Currently, there is no expert consensus, guidelines, or recommendations in the field of apical microsurgery. To address this issue and standardize the clinical application of apical microsurgery, the Chinese Stomatological Association convened experts in endodontics, periodontology, and oral surgery to develop an expert consensus on the procedure, standardizing its indications, contraindications, surgical protocols, and evaluation criteria. Their guidelines aim to improve treatment outcomes and preserve natural teeth.
Apical microsurgery has a success rate of over 90%. However, the authors of the guidelines note that differences in clinician awareness and skills lead to inappropriate case selection, inconsistent surgical protocols, severe complications, and inefficiencies. By providing this structured framework, they seek to improve consistency in case selection, surgical procedures, and long-term monitoring.
The newly established expert consensus clarifies indications for the procedure, such as when symptoms persist after root canal treatment or when root canal treatment or retreatment is not feasible. It also explains contraindications, including systemic conditions such as uncontrolled hypertension and diabetes, and anatomical challenges such as proximity to vital structures. To assess the case for indications and contraindications, the consensus provides guidance on preoperative workup, emphasizing thorough imaging, including cone beam computed tomography (CBCT), to assess the surgical site and ensure patient safety.
It also highlights best practices for flap design, osteotomy, apicectomy, apical preparation, and bioceramic retrograde filling. Guidance on microscopic positioning and hemostasis techniques is also provided.
The consensus emphasizes the importance of postoperative management, with a focus on preventing infection, relieving pain, and ensuring adequate healing through long-term follow-up, recommending radiographic and clinical evaluation at 3, 6, 12, and 24 months postoperatively to assess healing. It also lists potential complications, including sinus perforation, nerve injury, and surgical site infection, and describes their management.
The consensus document emphasizes the importance of structured training for clinicians. It also calls for further research into developing technologies, including ultrasonic osteotome surgery, augmented reality-guided surgery, and robotic surgery, which may further refine microsurgical techniques.
With this expert-backed agreement, apical microsurgery is expected to make an even greater contribution to endodontic care, offering a reliable, minimally invasive solution for patients facing complex periapical conditions.
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