MODERN APPROACHES IN APICOECTOMY: MICROSURGICAL TECHNIQUES AND PROGNOSTIC FACTORS

Cristian Budacu, Doriana Agop Forna, Iulia Chiscop, Trifăuțanu Petru, Cornea Diana, Cristian Levente Giuroiu

DOI : 10.62610/RJOR.2025.2.17.61

Abstract

Apicoectomy has evolved from a traditional endodontic surgical approach into a minimally invasive and highly predictable microsurgical technique. This review explores modern advancements in apicoectomy, including the use of dental operating microscopes, ultrasonic retropreparation, and bioactive root-end filling materials such as MTA and Biodentine. The transition from conventional to microsurgical protocols has significantly improved outcomes by enhancing visualization, reducing trauma, and increasing the precision of root-end management. Accurate case selection supported by CBCT imaging is essential, as is understanding the current indications, such as persistent periapical lesions, anatomical constraints, or failed orthograde retreatment. The success of the procedure relies on multiple prognostic factors, including root morphology, infection control, material selection, and operator skill. Despite high success rates, potential complications like sinus perforation, delayed healing, or lesion recurrence must be anticipated and managed appropriately. Future directions include the integration of nanomaterials, guided tissue regeneration, and artificial intelligence in diagnosis and surgical planning. Ultimately, microsurgical apicoectomy offers a biologically respectful alternative to tooth extraction, supporting the long-term preservation of natural dentition.