Abstract
Introduction: In the context of patients with chronic comorbidities, parendodontic surgery (or apical or endodontic surgery) becomes a challenge, requiring increased care. Parendodontic surgery is performed in the periapical region or bordering areas, aiming to solve problems that have not been successfully treated with conventional endodontic treatment. Objective: It was to present major clinical considerations of parendodontic surgery in patients with comorbidities. Methods: The systematic review rules of the PRISMA Platform were followed. The research was conducted from September to October 2025 using the Scopus, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: A total of 177 articles were found, 36 of which were evaluated in full, and 11 were included in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 33 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that periapical surgery constitutes a viable, safe, and effective alternative for eliminating bacteria from within the root canal system, even in patients with chronic comorbidities. Periapical surgery is increasingly used to repair problems that have not been resolved through conventional endodontic treatment. Through a correct diagnosis and the chosen surgical technique, success and an excellent prognosis are possible. Thus, the success rates of periapical surgeries depend on the surgical modality indicated, retrograde filling materials, the previous quality of root canal obturation, treatment of the surgical site, execution of the surgical technique, and periodontal conditions. Associations have been observed between the most severe clinical presentations (Ludwig's angina and submandibular infection) and the complexity of clinical care.