26 November 2025

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Surgical endodontics: a review of current best practice

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Aim

An apicectomy is an endodontic surgical procedure which involves root-end resection, apical curettage and root-end filling. This article aims to discuss current guidelines and review the recent literature published on this topic. Indications and contraindications are outlined. Various aspects of the surgical procedure are discussed, including flap design, root-end surgical management and current recommended root-end filling materials. The expected outcomes and associated complications are also presented.

Materials and methods

A targeted electronic search of PubMed and Medline databases was carried out. The keywords used in the search were ‘apicectomy, microsurgical endodontics, mineral trioxide aggregate, microsurgical instruments’. Articles from peer-reviewed journals were included. The search was limited to articles published since 1990.

Recommendations and conclusions

It is currently recommended that microsurgical techniques are incorporated in the practice of surgical endodontics. Ultrasonic tips are advised for retrograde root preparation. Amalgam is no longer recommended as a retrograde filling material. Mineral trioxide aggregate is now the material of choice. Surgical endodontics is an area where postgraduate training is advisable for those practising it.

Authors: T. Fahey, N. O'Connor, T. Walker, D. Chin-Shong

Source: https://onlinelibrary.wiley.com/