Effect of Targeted Endodontic Microsurgery on Quality of Life and Healing on Mandibular Molars

Targeted endodontic microsurgery represents precise and advanced approach to resolving persisting chronic periapical periodontitis after non- surgical root canal treatment. This specialised procedure involves accessing the root tip of the tooth under high magnification using dental operating microscopes and employing microsurgical instruments to remove infected or inflamed tissue, as well as any pathological lesions present in the periapical region. Targeted Endodontic Microsurgery is useful for osteotomy and root- end resection when exacting control of depth, diameter, and angulation of osteotomy and root end resection is necessary. Using a CBCT(cone beam computed tomography) designed 3D - printed surgical guideis a more accurate method for access to the apical portion of the root during surgical endodontics compared with a "freehand" CBCT - approximated conventional method. These guided have the potential to increase accuracy and precision and to reduce intraoperative time as well as postoperative complications. Additionally, it provides a viable treatment option for patients who may not be candidates for traditional root canal therapy or retreatment due to anatomical complexities or previous treatment failures.

Inclusion Criteria: * Patients with persistent symptomatic apical periodontitis and periapical radiolucency. * Tooth with a peri-radicular lesion of strictly endodontic origin (chronic apical periodontitis) and combined endodontic periodontic lesions with the size of lesion ≥5mm. Patients between 18-55 years of age. * No general medical contraindications for oral surgical procedures (ASA-1) according to the classification of the American Society of Anesthesiologists) * ASA 1- A normal healthy patient. Example: Fit, nonobese (BMI under 30), nonsmoking patient with good exercise tolerance. * Tooth with adequate final restoration without clinical evidence of coronal leakage. * No spontaneous pain or swelling. * Good periodontal health condition at tooth level * Able to completely understand and sign an informed consent form Exclusion Criteria: * Mandibular molar teeth in which non-surgical retreatment was unfeasible (e.g. owing to a post, a separated instrument or canal obliteration). * Patients with systemic diseases (diabetes mellitus, uncontrolled hypertension grade III, hepatic/renal disease, or systemic bleeding disorders) * Patients on anticoagulant/ antiplatelet drugs. * Fractured/perforated teeth. * Teeth with deep pockets (probing depth \> 4 mm). * Presence of vertical root fracture. * Miller class III/IV mobility. * Pregnancy.