Endodontic microsurgery

endodontic microsurgery

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.

Endodontic microsurgery of lower molar.

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

Hemostatic agents epi and AlCl were comparable in terms of impact they have on healing of apicoectomy. Peñarrocha-Diago JOE 2018

Incisor apicoectomy on a lower incisor

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% Bliggenstorfer JOE 2021.

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

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.

Endodontic microsurgery or apicoectomy survival rates
Studies on endodontic surgical treatment


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

Complications of endodontic microsurgery

Nerve damage is always possible with any surgery.