Surgical management of refractory periapical lesions: contemporary approaches and current evidence
DOI:
https://doi.org/10.55892/jrg.v9i20.3417Keywords:
Refractory periapical lesions, Endodontic microsurgery, Bioceramic materials, Endodontic surgery, CBCTAbstract
Refractory periapical lesions represent an important clinical challenge in Endodontics, particularly in cases where conventional root canal treatment and orthograde retreatment fail to promote adequate periradicular tissue healing. In this context, contemporary endodontic microsurgery has emerged as a relevant therapeutic alternative, driven by technological advances and the development of minimally invasive techniques. This study aimed to review the current scientific evidence regarding the surgical management of refractory periapical lesions, emphasizing contemporary microsurgical approaches, prognostic factors, biomaterials, and associated diagnostic methods. This is a narrative literature review conducted through bibliographic searches in the PubMed/MEDLINE, Scopus, and SciELO databases, considering studies published between 2018 and 2025. Articles related to endodontic surgery, endodontic microsurgery, bioceramic materials, prognostic factors, and cone-beam computed tomography (CBCT) were included. The analyzed studies demonstrated high clinical and radiographic success rates associated with modern endodontic microsurgery, especially when operative magnification, ultrasonic retrograde preparation, and bioceramic materials such as mineral trioxide aggregate (MTA) were employed. Furthermore, CBCT proved to be an important tool for surgical planning and postoperative follow-up, allowing more accurate three-dimensional evaluation of periapical structures. However, significant methodological heterogeneity was observed among the studies, involving differences in success criteria, follow-up periods, and surgical protocols. It can be concluded that contemporary endodontic microsurgery presents promising outcomes in the management of refractory periapical lesions, contributing to greater therapeutic predictability and tooth preservation, although further standardized long-term clinical studies are still necessary to strengthen the currently available scientific evidence.
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References
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