What is an apicoectomy or endodontic microsurgery?
Apicoectomy is the surgical removal of tissue from the tooth root tip, when a root canal is no longer working. Typically there is an infection at the root tip. Some make clarifications and separate apicoectomy and apical microsurgery but it’s all in regards to improvements in technology and products.
What techniques and products are best for endodontic microsurgery (apicoectomy)? – MTA Super EBA
Can use EndoSequence Root Repair Material Putty for apico.
BP-RPM is comparable to MTA for endodontic microsurgery according to Zhoe JOE 2017
There is no difference in success with MTA or Super EBA at 4 years 182 teeth RCT based on Kim JOE 2016 In this study they determine success by following healing using peri-apical x-rays from three angles.
Super EBA = MTA 260 RC study
ProRoot MTA beats SuperEBA May 12 170 RCT
What impact does hemostatic agents have on apical healing?
Hemostatic agents epi and AlCl were comparable in terms of impact they have on healing of apicoectomy. Peñarrocha-Diago JOE 2018
Aluminum chloride products MAY hinder healing. JOE 2025 Kim
What are the success rates for apical surgery?
10 year success rate was 80% for Arx JOE 2019 and that is in very close agreement with the 77%
Apicoectomy has better outcomes than retreatment. This makes sense for many reasons and I agree UNLESS we can see a reason for failure. Typically a reason for failure can be something like the original doctor not treating the MB2 canal. Curtis JOE 2018
Does Vitamin D or other medications have an impact on healing?
According tooptimizing vitamin D levels may be beneficial for the healing process of teeth with periapical lesions. Lesion area reduction was significantly greater in the vitamin D group of their study. It’s highly probable that medications and conditions that impact dental implants also impact apical surgery.
Endodontic microsurgery: When to give up on a tooth and do the dental implant
Dental implant is a superior option to endodontic microsurgery with respect to survival. Literature does not allow comparison of other relevant outcomes such as psycho-social, economic, and need for additional interventions. Systemic Review Torabinejad Jan 2015 JOE
Endodontic microsurgery (apicoectomy) survival rates are reported around 96% at 2-4 years and 88% at 4-6 years.
Additional reading for microsurgical endodontics.
Microsurgical endodontics by Khayat is a new textbook that has a nice review from JOE in 2019.
Apicoectomy steps and instrumentation
- Use the esthetic buccal flap
Complications of endodontic microsurgery
Nerve damage is always possible with any surgery.
