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Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. This surgical procedure is characterized by the use of an operating microscope which improves illumination and magnification, thus allowing to meticulously identify apical anatomy and examine the resected root surface. EMS also demands the use of ultrasonic devices to perform root-end preparation. An additional feature of microsurgery is the absence or minimal bevel of the root respected surface, to decrease the amount of dentinal tubules exposed to microbial leakage.
Periodontitis is defined as a chronic multifactorial inflammatory disease triggered by dysbiotic subgenvival biofilm that gradually promote the destruction of the tooth’s supporting structures, including alveolar bone and periodontal ligament. Periodontal attachment loss is diagnosed by clinical attachment loss, periodontal pocket depth, bleeding on probing, and radiographic alveolar bone loss . Severe periodontitis is the sixth most prevalent disease worldwide, with a prevalence of 11.2% and over 743 million affected people, significantly impairing quality of life as it may lead to tooth loss and considerable masticatory function compromise . Moreover, systemic health repercussions may occur. Furthermore, the current population aging is expected to become associated with an increase in the prevalence of periodontal attachment loss .
An endodontic-periodontal lesion yields a pathological communication between both pulp and periodontal tissue through the apex, lateral canals, and/or dentinal tubules . Regarding EMS in such clinical diagnosis, two scenarios may occur: the tooth subjected to the procedure may be posteriorly affected by periodontal attachment loss, or a tooth exhibiting periodontal disease can undergo EMS . In either scenario, EMS decreases root length, thus altering the crown-to-root ratio (CRR) and periodontal support. Also, this procedure modifies the tooth’s biomechanical response, causing unfavorable stress distribution and increased tooth mobility, which may influence tooth function and survival as it remains exposed to continuous occlusal loading . Periodontal bone loss also aggravates CRR, simultaneously increasing the clinical crown length and decreasing the supported root area. Since the functional stress is mostly concentrated on the cervical root third, periodontal bone loss has a greater influence on biomechanical parameters than the apical root resection itself . Moreover, as mentioned above, patients’ occlusion also impairs tooth stability after EMS. .
2. Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery
The entry is from 10.3390/medicina57090922
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