Endodontics
Root canal, micro endodontics
Root Canal Treatment
Root canal treatment removes infected or devitalised pulp from inside the tooth, then cleans, shapes and fills the canals with gutta-percha to keep the tooth.
Micro Endodontics
Micro endodontics is root canal treatment under a surgical microscope at high magnification, used for calcified canals, missed canals and retreatment.
Endodontic Surgery
Endodontic surgery removes the last few millimetres of a root and seals the canal end if infection persists after a root canal and retreatment is impossible.
Endodontics offers three routes in a fixed order: primary root canal treatment, retreatment under the microscope where it fails, and root-end surgery where retreatment is not possible. The choice between retreatment and surgery is not settled by evidence. In a systematic review of two randomised and three non-randomised studies following 529 teeth from 6 months to 8.7 years, neither option showed clear superiority, with apical surgery appearing better for periapical healing while tooth survival was higher in the non-surgical group (PubMed 35762859). The choice between root canal treatment, micro endodontics and endodontic surgery is decided by root anatomy and the state of any previous treatment.
- 01Survival and success measure different things. Survival counts whether the tooth is still in the mouth; success counts whether the lesion at the root tip has healed. Any quote or website quoting a single "success rate" should be asked which of the two it means.
- 02Under the microscope, endodontic microsurgery pooled a success rate of 91.3% across 453 teeth in randomised trials and 78.4% across 839 teeth in prospective clinical studies, with follow-up of 2 to 13 years (PubMed 32899437). The gap comes from study design rather than from technique.
- 03The factors that extend a root-filled tooth's life have been measured. In a systematic review of 14 studies, the strongest was placing a crown after treatment, followed by having both mesial and distal proximal contacts, not serving as an abutment for a removable or fixed prosthesis, and not being a molar (PubMed 20158529). A plan that treats the canal but leaves the crown out is an incomplete plan.
- 04In micro endodontics what is being chosen is magnification rather than a different treatment. Calcified canals, complex anatomy and the retreatment of previously failed cases are worked under the microscope.
- 1.Bucchi C, Rosen E, Taschieri S. Non-surgical root canal treatment and retreatment versus apical surgery in treating apical periodontitis: a systematic review. Int Endod J 2023;56(Suppl 3):475-486. PubMed 35762859
- 2.Pinto D, Marques A, Pereira JF, Palma PJ, Santos JM. Long-term prognosis of endodontic microsurgery: a systematic review and meta-analysis. Medicina (Kaunas) 2020;56(9):447. PubMed 32899437
- 3.Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J 2010;43(3):171-189. PubMed 20158529