When endodontic surgery (a.k.a. apico, apicoectomy) is indicated, certain steps must be followed in order to ensure a successful outcome. Skipping any of the steps below, specially steps 4 AND 5, may result in failure:
- Proper flap design.
- Adequate magnification and use of proper instruments.
- Root-end resection: to expose the uncleaned isthmi between the canals and to eliminate portal of exits/apical deltas which are more frequently seen in the apical 2-3mm.
- Retro-preparation: to create a class I cavity prep for placement of retro-filling material.
- Retro-filling: to seal the canal at the apical end, which is ABSOLUTELY NECESSARY for the apical surgery to be successful. Without this seal, the surgery is bound to fail as the root-end resection (Macro-surgery) alone cannot prevent the bugs from coming out of the canal system and causing the periapical lesion.
- Primary flap closure: in order to allow the stabilized clot that forms in the surgical site turning into bone in the absence of micro-organisms.