Apical microsurgery has changed drastically with the use of microscopes, ultrasonics and new root end filling materials. It is now possible to minimize the size of the osteotomies, preserve bone and have access to difficult to reach areas. There are also prospective clinical studies with long-term follow-ups using current surgical techniques and materials that show over 90% success in saving natural teeth using apical surgery option.
This is an example of palatal root surgery.
Tooth #14 was retreated 1 month prior to this film. Regretfully, I lost apical control of my obturation on the palatal root and this tooth was symptomatic (biting tenderness).
Pre-op
All roots were resected, root-end preparations were made using ultrasonic instruments and MTA root-end fillings were placed.
MTA in MB1, MB2, isthmus, and DB
MTA in the palatal root
Post-op
5 days post-op at suture removal
18 months follow-op
At 18 months follow up, although radiographically there is no complete healing observed, the tooth is asymptomatic and functional.