Endodontic Retreatment vs. Apical Surgery: Evidence- Based Decision Making

Abstract

Recurrent periapical pathology after root canal therapy poses
a clinical dilemma as both nonsurgical endodontic retreatment
and surgery are required. The present paper is a critical review
of evidence on the topic of endodontic retreatment versus apical
surgery in regards to indications, success rates, long-term
prognosis, patient-centered outcomes, and cost-effectiveness.
Published systematic reviews and meta-analyses to 2020
indicate that nonsurgical retreatment has positive long-term
results, especially when failure occurs due to poor obturation,
missed canals, or coronal leakage. On the other hand, apical
surgery particularly in cases where surgery is done with
modernized microsurgical instruments and bioceramic rootend
filling substances is more successful in the short-term
with increased likelihood of success but eventually resulting
in failure. Tooth- and patient-specific, restorative prognosis,
clinician knowledge, and modern diagnostic technologies,
e.g., cone-beam computed tomography, should be combined
in decision-making. There is evidence that there is no such
thing as the best modality; therefore, specific, evidence-based
planning of treatment is necessary to maximize clinical and
patient-reported outcomes. The treatment paradigm can be
further improved with future developments in regenerative
endodontics, artificial intelligence, and minimally invasive
treatment.