Periradicular surgery is commonly performed to remove a portion of the root with undebrided canal space or to retroseal the canal when a complete seal cannot be obtained with an orthograde (through the crown) approach. The main indications for periradicular surgery are (1) nonsurgical root canal therapy is unfeasible (2) retreatment of failed root canal therapy is impossible or would not produce a better result (3) biopsy is indicated.
Specifically, periapiacal surgery may be neccesary in the folowing situations: (a) anatomic problems (b) procedural accidents requiring surgery (c) irretrievable materials in the canal (d) persistent symptoms (e) horizontal root fractures with apical necroses (f) irretrievable material preventing canal treatment (g) procedural error during treatment (h) large unresolved lessions following root canal treatment.
Contraindications on the other hand include: (a) unidentified cause of treatment failure (b) conventional root canal treatment is possible (c) combined coronal treatment / apical (d) failure of retreatment (e) anatomic structures are in jeopardy (f) structures interfere with access and visibility (g) compromise of crown / root ratio and (h) systemic complications like blood disorders, terminal disease, uncontrolled diabetes or severe heart disease.
When a nonsurgical approach would probably result in successful treatment, surgery is not indicated. The choice of treatment should be based on the best available evidence, case specific, clinical judgement and patients preference.
Dr. Napoleon S. Navarrette
Assistant Dean, National University College of Dentistry
Member, International Association of Orthodontics