthmus. Part 1. Mesiobuccal root of the maxillary first molar. , 1995, Journal of endodontics.

[128]  M. Torabinejad,et al.  Clinical applications of mineral trioxide aggregate. , 1999, Journal of endodontics.

[129]  M. Tyas,et al.  Apical dentin permeability and microleakage associated with root end resection and retrograde filling. , 1994, Journal of endodontics.