Abstract
Introduction: In the context of parendodontic surgery (or endodontic/apical surgery), root canal therapy has a success rate above 80%, and root canal retreatment has a success rate of 50 to 80%. The introduction of dental operating microscopes has helped increase treatment success rates. Objective: The aim was to develop a systematic review of the literature to highlight and describe the main approaches of parendodontic surgery and microsurgery in relation to the success of endodontic treatment. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to June 2025 in 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 116 articles were found, and 50 articles were evaluated in full and 43 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. It was concluded that the success rates of parendodontic surgeries depend on the surgical modality indicated, the type of retrofilling materials used, the quality of the root canal filling prior to surgery, the treatment of surgical pockets, the execution of surgical techniques, and the periodontal conditions. The success of the surgery is higher when it is supplemented by root canal retreatment. Parendodontic surgery aims to remove the etiological factor and prevent recontamination of periodontal tissues after the etiological agent has been removed. The main indications for periodontal surgery are anatomical complications, drainage, pain relief, iatrogenic problems, trauma, periodontal problems, the need for biopsy, foreign bodies in the apical region, incomplete or dilated apices, prosthetic procedures after endodontics, and failures or problems during treatment.