Advances in Endodontic Microsurgery: Techniques, Materials, and Innovations for Enhanced Patient Outcomes

Abstract

Recent advancements in endodontic microsurgery have redefined the field, providing clinicians with more precise, minimally invasive techniques for managing complex root canal cases. This review highlights the critical role of enhanced magnification, specialized microsurgical instruments, and biocompatible materials in elevating the success rates and predictability of these procedures. Surgical operating microscopes and refined ultrasonic instruments now allow for improved visibility and precise manipulation in root-end surgeries, minimizing trauma and accelerating healing. Biocompatible filling materials, such as Mineral Trioxide Aggregate (MTA) and Biodentine, offer enhanced sealing and integration with periapical tissues, fostering superior healing outcomes. State-of-the-art imaging techniques, including cone beam computed tomography (CBCT) and emerging magnetic resonance imaging (MRI) applications, provide comprehensive, three-dimensional anatomical views that support meticulous preoperative planning and reduce surgical risk. Furthermore, CAD/CAM and 3D printing technologies enable customized surgical guides, improving precision and minimizing invasiveness. Nanotechnology has introduced novel materials with antimicrobial properties, enhancing canal disinfection, sealing, and regenerative potential, which is particularly beneficial for persistent infections. Instruments used in canal shaping have evolved from manual to advanced rotary and reciprocating systems, increasing efficiency and reducing operator fatigue and procedural complications. The integration of fluid dynamics-based systems, such as the GentleWave system, offers a non-instrumental approach for enhanced root canal disinfection, addressing biofilm presence within intricate canal anatomies. Laser-assisted endodontic disinfection (LAED) provides deeper bacterial elimination, leveraging the precise targeting and minimal thermal diffusion of lasers like Erbium and diode types. Pain management has also progressed with buffered anesthetics, computer-assisted delivery systems, and low-level laser therapy (LLLT), offering greater patient comfort and minimizing postoperative discomfort. Lastly, artificial intelligence (AI) has become an essential tool in endodontic diagnostics and treatment planning, enabling accurate identification of canal morphologies, prediction of treatment outcomes, and personalized care planning. These innovations in visualization, materials, instrumentation, and digital technologies collectively signal a transformative era in endodontic microsurgery, emphasizing precision, biocompatibility, and patient-centered care. As the field progresses, these advancements are poised to further improve procedural predictability, reduce treatment morbidity, and optimize patient outcomes, positioning endodontic microsurgery at the forefront of dental medicine.