Periapical microsurgical endodontic treatment of the maxillary second premolar: a clinical case

Abstract

The primary objective of endodontic treatment and apical surgery is the prevention or elimination of inflammatory conditions in the periapical tissues. Such inflammation develops as a result of the metabolic activity of diverse colonies of pathogenic and opportunistic microorganisms colonizing the root canal system. Apical microsurgical intervention represents a promising treatment modality for teeth resistant to conventional (orthograde) therapy. The reported success rate of this procedure exceeds 90%, even in the presence of complications. The occurrence of such complications is often associated with insufficient theoretical training of narrowly specialized clinicians, a lack of appropriate instrumentation, and limited access to magnification equipment, such as binocular loupes or a stationary operating microscope. In some cases, repeated endodontic retreatment proves ineffective and leads to the persistence of apical periodontitis despite technically successful conservative therapy. In these situations, the inflammatory focus is localized within the periodontal space at the apex of the affected tooth. Its etiology is attributed to bacteria persisting in anatomically inaccessible areas of the root canal system. The bacterial biofilm in the apical portion of the root canal system exhibits a complex anatomical configuration, which often cannot be completely eliminated using conventional endodontic techniques.