New expert consensus offers guide to apical microsurgery

Dental Tribune International

Wed. 12. March 2025

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XI’AN, China: To date, there have been no expert consensus, guidelines or recommendations on apical microsurgery. To address this and standardise the clinical application of apical microsurgery, the Chinese Stomatological Association convened a panel of experts in endodontics, periodontics and oral surgery to develop an expert consensus on the procedure, standardising its indications, contra-indications, surgical protocols and evaluation criteria. Their guidelines aim to enhance treatment outcomes and preserve natural teeth.

Apical microsurgery boasts a success rate exceeding 90%. However, the guideline authors explain that variability in clinician awareness and technique continues results in improper case selection, inconsistent surgical protocols, serious complications and low efficacy. By providing this structured framework, they seek to improve consistency in case selection, procedural execution and long-term monitoring.

The newly established expert consensus outlines clear indications for the procedure, such as persistent symptoms after root canal therapy or cases where root canal therapy or retreatment is not feasible. It also explains the contra-indications, including systemic conditions like uncontrolled hypertension and diabetes, as well as anatomical challenges such as proximity to vital structures. To assess the case regarding indications and contra-indications, the consensus sets out guidance on preoperative examination, emphasising thorough imaging, including CBCT, to assess the surgical site and ensure patient safety.

It also emphasises best practices for flap design, osteotomy, root-end resection, root-end preparation and bioceramic retro-filling. Guidance on microscope positioning and haemostatic techniques is also given.

The consensus stresses the importance of postoperative management, focusing on preventing infections, reducing pain and ensuring proper healing through long-term follow-up, recommending radiographic and clinical evaluations at three, six, 12 and 24 months postoperatively to assess healing. It also sets out potential complications—including maxillary sinus perforation, nerve injury and surgical site infections—and their management.

The consensus document highlights the importance of structured training for clinicians. It also calls for further research into evolving technologies, including piezoelectric surgery, augmented reality-guided procedures, and robotics, which could further refine microsurgical techniques.

With this expert-backed protocol, apical microsurgery is poised to contribute further to endodontic care, offering a reliable, minimally invasive solution for patients facing complex periapical conditions.

The study, titled “Expert consensus on apical microsurgery”, was published online on 2 January 2025 in the International Journal of Oral Science.