Major aspects of minimally invasive endodontic surgery using microsurgery: a systematic review

Abstract

Introduction: Knowledge about endodontic infections has increased significantly over the last 50 years and, although many issues still require elucidation, endodontics has become the dental science that has the most improved approaches and technologies to increase the success and longevity of treatments dental organs. Endodontic microsurgery has produced highly successful results in preserving teeth with persistent or recurrent cases of periapical periodontitis that could not be successfully treated by non-surgical endodontic approaches. Objective: It was to list the main clinical considerations of minimally invasive endodontic surgery using apical microsurgery, as well as point out the success rate of this technique. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, 50 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=58.5%<50%. It was concluded that the success of apical endodontic surgery in terms of healing existing periapical pathology, together with a good long-term prognosis, depends on correct diagnosis and planning, as well as the association of surgical techniques, well-executed protocols, and biocompatible materials. The apical endodontic microsurgery approach is predictable and has a high success rate, which resulted from the introduction of cone beam computed tomography, microscope, ultrasonic instruments, and materials such as mineral trioxide aggregate (MTA) and bioceramics for retro-fillings.