Abstract
Introduction: In the context of chronic diseases and the challenges of endodontic surgery, there are some cases where, even after the correct use of endodontic resources, treatment fails, and the endodontist's first option is to perform retreatment. Objective: It was to develop a systematic review to list the main approaches and clinical challenges of endodontic surgery. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from November to December 2024 in Scopus, Embase, 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 230 articles were found, and 37 articles were evaluated in full and 26 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 33 studies with a high risk of bias and 53 studies that did not meet GRADE and AMSTAR-2. It was concluded that periodontal surgery is a viable, safe, and effective alternative for patients with chronic diseases. Proper planning, where indications are taken into account, is directly linked to the success rate of clinical cases. Apicoectomy combined with apical curettage significantly improves the prognosis of the case. Mineral Trioxide Aggregate is the material most often described as having the highest positivity for retrofilling. The best way to perform a retroperitoneal preparation is with the aid of ultrasound. The laser is a technological advance in the decontamination of the apical region, and the microscope is a magnificent aid in visualizing the operated area, increasing the rate of surgical success. Through a correct diagnosis and the technique chosen to perform the surgical treatment, it is possible to have a successful surgery and an excellent prognosis. Thus, the success rates of endodontic surgeries depend on the indication of the surgical modality, retro-obturator materials, previous quality of the root canal filling, treatment of the surgical pocket, execution of the surgical technique, and periodontal conditions.