By Dr Randa Harik, Dr Grace Issa & Prof. Philippe Sleiman, Lebanon

Surgical endodontic treatment is a therapy modality for teeth with apical periodontitis and may be indicated for teeth that previously underwent an unsuccessful endodontic treatment, as well as teeth where a non-surgical approach has a high risk of failure. The procedure usually consists of several steps and includes a retrograde obturation, which is performed after root resection followed by a retrograde preparation of the root canal.

Also, presence of true apical cysts requires a surgical treatment as such cysts are less likely to heal by conventional root canal therapy because they are self-sustaining and no longer dependent on the presence or absence of root canal infection. That is why many suggest that surgical intervention is necessary in the treatment of true apical cysts.

The limitations of periapical radiography have led to significant interest in cone beam computed tomography (CBCT) in endodontic applications. It seems that the number of CBCT scans taken every year is growing as awareness and resolution are increased and costs are reduced. CBCT can be helpful, if not instrumental, in the differential diagnostics of cystic lesions. In particular, CBCT images can provide a moderately accurate diagnosis between cysts and granulomas.Simon et al. found that the CBCT may provide a more accurate diagnosis than biopsy and histology providing a diagnosis without invasive surgery and/ or waiting a year to see if non-surgical therapy is effective.

In this article, we will describe a new approach in surgical endodontics that focuses on preserving the integrity of the apical part of the root and removing the cyst or cysts completely. We will illustrate this approach with a series of cases showing preoperative condition and postoperative healing.