NONSURGICAL ROOT-CANAL THERAPY TREATMENT WITH APPARENT INDICATIONS FOR ROOT-END SURGERY

The recent introduction of the surgical microscope to the practice of endodontics, especially for surgery, has allowed clearer visualization of the periapex during root-end resection and filling. However, despi te this and other technologic advances, it has not been demonstrated t hat in the absence of thorough canal debridement the success rate of p eriapical surgery has improved over the 50% to 60% demonstrated in mos t long-term prognosis studies. Therefore it remains important to fully instrument and obturate the root canal system with conventional thera py before surgery is considered; this considerably improves the long-t erm prognosis. Each of the case reports in this article involves a sit uation in which conventional treatment was performed when a surgical a pproach might have been considered as the treatment of choice. Surgery should not be considered to be the primary treatment when root canal treatment or retreatment may be readily achieved. Indeed, the operatin g microscope and other technical aids will probably allow more cases t o be treated and retreated conventionally that might otherwise have re quired surgical intervention.