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Download free Guidelines for Surgical Endodontics.pdf The aetiology of periapical (periradicular) periodontitis is microbial ( Kakehashi et a 1965, Sundqvist 1976, Moller et al 1981,). The presence of micro-organisms within the root canal system induces an inflammatory and immune response within the periradicular tissues resulting in discreet bone destruction. In addition, contamination of the periradicular tissues by micro-organisms and root filling materials may initiate a foreign body reaction and healing cannot then take place

It is recognised that the aim of root canal treatment is to clean and disinfect the root canal system to reduce microbial numbers and remove necrotic tissue, and then seal the system to prevent recontamination. Success rates of up to 95% have been quoted for de novo root canal treatment but failure may occur subsequent to treatment. Options for the treatment of these failures can be non-surgical and surgical (Briggs & Scott, 1997). Non-surgical retreatment may provide a better opportunity to clean the root canal system than a surgical approach, where the coronal part of the root canal system remains untouched Danin et al 1999). However there are instances when non-surgical intervention is inappropriate.

The clinical evidence comparing particular endodontic procedures is sparse. There have been only two randomised controlled trails comparing root canal retreatment using surgical and non-surgical approaches (Danin et al 1999; Kvist & Reit 1999). However, there have been a number of pragmatic trials using various materials and procedures.

Surgical endodontics as described in this text includes root-end resection, apical curettage and root-end filling. Other procedures such as apical curettage alone, root resection, hemisection, intentional replantation and regenerative procedures have not been included.


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