FROM RESECTION TO REGENERATION: CLINICAL EVALUATION OF CONTEMPORARY ENDODONTIC MICROSURGERY USING ULTRASONIC ROOT-END PREPARATION AND BIOCERAMIC ROOT-END FILLING

Abstract

Aim: To clinically and radiographically evaluate the outcome of contemporary endodontic microsurgery performed with ultrasonic root-end preparation and a calcium-silicate–based bioceramic root-end filling material, and to identify prognostic factors influencing periapical healing at 12 months. Methodology: In this prospective clinical study, 42 teeth in 40 patients with persistent apical periodontitis refractory to non-surgical retreatment were treated using a standardized microsurgical protocol under the operating microscope. After osteotomy and 3 mm root-end resection with minimal bevel, root-end cavities were prepared to a depth of 3 mm using ultrasonic retro-tips and filled with a premixed bioceramic root-repair material. Healing was assessed clinically and radiographically at 6 and 12 months using two-dimensional criteria (Rud/Molven) and cone-beam computed tomography (CBCT)–based modified three-dimensional criteria. Outcomes were dichotomized as “healed” (complete + incomplete healing) or “not healed” (uncertain + unsatisfactory). Associations between healing and preoperative variables were analyzed using the chi-square/Fisher exact test, with significance set at p < 0.05. Results: Thirty-nine teeth in 37 patients completed the 12-month review (recall rate 92.9%). The overall success rate was 92.3% (36/39) by two-dimensional criteria and 89.7% (35/39) by CBCT-based criteria. Complete osseous healing was observed in 30 teeth. Smaller preoperative lesions (≤5 mm), the absence of a preoperative sinus tract, and adequate coronal restoration were significantly associated with favorable healing (p < 0.05). Tooth type, arch, and patient sex were not significant predictors. No serious adverse events were recorded, and postoperative morbidity was mild and transient. Conclusion: Contemporary endodontic microsurgery combining ultrasonic root-end preparation with a bioceramic root-end filling produced predictable, high-rate periapical healing at 12 months. The technique represents a reliable, tissue-conserving approach that supports the transition from mechanical resection toward biologically driven periradicular regeneration.