The aim of this manuscript is to describe and discuss the advantages and obstacles of using a guided implant system adapted for endodontic microsurgery in the execution of a case with indication of multiple endodontic microsurgery intervention in a single appointment. Cone-beam computed tomography (CBCT) scans were aligned and processed with the planning software, complementing the Straumann® guided instruments. The drill handles of the system employed directed milling cutters and guided drills based on the sleeve-in-sleeve concept used in the osteotomy and apical resection of teeth #13, #14, #23 and #24. The root-ends were retro-prepared and sealed with putty bioceramic sealer. The patient was completely asymptomatic at the 12 months follow up visit and CBCT revealed complete tissue healing of the involved teeth. The protocol demonstrated to be reliable and reproducible. Its applicability can be extended to other anatomical complex scenarios. The reproducibility of the technique would encourage the maintenance of teeth in patients with indication to multiple endodontic surgery and permitted the conclusion of this case with precision and comfort to both patient and operator.

Apical surgery (AS) is considered as the last resort to save teeth which cannot be treated with a conventional endodontic approach. The main goal of apical surgery is to create a barrier between the root canal system and the peri-radicular tissues by means of a tight root-end filling after resection. However, failures in this treatment usually result in tooth loss. In such cases surgical re-treatment should be considered as a viable alternative. In this case series, successful ARs are presented that were performed on ten teeth in five patients referring for extraction after an unsuccessful apical surgery. It should be noted that if appropriate surgical and endodontic intervention is performed and adequate apical obturation is provided with retro-grade filling, teeth can be treated without extraction.

Dens invagination is a developmental anomaly that required specific treatment approaches. The invagination is truly negligible and enamel-lined for which the crown of the tooth is the only range and there is no extension on the level of the external amelocemental junction. A well ending surgical root canal treatment of an invaginated tooth applied a retrograde filling with MTA is concluded by this study. Periapical radiographic examination after 3 month and 6 year follow-up showed periapical healing with osseous formation.

The aim of the present study was to describe two clinical cases showing postoperative pain associated with the use of plastic carrier obturation system and apical bone fenestration. The patients were treated by surgical access and apicoectomy through a modern technique (using magnification and microsurgical approach), thus removing the direct contact between obturation material and submucosal connective tissue. The surgical interventions were carried on without the occurrence of any complication. Postsurgical adverse sequelae were negligible. After few weeks from the surgery, all symptoms disappeared. Radiographic healing was observed after 48 months. The presence of apical bone fenestration could be the cause of persistent pain after root canal treatment. The contact between plastic carrier and submucosal connective tissue could be the direct cause of spontaneous pain even in absence of periapical infection. Since the clinical diagnosis could be difficult, the use of tridimensional radiology could be justified. Surgical approach, by the removal of the contact between the carrier and connective tissues, can be considered a viable option to treat these particular affections.

Background and Aim: The main goal of endodontic treatments is eliminating the etiologic factors of pulpal and periapical diseases as well as maintaining this condition via providing a hermetic seal between periodontium and root canal system. If these were not possible through orthograde approach, periradicular surgery and root-end filling are indicated. Review of Literature: Different materials have been used as root-end fillings. Amalgam, in 1884, and some other materials were used thereafter for root-end filling. A search in medical data bank provides hundreds of articles related to endodontic surgeries and root-end filling materials; however, there are less than 10 review articles which compare these materials and also there is just one systematic review in this field. Additionally, there is no Meta-analysis with reference to this subject due to scarcity of Randomized Clinical Trials. In this article, we focus on favorable properties of root-end fillings as well as introducing different types of these materials and the ideal choice for endodontic surgeries.Conclusion: Dentists should be informed about different properties of an ideal root-end filling so that they can choose and utilize a favorable material in endodontic surgeries. Since the histological evidences declare successful treatment results for MTA and CEM cement, due to cementogenesis over their surfaces, these biomaterials are recommended for clinical use.

Background: This study aimed to evaluate the reaction of the periapical tissue to Cold ceramic and mineral trioxide aggregate (MTA) following periapical endodontic surgery. Materials and Methods: In this experimental study, a total of 12 mandibular first, second, and third premolars of two male dogs were selected. All procedures were performed under general anesthesia. The access cavities were prepared, and the length of canals was determined. Root canal treatment was performed. A week later, periradicular surgery was performed. After osteotomy, 3 mm of the root end was cut. Then, a 3‑, mm cavity was created by an ultrasonic. The teeth were randomly divided into two groups (n = 12). The root‑, end cavities were filled with MTA in the first group and with Cold ceramic in the second group. After 4 months, the animals were scarified. Histological evaluation of the periapical tissues was performed. Data were analyzed using SPSS 22 and Chi‑, square test and P = 0. 05. Results: The findings showed 87. 5% and 58. 3% cementum formation in MTA and Cold ceramic groups, respectively, indicating a significant difference (P < 0. 001). In addition, the results showed 91. 7% and 83. 3% bone formation in MTA and Cold ceramic groups, respectively, but the difference was not statistically significant (P = 0. 6). Furthermore, the findings revealed 87. 5% and 58. 3% periodontal ligament (PDL) formation in MTA and Cold ceramic groups, respectively (P = 0. 05). Conclusion: Cold ceramic was able to induce the regeneration of cementum, bone, and PDL,hence, it can be considered as a biocompatible root‑, end filling material in endodontic surgery.

As a rare ectomesenchymal neoplasm, benign cementoblastoma comprises less than 6% of all odontogenic tumors. The typical treatment plan involves surgical excision and extraction of the affected tooth. Limited evidence, however, suggests the conservative management of this condition as the best treatment. This article discusses the case of a 32-year-old man who had benign cementoblastoma and underwent conservative treatment. The diagnosis was established based on clinical and radiological features analyses. Root canal therapy was performed on the tooth, followed by enucleation, curettage, apicoectomy, and guided bone regeneration (GBR) 30 days later. After a year of follow-up, there was no recurrence, and the tooth was in healthy conditions. These findings demonstrated that the tooth affected by cementoblastoma can be saved. It was treated conservatively to preserve the patient’, s oral health and masticatory function.

Statement of the Problem: Endodontic surgery if required is considered as an additive therapy after classic endodontic treatments. The most prevalent type of endodontic surgeries are apicoectomy and corrective surgeries. Type of material applied in apicoectomies is of high importance. Root end filling material should not only be biocompatible but also provide appropriate seal. Considering these findings, the subject of this paper was to compare the histologic responses of the periradicular tissues after using Root MTA and Portland cement, as Root end fillings, with Pro Root MTA. Purpose: The aim of the present study was to introduce a suitable material for root end filling. Materials and Methods: The canals of sixty maxillary canines of cats, after cutting the crowns and exposing the pulps, were instrumented 1 mm beyond the apex until 25 # file to develop periapical lesion after 28 days. They were then randomly divided into five groups. After apicoectomy, Pro Root MTA, Root MTA and Portland cement were placed, as root end filling materials in three experimental groups whereas the two remaining groups were considered as positive and negative controls. After 3, 6 and 12 weeks the animals were sacrificed and the specimens were stained for histologic evaluation under light microscope. The data were submitted to statistical analyses (Fisher exact test, k2 test and one- way variance analysis). Results: No statistically significant difference was found between these three materials in cementum apposition on roots and implanted materials, fibrous capsule formation and the severity of inflammation, however, bone formation in Root MTA group was significantly less than pro Root MTA and Portland cement groups. The extent of inflammation thickness in Portland cement group was significantly less than Pro Root MTA group. Conclusion: According to these findings if long term investigations with larger sample size confirm the obtained results of the present study, Root MTA and Portland cement which are cost- effective and readily available, can replace Pro Root MTA in endodontic surgeries.

This case report presents the successful surgical treatment of a symptomatic open apex upper central incisor with a failed overfilled mineral trioxide aggregate (MTA) apical plug.Unintentional overextension of the MTA had occurred two years before the initial visit. An apical lesion adjacent to the excess MTA was radio graphically detectable. Endodontic surgery was performed using calcium-enriched mixture (CEM) cement as a root-end filling material.Curettage of the apical lesion showed a mass of unset MTA particles; histopathological examination revealed fragments of MTA and granulation tissues. Up to 18-month follow-up, the tooth was clinically asymptomatic and fully functional. Periapical radiograph and CBCT images showed a normal periodontal ligament around the root. In conclusion, favorable outcomes in this case study suggested that root-end filling with CEM cement might be an appropriate approach; in addition, however many factors probably related to the initial failure of the case, the extrusion of MTA into the periapical area should be avoided.

Introduction: Sealing ability of a retrograde filling material is an important factor for a successful endodontic apicoectomy. The purpose of this in-vitro study was to compare the sealing ability of calcium enriched mixture (CEM) cement versus amalgam as root-end filling materials. Methods: A total of 36 canals of extracted maxillary central incisors were instrumented and obturated using lateral compaction technique. The apical 3 mm of each root was resected and root-end prepared to a depth of 3mm. The teeth were randomly divided into two experimental groups of 15 teeth according to tested materials (Amalgam, CEM cement) and two negative and positive control groups of 3 teeth. Root-end cavities were restored with amalgam (group 1) or CEM (group 2). Sealing ability was evaluated by dye penetration method using Pelikan ink, and a stereomicroscope at x10 magnifications and 0. 01 mm accuracy. Data were analyzed by T-test and P<0. 05. Results: The mean linear dye microleakage for CEM cement and amalgam retrofilled groups were 2. 08 and 3. 77 mm, respectively. There was a statistically significant difference between the two groups (p<0. 0001). Conclusion: under the condition of this in vitro study, CEM cement provides a better seal than amalgam when used as a retrograde filling material.