Ingestions and aspirations of foreign bodies are rare, but do occasionally occur during dental treatment. Although reports exist, few include photos demonstrating the extensive surgical intervention that may be necessary to manage such events. Perhaps this lack of visualization, and associated lack of awareness, is one of the reasons some clinicians still provide non-surgical root canal therapy (NSRCT) without a rubber dam. This case report outlines the medical treatment of a 30-year-old male who initially presented to a general dentist’s office (not associated with the authors) for NSRCT of their mandibular right first molar. A rubber dam was not used for this procedure, during which the accidental ingestion of an endodontic K-file occurred. The patient was subsequently hospitalized for evaluation and treatment, consisting of numerous imaging studies, endoscopic evaluation, and surgical removal of the file from his small intestine. The ingestion of foreign bodies, and the associated complications, can be reduced through the routine use of a rubber dam, which is considered the standard of care for NSRCT. This case graphically illustrates the potential consequences associated with deviating from the standard of care and should remind clinicians that a rubber dam is necessary for all cases of NSRCT.

Citations

Citations to this article as recorded by  

• Dental Dam Isolation for Crown Removal, Atraumatic Tooth Extraction, Immediate Implant Placement, and Restoration Cementation: A Case Study
  G Guzman-Perez, S Rojas-Rueda, F Floriani, A Unnadkat, C-C Fu, CA Jurado
  Operative Dentistry.2025; 50(1): 5.     CrossRef

Citations

Citations to this article as recorded by  

• Proximity of maxillary molar palatal roots to adjacent structures for endodontic microsurgery: a cone-beam computed tomography study
  Xiaoxiang Huang, Jun Xu, Benxiang Hou, Ying Wang
  BMC Oral Health.2025;[Epub]     CrossRef

Endodontic microsurgery is a predictable treatment option when orthograde treatment or retreatment is unsuccessful or unfeasible. However, when there is a gross compromise of periapical bone, achievement of bone regeneration after the surgical procedure may be hampered. In such cases, the application of guided tissue regeneration principles, with adjunctive use of leukocyte platelet-rich fibrin to fill the bone defect as a bone substitute and as a membrane to cover the site, provides a cost-effective solution with the benefits of accelerated physiological healing and reduced post-surgical pain and discomfort. This case report presents 2 cases of endodontic microsurgery of the upper lateral incisors with loss of buccal cortical plate, where platelet-rich fibrin was successfully applied.

Citations

Citations to this article as recorded by  

• Focuses and Trends of Research on Platelet-Rich Fibrin: A Bibliometric and Visual Analysis
  Ying Zhao, Chen Dong, Liumeizi Fan, Ting Lei, Xin Ge, Zhou Yu, Sheng Hu
  Indian Journal of Plastic Surgery.2024; 57(05): 356.     CrossRef

Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical ‘bone-window technique’ using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess. Periapical lesions were confirmed using cone-beam computed tomography (CBCT). Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.

Citations

Citations to this article as recorded by  

• Accuracy of Guided Dual Technique in Esthetic Crown Lengthening: A Prospective Case‐Series Study
  Meritxell Enfedaque‐Prat, Albert González‐Barnadas, Adrià Jorba‐García, Javi Vilarrasa, Jorge Toledano‐Serrabona, Rui Figueiredo, Eduard Valmaseda‐Castellón, Octavi Camps‐Font
  Journal of Esthetic and Restorative Dentistry.2025;[Epub]     CrossRef
• Endodontic Microsurgery of a Mandibular Molar Using a Dynamic Navigation System (DNS) and Cortical Window Technique: A Case Report
  Gustavo Castillo, Silvia Restrepo-Méndez, Oscar Zuluaga, Paola Escobar-Villegas
  Journal of Endodontic Microsurgery.2024; 3: 1.     CrossRef
• The bone lid technique in endodontic microsurgery
  Min Zhang, He Liu, Ya Shen
  Asian Journal of Surgery.2024; 47(7): 3126.     CrossRef
• Guided Periradicular Surgery with Er,Cr:YSGG Laser Osteotomy: A Case Report
  Julian Torres Celeita, Johanna Hernández la Rotta, Amdie Chirinos Salazar, Jorge Fandiño Rodríguez, Laura López Rincón, Mauren Orduz Solorzano, Diana Parra Galvis, Oscar Jiménez Peña
  Journal of Endodontic Microsurgery.2024;[Epub]     CrossRef
• Piezoelectric Endodontic Microsurgery with Modified Cortical Window Technique: A Case Report
  Rafael Fernández-Grisales, Wilder Rojas, Carolina Berruecos-Orozco
  Journal of Endodontic Microsurgery.2023; 2: 34.     CrossRef
• The Impact of the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 Guidelines on the Reporting of Endodontic Case Reports
  Sofian Youssef, Phillip Tomson, Amir Reza Akbari, Natalie Archer, Fayjel Shah, Jasmeet Heran, Sunmeet Kandhari, Sandeep Pai, Shivakar Mehrotra, Joanna M Batt
  Cureus.2023;[Epub]     CrossRef
• Clinical and radiological outcomes of dynamic navigation in endodontic microsurgery: a prospective study
  Chen Chen, Rui Zhang, Wei Zhang, Fangzhe Li, Zan Wang, Li Qin, Yun Chen, Zhuan Bian, Liuyan Meng
  Clinical Oral Investigations.2023; 27(9): 5317.     CrossRef
• New-designed 3D printed surgical guide promotes the accuracy of endodontic microsurgery: a study of 14 upper anterior teeth
  Dan Zhao, Weige Xie, Tianguo Li, Anqi Wang, Li Wu, Wen Kang, Lu Wang, Shiliang Guo, Xuna Tang, Sijing Xie
  Scientific Reports.2023;[Epub]     CrossRef
• Failure case analysis during each stage of endodontic microsurgery: A retrospective study based on clinical databases
  Changwoo Ryu, Sooil Shin, Yong-Bum Cho, Euiseong Kim, Minju Song
  Saudi Endodontic Journal.2023; 13(2): 160.     CrossRef
• Piezoelectric Device and Dynamic Navigation System Integration for Bone Window-Guided Surgery
  Frederico C. Martinho, Ina L. Griffin, Patricia A. Tordik
  Journal of Endodontics.2023; 49(12): 1698.     CrossRef
• Bone Window Technique in Endodontic Microsurgery – Report of Two Cases
  Spyros Floratos, Vasileios Molonis, Apostolos Tsolakis, Stylianos Kykalos, Konstantinos Kontzoglou
  Journal of Endodontic Microsurgery.2022; 2: 24.     CrossRef
• An Update on Endodontic Microsurgery of Mandibular Molars: A Focused Review
  Sun Mi Jang, Euiseong Kim, Kyung-San Min
  Medicina.2021; 57(3): 270.     CrossRef

We report the surgical endodontic treatment of a maxillary first premolar with a lateral lesion that originated from an accessory canal. Although lesions originating from accessory canals frequently heal with simple conventional endodontic therapy, some lesions may need additional and different treatment. In the present case, conventional root canal retreatment led to incomplete healing with the need for further treatment (i.e., surgery). Surgical endodontic management with a fast-setting calcium silicate cement was performed on the accessory canal using a dental operating microscope. At the patient's 9-month recall visit, the lesion was resolved upon radiography.

Citations

Citations to this article as recorded by  

• The Impact of the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 Guidelines on the Reporting of Endodontic Case Reports
  Sofian Youssef, Phillip Tomson, Amir Reza Akbari, Natalie Archer, Fayjel Shah, Jasmeet Heran, Sunmeet Kandhari, Sandeep Pai, Shivakar Mehrotra, Joanna M Batt
  Cureus.2023;[Epub]     CrossRef
• Main and Accessory Canal Filling Quality of a Premixed Calcium Silicate Endodontic Sealer According to Different Obturation Techniques
  Su-Yeon Ko, Hae Won Choi, E-Deun Jeong, Vinicius Rosa, Yun-Chan Hwang, Mi-Kyung Yu, Kyung-San Min
  Materials.2020; 13(19): 4389.     CrossRef

Endodontic microsurgery is defined as the treatment performed on the root apices of an infected tooth, which was unresolved with conventional root canal therapy. Recently, the advanced technology in 3-dimensional model reconstruction based on computed tomography such as cone beam computed tomography has opened a new avenue in application of personalized, accurate diagnosis and has been increasingly used in the field of dentistry. Nevertheless, direct intra-oral localization of root apex based on the 3-dimensional information is extremely difficult and significant amount of bone removal is inevitable when freehand surgical procedure was employed. Moreover, gingival flap and alveolar bone fenestration are usually required, which leads to prolonged time of surgery, thereby increasing the chance of trauma as well as the risk of infection. The purpose of this case report is to present endodontic microsurgery using the guide template that can accurately target the position of apex for the treatment of an anterior tooth with calcified canal which was untreatable with conventional root canal therapy and unable to track the position of the apex due to the absence of fistula.

Citations

Citations to this article as recorded by  

• A narrative review of papilla preservation techniques in clinical dentistry
  Yinghua Fu, Zhixin Zhang, Xiaoping Tang, Jiangling Su
  Medicine.2025; 104(3): e41033.     CrossRef
• Segmentation algorithms of dental CT images: A comprehensive review from classical to deep learning trend
  Dianhao Wu, Jingang Jiang, Jinke Wang, Zhuming Bi, Guang Yu
  Expert Systems with Applications.2025; 275: 126853.     CrossRef
• 3D finite element analysis of stress distribution on the shape of resected root-end or with/without bone graft of a maxillary premolar during endodontic microsurgery
  Aein Mon, Mi-El Kim, Kee-Yeon Kum, Ho-Beom Kwon
  Journal of Dental Sciences.2024; 19(2): 837.     CrossRef
• TREATMENT OF YATROGENIC POST-TRAUMATIC NEUROPATHY ASSOCIATED WITH ENDODONTIC THERAPY USING 3D TECHNOLOGIES
  Karen Sevterteryan, Vladislav Tarasenok, Lyudmila Tatintsyan
  BULLETIN OF STOMATOLOGY AND MAXILLOFACIAL SURGERY.2024; : 73.     CrossRef
• Advancements in guided surgical endodontics: A scoping review of case report and case series and research implications
  Giusy Rita Maria La Rosa, Matteo Peditto, Andrea Venticinque, Antonia Marcianò, Alberto Bianchi, Eugenio Pedullà
  Australian Endodontic Journal.2024; 50(2): 397.     CrossRef
• Comparison of a Novel Static Computer-aided Surgical and Freehand Techniques for Osteotomy and Root-end Resection
  Kyle Westbrook, Corey Rollor, Sara A. Aldahmash, Guadalupe G. Fay, Elias Rivera, Jeffery B. Price, Ina Griffin, Patricia A. Tordik, Frederico C. Martinho
  Journal of Endodontics.2023; 49(5): 528.     CrossRef
• Comparison of the Three-Dimensional Accuracy of Guided Apicoectomy Performed with a Drill or a Trephine: An In Vitro Study
  Ramóna Kiscsatári, Eszter Nagy, Máté Szabó, Gábor Braunitzer, József Piffkó, Márk Fráter, Márk Ádám Antal
  Applied Sciences.2023; 13(17): 9642.     CrossRef
• Review of “Outcome of Endodontic Surgery: A Meta- Analysis of the Literature—Part 1: Comparison of Traditional Root-End Surgery and Endodontic Microsurgery” by Setzer and Colleagues in J Endod 36(11):1757-1765, 2010
  Oleksandr Nozhenko
  Journal of Endodontic Microsurgery.2023; 2: 41.     CrossRef
• The Impact of the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 Guidelines on the Reporting of Endodontic Case Reports
  Sofian Youssef, Phillip Tomson, Amir Reza Akbari, Natalie Archer, Fayjel Shah, Jasmeet Heran, Sunmeet Kandhari, Sandeep Pai, Shivakar Mehrotra, Joanna M Batt
  Cureus.2023;[Epub]     CrossRef
• New-designed 3D printed surgical guide promotes the accuracy of endodontic microsurgery: a study of 14 upper anterior teeth
  Dan Zhao, Weige Xie, Tianguo Li, Anqi Wang, Li Wu, Wen Kang, Lu Wang, Shiliang Guo, Xuna Tang, Sijing Xie
  Scientific Reports.2023;[Epub]     CrossRef
• An Exploratory In Vitro Microcomputed Tomographic Investigation of the Efficacy of Semicircular Apicoectomy Performed with Trephine Bur
  Eszter Nagy, Brigitta Vőneki, Lívia Vásárhelyi, Imre Szenti, Márk Fráter, Ákos Kukovecz, Márk Ádám Antal
  Applied Sciences.2023; 13(16): 9431.     CrossRef
• The Time Has Come: Journal of Endodontic Microsurgery: A First Peer-Reviewed Open Access Publication Focused on Microsurgery in Endodontics
  Ievgen Fesenko
  Journal of Endodontic Microsurgery.2022;[Epub]     CrossRef
• Prefabricated Grid-guided Endodontic Microsurgery: A Pilot Study
  Cruz Nishanthine, Manali Ramakrishnan Srinivasan, Ravi Devi, Kadhar Begam Farjana, Dasarathan Duraivel
  Journal of Operative Dentistry & Endodontics.2022; 6(2): 58.     CrossRef
• Guided osteotomy
  Saini Rashmi, Saini V Kr
  Tanta Dental Journal.2022; 19(3): 172.     CrossRef
• Accuracy of digitally planned, guided apicoectomy with a conventional trephine and a custom-made endodontic trephine: An in vitro comparative study
  Eszter Nagy, Gábor Braunitzer, Dániel Gerhard Gryschka, Ibrahim Barrak, Mark Adam Antal
  Journal of Stomatology, Oral and Maxillofacial Surgery.2022; 123(4): 388.     CrossRef
• Stress Distribution on Trephine-Resected Root-end in Targeted Endodontic Microsurgery: A Finite Element Analysis
  Yeon-Jee Yoo, Hiran Perinpanayagam, Miel Kim, Qiang Zhu, Seung-Ho Baek, Ho-Beom Kwon, Kee-Yeon Kum
  Journal of Endodontics.2022; 48(12): 1517.     CrossRef
• An Update on Endodontic Microsurgery of Mandibular Molars: A Focused Review
  Sun Mi Jang, Euiseong Kim, Kyung-San Min
  Medicina.2021; 57(3): 270.     CrossRef
• When to consider the use of CBCT in endodontic treatment planning in adults
  Nisha Patel, Andrew Gemmell, David Edwards
  Dental Update.2021; 48(11): 932.     CrossRef

Citations

Citations to this article as recorded by  

• Biomineralization reaction from nanosized calcium silicate: A new method for reducing dentin hypersensitivity
  Mi-Jeong Jeon, Yu-Sung Choi, Jeong-Kil Park, Jin-Soo Ahn, Yu-Chih Chiang, Deog-Gyu Seo
  Journal of Dental Sciences.2025; 20(1): 428.     CrossRef
• Efficacy of seventh generation bonding agents as desensitizers in patients with dentin hypersensitivity: a randomized clinical trial
  Sumaiya Shabbir, Shahbaz Ahmed, Syed Jaffar Abbas Zaidi, Sania Riaz, Huma Sarwar, Muhammad Taqi, Zia ur Rahman Khan
  BMC Oral Health.2024;[Epub]     CrossRef
• Investigation of the crystal formation from calcium silicate in human dentinal tubules and the effect of phosphate buffer saline concentration
  Mi-Jeong Jeon, Jin-Soo Ahn, Jeong-Kil Park, Deog-Gyu Seo
  Journal of Dental Sciences.2024; 19(4): 2278.     CrossRef
• The effect of fluoride iontophoresis on seal ability of self-etch adhesive in human dentin in vitro
  Kanittha Kijsamanmith, Parintorn Wallanon, Chanya Pitchayasatit, Poonnapha Kittiratanaviwat
  BMC Oral Health.2022;[Epub]     CrossRef
• The study of toothpaste desensitizing properties
  S. B. Ulitovskiy, O. V. Kalinina, A. A. Leontev, O. V. Khabarova, L. I. Pankrateva, E. S. Soloveva, N. K. Fok
  Parodontologiya.2022; 27(1): 81.     CrossRef
• Effectiveness and cytotoxicity of two desensitizing agents: a dentin permeability measurement and dentin barrier testing in vitro study
  Ruodan Jiang, Yongxiang Xu, Feilong Wang, Hong Lin
  BMC Oral Health.2022;[Epub]     CrossRef
• A randomized clinical trial of dentin hypersensitivity reduction over one month after a single topical application of comparable materials
  Samar Hatem Abuzinadah, Abdulrahman Jafar Alhaddad
  Scientific Reports.2021;[Epub]     CrossRef
• Comparison between effectiveness of dentine desensitizer and one bottle self-etch adhesive on dentine hypersensitivity
  Muhammad Zohaib Younus, Muhammad Adeel Ahmed, Azeem Ul Yaqin Syed, Jiand Malik Baloch, Muhammad Ali, Abubakar Sheikh
  Technology and Health Care.2021; 29(6): 1153.     CrossRef
• A long-term evaluation of experimental potassium oxalate concentrations on dentin hypersensitivity reduction: A triple-blind randomized clinical trial
  Alexia da Mata Galvão, Livia Fávaro Zeola, Guilherme Faria Moura, Daniela Navarro Ribeiro Teixeira, Ramon Corrêa de Queiroz Gonzaga, Gisele Rodrigues da Silva, Paulo Vinícius Soares
  Journal of Dentistry.2019; 89: 103180.     CrossRef

Citations

Citations to this article as recorded by  

• Expert consensus on intentional tooth replantation
  Zhengmei Lin, Dingming Huang, Shuheng Huang, Zhi Chen, Qing Yu, Benxiang Hou, Lihong Qiu, Wenxia Chen, Jiyao Li, Xiaoyan Wang, Zhengwei Huang, Jinhua Yu, Jin Zhao, Yihuai Pan, Shuang Pan, Deqin Yang, Weidong Niu, Qi Zhang, Shuli Deng, Jingzhi Ma, Xiuping
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Outcome of intentional replantation of endodontically treated teeth with periapical pathosis: A systematic review and meta‐analysis
  Faizan Javed, Kamil Zafar, Farhan R. Khan
  Australian Endodontic Journal.2023; 49(S1): 494.     CrossRef
• Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus
  Han Shin Lee, Dokyung Kim, Sung Kyo Kim
  Restorative Dentistry & Endodontics.2022;[Epub]     CrossRef
• Alveolar bone thickness overlying healthy maxillary and mandibular teeth: A systematic review and meta-analysis
  Marziyeh Shafizadeh, Azita Tehranchi, Armin Shirvani, Saeed Reza Motamedian
  International Orthodontics.2021; 19(3): 389.     CrossRef
• Relationship between the anatomic structures and mandibular posterior teeth for endodontic surgery in a Turkish population: a cone-beam computed tomographic analysis
  Zeliha Uğur Aydın, Duygu Göller Bulut
  Clinical Oral Investigations.2019; 23(9): 3637.     CrossRef

Although it is challenging, the early diagnosis of a vertical root fracture (VRF) is crucial in order to ensure tooth preservation. The purpose of this clinical case report was to describe reparative surgery performed to treat a tooth affected by an incomplete VRF. A 26 year old male patient was suspected to have a VRF in a maxillary left central incisor, and an exploratory flap was performed in order to confirm the diagnosis. After detecting the fracture, the lesion was surgically treated, the fracture and the infected root-end were removed, and a platelet-rich plasma membrane was used to cover the defect in order to prevent bacterial migration. A 24 month clinical and radiological follow-up examination showed that the tooth was asymptomatic and that the healing process was in progress. The surgical approach described here may be considered an effective treatment for a combined endodontic-periodontal lesion originating from an incomplete VRF and a recurrent periapical lesion.

Citations

Citations to this article as recorded by  

• Biomechanical perspectives on dentine cracks and fractures: Implications in their clinical management
  Sishi Chen, Dwayne Arola, Domenico Ricucci, Brian E. Bergeron, John A. Branton, Li-sha Gu, Franklin R. Tay
  Journal of Dentistry.2023; 130: 104424.     CrossRef
• Efficacy of Autologous Platelet Concentrates in Regenerative Endodontic Treatment: A Systematic Review of Human Studies
  Joanna Metlerska, Irini Fagogeni, Alicja Nowicka
  Journal of Endodontics.2019; 45(1): 20.     CrossRef
• The preservation of teeth with root-originated fractures
  Eyal Rosen, Ilan Beitlitum, Igor Tsesis
  Evidence-Based Endodontics.2018;[Epub]     CrossRef

Non-carious cervical lesions (NCCLs) with gingival recession require specific consideration on both aspects of hard and soft tissue lesion. In the restorative aspect, careful finishing and polishing of the restorations prior to mucogingival surgery is the critical factor contributing to success. Regarding surgery, assessment of the configuration of the lesion and the choice of surgical technique are important factors. The precise diagnosis and the choice of the proper treatment procedure should be made on the basis of both restorative and surgical considerations to ensure the successful treatment of NCCLs.

Citations

Citations to this article as recorded by  

• The link between Noncarious Cervical Lesions (NCCL) and gingival recession. Etiology and treatment. A narrative review.
  Luminița Lazăr, Zsigmond-Loránd Makkai, Timea Dakó, Mircea Suciu, Ana-Petra Lazăr
  Acta Stomatologica Marisiensis Journal.2023; 6(1): 5.     CrossRef
• Treatment efficacy of gingival recession defects associated with non-carious cervical lesions: a systematic review
  Lívia Maria Lopes de Oliveira, Camila Agra Souza, Sinara Cunha, Rafael Siqueira, Bruna de Carvalho Farias Vajgel, Renata Cimões
  Journal of Periodontal & Implant Science.2022; 52(2): 91.     CrossRef
• Clinical Behavior of the Gingival Margin following Conservative “Coronally Dynamic” Restorations in the Presence of Non-Carious Cervical Lesions Associated with Gingival Recession: A Pilot Study
  Felice Femiano, Rossella Sorice, Rossella Femiano, Luigi Femiano, Ludovica Nucci, Vincenzo Grassia, Marco Annunziata, Andrea Baldi, Nicola Scotti, Livia Nastri
  Dentistry Journal.2022; 10(7): 132.     CrossRef
• Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial
  Morgana Favetti, Anelise Fernandes Montagner, Silvia Terra Fontes, Thiago Marchi Martins, Alexandre Severo Masotti, Patricia dos Santos Jardim, Fernanda Oliveira Bello Corrêa, Maximiliano Sergio Cenci, Francisco Wilker Mustafa Gomes Muniz
  Journal of Dentistry.2021; 106: 103571.     CrossRef

Citations

Citations to this article as recorded by  

• Effectiveness of Sectioning Method and Filling Materials on Roughness and Cell Attachments in Root Resection Procedure
  Tarek Ashi, Naji Kharouf, Olivier Etienne, Bérangère Cournault, Pierre Klienkoff, Varvara Gribova, Youssef Haikel
  European Journal of Dentistry.2025; 19(01): 240.     CrossRef
• Questioning the spot light on Hi-tech endodontics
  Jojo Kottoor, Denzil Albuquerque
  Restorative Dentistry & Endodontics.2016; 41(1): 80.     CrossRef

Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.

Citations

Citations to this article as recorded by  

• Expert consensus on apical microsurgery
  Hanguo Wang, Xin Xu, Zhuan Bian, Jingping Liang, Zhi Chen, Benxiang Hou, Lihong Qiu, Wenxia Chen, Xi Wei, Kaijin Hu, Qintao Wang, Zuhua Wang, Jiyao Li, Dingming Huang, Xiaoyan Wang, Zhengwei Huang, Liuyan Meng, Chen Zhang, Fangfang Xie, Di Yang, Jinhua Yu
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Assessing the efficacy of apicoectomy without retrograde filling in treating periapical inflammatory cysts
  Jeong-Kui Ku, Woo-Young Jeon, Seung-O Ko, Ji-Young Yoon
  Journal of the Korean Association of Oral and Maxillofacial Surgeons.2024; 50(3): 140.     CrossRef
• Functional and structural neurodegenerative activities of Ankaferd BloodStopper in a mouse sciatic nerve model
  Ramazan Üstün, Elif Oğuz, Ayşe Şeker, Filiz Taspinar
  Experimental and Therapeutic Medicine.2024;[Epub]     CrossRef
• Local and Systemic Hemostatic Agents: A Comprehensive Review
  Bardia Jamali, Saeed Nouri, Salimeh Amidi
  Cureus.2024;[Epub]     CrossRef
• PLGA Nanoparticle Rapamycin- or Necrostatin-1-Coated Sutures Inhibit Inflammatory Reactions after Arterial Closure in Rats
  Liwei Zhang, Wang Wang, Boao Xie, Peng Sun, Shunbo Wei, Haoliang Wu, Cong Zhang, Jingan Li, Zhuo Li, Hualong Bai
  ACS Applied Bio Materials.2022; 5(4): 1501.     CrossRef
• COMPARING THE CLINICAL AND RADIOGRAPHIC OUTCOMES OF PULPOTOMIES IN PRIMARY MOLARS USING BIOACTIVE ENDODONTIC MATERIALS AND FERRIC SULFATE – A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS
  VELLORE KANNAN GOPINATH, SHAJU JACOB PULIKKOTIL, SAJESH K VEETTIL, LALLI DHARMARAJAN, PONNUDURAI SAMUEL GNANA PRAKASH, VINEET DHAR, JAYAKUMAR JAYARAMAN
  Journal of Evidence-Based Dental Practice.2022; 22(4): 101770.     CrossRef
• Perioperative Antiplatelet and Anticoagulant Management with Endodontic Microsurgical Techniques
  Anita Aminoshariae, Mark Donaldson, Michael Horan, James C. Kulild, Dale Baur
  Journal of Endodontics.2021; 47(10): 1557.     CrossRef
• Effect of blood contamination and various hemostatic procedures on the push-out bond strength of Biodentine when used for furcation perforation repair
  Shanthana Reddy, Ramya Shenoy, LohithReddy Mandadi, Ishani Saluja, ManuelS Thomas
  Journal of Conservative Dentistry.2021; 24(3): 260.     CrossRef
• Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix
  Talal Al-Nahlawi, Maisour Ala Rachi, Amjad Abu Hasna, Zohaib Khurshid
  International Journal of Dentistry.2021; 2021: 1.     CrossRef
• Hemostatic agents in periapical surgery: The systematic review
  Z. S. Khabadze, D. A. Nazarova, E. S. Shilyaeva, A. P. Kotelnikova, Yu. A. Bakayev, S. M. Abdulkerimova, Kh. O. Omarova
  Endodontics Today.2021; 19(3): 184.     CrossRef
• An Innovative Bioceramic Bone Graft Substitute for Bone Defect Treatment: In Vivo Evaluation of Bone Healing
  Syamsiah Syam, Yung-Chieh Cho, Chung-Ming Liu, Mao-Suan Huang, Wen-Chien Lan, Bai-Hung Huang, Takaaki Ueno, Chi-Hsun Tsai, Takashi Saito, May-Show Chen, Keng-Liang Ou
  Applied Sciences.2020; 10(22): 8303.     CrossRef
• Trial finds better haemostasis with aluminium chloride during periapical surgery
  Niall Mc Goldrick, Carly Ross, James Nelson
  Evidence-Based Dentistry.2017; 18(2): 50.     CrossRef
• Comparison of the Hemostatic Activity of Quercus persica Jaub. & Spach. (Oak) With Ferric Sulfate in Bony Crypts
  Mohammad Reza Nabavizadeh, Arman Zargaran, Fariborz Moazami, Fatemeh Askari, Safoora Sahebi, Alireza Farhadpoor, Pouya Faridi
  Journal of Evidence-Based Complementary & Alternative Medicine.2016; 21(1): 34.     CrossRef
• Effect of the plant-based hemostatic agent Ankaferd Blood Stopper® on the biocompatibility of mineral trioxide aggregate
  Muzaffer Emir Dinçol, Hakan Ozbas, Bulent Yılmaz, Handan Ersev, Selcuk Gokyay, Vakur Olgac
  BMC Oral Health.2016;[Epub]     CrossRef

Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.

Citations

Citations to this article as recorded by  

• Expert consensus on apical microsurgery
  Hanguo Wang, Xin Xu, Zhuan Bian, Jingping Liang, Zhi Chen, Benxiang Hou, Lihong Qiu, Wenxia Chen, Xi Wei, Kaijin Hu, Qintao Wang, Zuhua Wang, Jiyao Li, Dingming Huang, Xiaoyan Wang, Zhengwei Huang, Liuyan Meng, Chen Zhang, Fangfang Xie, Di Yang, Jinhua Yu
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Effects of nasal desmopressin spray versus topical epinephrine on surgical field clarity and hemodynamics in endonasal dacryocystorhinostomy: a randomized clinical study
  Mohamed G.M. El Sayed, Marwa M. Medhat, Dina A.E. Salem, Marwa A.M. Khedr, Alshaimaa A.F. Kamel
  Research and Opinion in Anesthesia & Intensive Care.2024; 11(1): 1.     CrossRef
• Is 1:1000 adrenaline as a topical haemostat an effective alternative to control bleeding in dentistry and oral surgery?
  Raj D. Aslam, Jonathan Liew, Eleni Besi
  British Dental Journal.2023; 235(1): 29.     CrossRef
• Effect of Flumazenil on Emergence Agitation after Orthognathic Surgery: A Randomized Controlled Trial
  Young Hyun Koo, Geun Joo Choi, Hyun Kang, Yong Hun Jung, Young Cheol Woo, Young-Jun Choi, Chong Wha Baek
  Journal of Personalized Medicine.2022; 12(3): 416.     CrossRef
• Hemostatic agents in periapical surgery: The systematic review
  Z. S. Khabadze, D. A. Nazarova, E. S. Shilyaeva, A. P. Kotelnikova, Yu. A. Bakayev, S. M. Abdulkerimova, Kh. O. Omarova
  Endodontics Today.2021; 19(3): 184.     CrossRef
• THE EFFECT OF ADRENALINE ON DYNAMICS OF CARBOHYDRATE METABOLISM INDICES IN RATS
  S. Shkurashivska, H. Ersteniuk
  Visnyk of Lviv University. Biological series.2017; (75): 151.     CrossRef
• The Correlation between the Blood Sugar and Allergy of the Trauma Patient
  Jeong Soo Lee, Sung Hee Hyun, Ji-Sook Lee, In Sik Kim
  Korean Journal of Clinical Laboratory Science.2014; 46(1): 22.     CrossRef
• Biologic response of local hemostatic agents used in endodontic microsurgery
  Youngjune Jang, Hyeon Kim, Byoung-Duck Roh, Euiseong Kim
  Restorative Dentistry & Endodontics.2014; 39(2): 79.     CrossRef

Nowadays, oral anticoagulants are commonly prescribed to numerous patients for preventing cardiovascular accident such as thromboembolism. An important side effect of anticoagulant is anti-hemostasis. In a major surgery, the oral anticoagulant therapy (OAT) regimen must be changed before the surgery for proper post-operative bleeding control. However, in a minor dental surgery and endodontic surgery, the necessity for changing or discontinuing the OAT is open to debate. In this study, risks of the consequences were weighed and analyzed. In patients who stop the OAT, the occurrence of thromboembolic complication is rare but the result is fatal. In patients who continuing the OAT, post-operative bleeding can be controlled well with the local hemostatic measures. In the endodontic surgery, there are almost no studies about this issue. The intra-operative bleeding control is particularly important in the endodontic surgery because of its delicate and sensitive procedures such as inspection of resected root surface using dental microscope and retrograde filling. Further studies are necessary about this issue in the viewpoint of endodontic surgery.

Citations

Citations to this article as recorded by  

• Expert consensus on apical microsurgery
  Hanguo Wang, Xin Xu, Zhuan Bian, Jingping Liang, Zhi Chen, Benxiang Hou, Lihong Qiu, Wenxia Chen, Xi Wei, Kaijin Hu, Qintao Wang, Zuhua Wang, Jiyao Li, Dingming Huang, Xiaoyan Wang, Zhengwei Huang, Liuyan Meng, Chen Zhang, Fangfang Xie, Di Yang, Jinhua Yu
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Management of Patients Receiving Anticoagulation Therapy in Dental Practice: A Systematic Review
  Francesco Inchingolo, Angelo Michele Inchingolo, Fabio Piras, Laura Ferrante, Antonio Mancini, Andrea Palermo, Alessio Danilo Inchingolo, Gianna Dipalma
  Healthcare.2024; 12(15): 1537.     CrossRef
• Hemostatic Alginate/Nano-Hydroxyapatite Composite Aerogel Loaded with Tranexamic Acid for the Potential Protection against Alveolar Osteitis
  Mai El Halawany, Randa Latif, Mohamed H. H. AbouGhaly
  Pharmaceutics.2022; 14(10): 2255.     CrossRef
• Perioperative Antiplatelet and Anticoagulant Management with Endodontic Microsurgical Techniques
  Anita Aminoshariae, Mark Donaldson, Michael Horan, James C. Kulild, Dale Baur
  Journal of Endodontics.2021; 47(10): 1557.     CrossRef
• Administration of Coagulation-Altering Therapy in the Patient Presenting for Oral Health and Maxillofacial Surgery
  Thomas M. Halaszynski
  Oral and Maxillofacial Surgery Clinics of North America.2016; 28(4): 443.     CrossRef
• Biologic response of local hemostatic agents used in endodontic microsurgery
  Youngjune Jang, Hyeon Kim, Byoung-Duck Roh, Euiseong Kim
  Restorative Dentistry & Endodontics.2014; 39(2): 79.     CrossRef
• Cardiovascular effect of epinephrine in endodontic microsurgery: a review
  Youngjune Jang, Euiseong Kim
  Restorative Dentistry & Endodontics.2013; 38(4): 187.     CrossRef

Apical surgery cuts off the apical root and the crown-to-root ratio becomes unfavorable. Crown-to-root ratio has been applied to periodontally compromised teeth. Apical root resection is a different matter from periodontal bone loss. The purpose of this paper is to review the validity of crown-to-root ratio in the apically resected teeth. Most roots have conical shape and the root surface area of coronal part is wider than apical part of the same length. Therefore loss of alveolar bone support from apical resection is much less than its linear length.The maximum stress from mastication concentrates on the cervical area and the minimum stress was found on the apical 1/3 area. Therefore apical root resection is not so harmful as periodontal bone loss. Osteotomy for apical resection reduces longitudinal width of the buccal bone and increases the risk of endo-perio communication which leads to failure. Endodontic microsurgery is able to realize 0 degree or shallow bevel and precise length of root resection, and minimize the longitudinal width of osteotomy. The crown-to-root ratio is not valid in evaluating the prosthodontic prognosis of the apically resected teeth. Accurate execution of endodontic microsurgery to preserve the buccal bone is essential to avoid endo-perio communication.

Citations

Citations to this article as recorded by  

• Expert consensus on apical microsurgery
  Hanguo Wang, Xin Xu, Zhuan Bian, Jingping Liang, Zhi Chen, Benxiang Hou, Lihong Qiu, Wenxia Chen, Xi Wei, Kaijin Hu, Qintao Wang, Zuhua Wang, Jiyao Li, Dingming Huang, Xiaoyan Wang, Zhengwei Huang, Liuyan Meng, Chen Zhang, Fangfang Xie, Di Yang, Jinhua Yu
  International Journal of Oral Science.2025;[Epub]     CrossRef
• Coexistence of horizontal bone loss and dehiscence with the bundle and conventional fiber post: a finite element analysis
  Deniz Yanık, Nurullah Türker, Ahmet Mert Nalbantoğlu
  Computer Methods in Biomechanics and Biomedical Engineering.2024; : 1.     CrossRef
• The tooth survival of non‐surgical root‐filled posterior teeth and the associated prognostic tooth‐related factors: A systematic review and meta‐analysis
  S. R. Patel, F. Jarad, E. Moawad, A. Boland, J. Greenhalgh, Maria Liu, Michelle Maden
  International Endodontic Journal.2024; 57(10): 1404.     CrossRef
• New-designed 3D printed surgical guide promotes the accuracy of endodontic microsurgery: a study of 14 upper anterior teeth
  Dan Zhao, Weige Xie, Tianguo Li, Anqi Wang, Li Wu, Wen Kang, Lu Wang, Shiliang Guo, Xuna Tang, Sijing Xie
  Scientific Reports.2023;[Epub]     CrossRef
• Multifactorial Analysis of Endodontic Microsurgery Using Finite Element Models
  Raphael Richert, Jean-Christophe Farges, Jean-Christophe Maurin, Jérôme Molimard, Philippe Boisse, Maxime Ducret
  Journal of Personalized Medicine.2022; 12(6): 1012.     CrossRef
• Mid‐term outcomes and periodontal prognostic factors of autotransplanted third molars: A retrospective cohort study
  Ernest Lucas‐Taulé, Marc Llaquet, Jesús Muñoz‐Peñalver, José Nart, Federico Hernández‐Alfaro, Jordi Gargallo‐Albiol
  Journal of Periodontology.2021; 92(12): 1776.     CrossRef
• Effect of length of apical root resection on the biomechanical response of a maxillary central incisor in various occlusal relationships
  S. J. Ran, X. Yang, Z. Sun, Y. Zhang, J. X. Chen, D. M. Wang, B. Liu
  International Endodontic Journal.2020; 53(1): 111.     CrossRef
• Changes of Root Length and Root-to-Crown Ratio after Apical Surgery: An Analysis by Using Cone-beam Computed Tomography
  Thomas von Arx, Simon S. Jensen, Michael M. Bornstein
  Journal of Endodontics.2015; 41(9): 1424.     CrossRef
• Influence of Apical Root Resection on the Biomechanical Response of a Single-rooted Tooth—Part 2: Apical Root Resection Combined with Periodontal Bone Loss
  Youngjune Jang, Hyoung-Taek Hong, Heoung-Jae Chun, Byoung-Duck Roh
  Journal of Endodontics.2015; 41(3): 412.     CrossRef
• Influence of Apical Root Resection on the Biomechanical Response of a Single-rooted Tooth: A 3-dimensional Finite Element Analysis
  Youngjune Jang, Hyoung-Taek Hong, Byoung-Duck Roh, Heoung-Jae Chun
  Journal of Endodontics.2014; 40(9): 1489.     CrossRef

In current endodontic practice, introduction of operating microscope, ultrasonic instruments, and microinstruments has induced a big change in the field of surgical retreatment. In this study, we aimed to offer key steps of endodontic microsurgery procedure compared with traditional root-end surgery, and to evaluate factors influencing success and failure based on published articles.

Endodontic microsurgery is a surgical procedure performed with the aid of a microscope, ultrasonic instruments and modern microsurgical instruments. The microscope provides magnification and illumination - essential for identifying minute details of the apical anatomy. Ultrasonic instruments facilitate the precise root-end preparation that is within the anatomical space of the canal. Modern endodontics can therefore be performed with precision and predictability, thus eliminating the disadvantages inherent in traditional periapical surgery such as large osteotomy, beveled apicoectomy, inaccurate root-end preparation and the inability to observe isthmus.

Factors influencing the outcomes of endodontic microsurgery may be diverse, but standardization of procedures can minimize its range. Among patient and tooth-related factors, periodontal status and tooth position are known to be prognostic, but there are only few articles concerning this matter. High-evidence randomized clinical trials or prospective cohort studies are needed to confirm these findings.

Citations

Citations to this article as recorded by  

• Treatment-Related Factors Affecting the Success of Endodontic Microsurgery and the Influence of GTR on Radiographic Healing—A Cone-Beam Computed Tomography Study
  Daniel Bieszczad, Jarosław Wichlinski, Tomasz Kaczmarzyk
  Journal of Clinical Medicine.2023; 12(19): 6382.     CrossRef
• Factors Affecting the Success of Endodontic Microsurgery: A Cone-Beam Computed Tomography Study
  Daniel Bieszczad, Jaroslaw Wichlinski, Tomasz Kaczmarzyk
  Journal of Clinical Medicine.2022; 11(14): 3991.     CrossRef
• Comparison of Clinical Outcomes of Endodontic Microsurgery: 1 Year versus Long-term Follow-up
  Minju Song, Taekjin Nam, Su-Jung Shin, Euiseong Kim
  Journal of Endodontics.2014; 40(4): 490.     CrossRef
• The Influence of Bone Tissue Deficiency on the Outcome of Endodontic Microsurgery: A Prospective Study
  Minju Song, Sahng Gyoon Kim, Su-Jung Shin, Hyeon-Cheol Kim, Euiseong Kim
  Journal of Endodontics.2013; 39(11): 1341.     CrossRef
• Prognostic Factors of Clinical Outcomes in Endodontic Microsurgery: A Prospective Study
  Minju Song, Sahng Gyoon Kim, Seung-Jong Lee, Baekil Kim, Euiseong Kim
  Journal of Endodontics.2013; 39(12): 1491.     CrossRef
• Is stopping of anticoagulant therapy really required in a minor dental surgery? - How about in an endodontic microsurgery?
  Yong-Wook Cho, Euiseong Kim
  Restorative Dentistry & Endodontics.2013; 38(3): 113.     CrossRef