Advances and clinical benefits of endodontic microsurgery: A contemporary perspective

Endodontic microsurgery (EMS) represents a significant advancement in the treatment of persistent periapical disease, evolving from conventional apicoectomy techniques into a precise, minimally invasive procedure. Indications for EMS include nonsurgical retreatment has failed or is not feasible, the primary endodontic treatment cannot be improved upon, insufficient residual dentin thickness, extra-radicular infection, among others. EMS follows a precise sequence: diagnosis and planning, surgical access, osteotomy, root-end resection, retrograde preparation and filling, and final closure; performed under advanced magnification and microsurgical techniques. The positive result of EMS is the healing of apical periodontitis. Nowadays, with the use of an operating microscope, which provides high magnification, has demonstrated high success rates, ranging from 91.4% to 94.4%. The integration of three-dimensional (3D) navigation technology into EMS has marked a significant advancement in the field, offering unparalleled precision and control during surgical procedures. Guided EMS, whether through static, dynamic or robotic navigation, enables clinicians to accurately plan and execute osteotomies and apical resections while minimizing damage to surrounding anatomical structures. This article provides an overview of the current state of EMS. It highlights the most recent innovations in clinical protocols and discusses their impact on treatment outcomes. KEY POINTS: Endodontic microsurgery (EMS) is a predictable, minimally invasive treatment for persistent periapical disease, especially when nonsurgical retreatment is not feasible or has failed. Advanced imaging (CBCT), microsurgical techniques, and biocompatible root-end filling materials significantly enhance diagnosis, surgical precision, and long-term treatment outcomes. Guided EMS, using static or dynamic navigation systems, improves accuracy and safety in complex cases, reducing the risk to surrounding anatomical structures and increasing procedural predictability. PLAIN LANGUAGE SUMMARY: Endodontic microsurgery (EMS) is a major improvement in treating ongoing endodontic problems. It updates traditional root-end surgery by making it more precise and less invasive. EMS is used when standard treatments fail or aren't possible, when the initial treatment can't be improved, when there isn't enough tooth dentin, or when there's an external infection. The process includes diagnosing the problem, planning, accessing the tooth, removing the infected root section, filling the area, and final closure. This is done using advanced magnifying microscopes and microsurgery techniques. One key benefit of EMS is its ability to help heal apical periodontitis, an infection at the root end. Using high-magnification microscopes, success rates for this procedure are impressive, ranging from 91.4% to 94.4%. Incorporating 3D navigation technology into EMS allows for even more accuracy during surgery, helping dentists carefully plan procedures while minimizing damage to surrounding tissues. This article reviews the current state of EMS, focusing on the latest advancements in techniques and their positive effects on treatment outcomes.