Timeliness and effectiveness in the surgical management of persistent post‐treatment periapical pathosis

Abstract

Common problems that cause persistent post‐treatment periapical pathosis include infection remaining in the apical inaccessible areas, extraradicular infection including apically extruded dentine debris with bacteria present in dentinal tubules, radicular true cysts, foreign body reactions, inadequate non‐surgical root canal treatment with or without iatrogenically altered root canal morphology, and vertical root fractures. Inadequate root canal treatment may be corrected non‐surgically, while more complex problems may require surgical intervention. The important factors that warrant a successful surgery include good quality of the orthograde root canal treatment, deep retrograde preparation of the apical canal, and carefully cleaning and filling of the exposed isthmuses and accessory canals. Ideally, apical surgery and orthograde retreatment are performed simultaneously. In a recent study, 97% of the lesions including large ones of >10 mm in diameter healed completely within 1 year after surgical intervention. Of the teeth that showed ‘complete healing’ at 4 years more than 85% already ‘completely healed’ at 2 years; thus, the endodontic post‐treatment disease might be treated surgically or non‐surgically within 2 years after the previous treatment.