Palatal root endodontic microsurgery in maxillary molars using the palatal approach: a case study.

Area of Science:

• Endodontic Microsurgery
• Oral and Maxillofacial Surgery

Background:

• The buccal approach is standard for endodontic microsurgery.
• The palatal approach presents challenges due to root length, the greater palatine artery (GPA) and foramen (GPF), and limited surgical field.
• However, anatomical factors may favor the palatal approach for palatal roots of maxillary molars with apical periodontitis.

Purpose of the Study:

• To evaluate the feasibility and outcomes of the palatal approach for endodontic microsurgery on the palatal root of maxillary molars.
• To identify and propose surgical techniques to overcome challenges associated with the palatal approach.

Main Methods:

• Cone-beam computed tomography (CBCT) imaging was utilized.
• The palatal approach was applied in nine cases of endodontic microsurgery for maxillary molars with periapical lesions.
• Surgical positioning, incision design, flap modification, bone removal, and root-end resection were key considerations.

Main Results:

• Successful application of the palatal approach in all nine cases.
• Complete healing was achieved in all patients, confirmed by clinical and radiographic assessments at 3 and 24 months.
• The study identified several practical tips for successful palatal surgery.

Conclusions:

• The palatal approach is a successful surgical option for endodontic microsurgery of the palatal root of maxillary molars.
• Specific surgical techniques can mitigate challenges, leading to favorable outcomes.
• This approach provides an alternative when the buccal approach is less suitable.