Advanced endodontic microsurgery: clinical tips for molars and grafting strategies

Endodontic microsurgery has evolved significantly and is now a predictable procedure even in molar teeth, although it still remains intimidating for many practitioners. The introduction of the operating microscope has dramatically improved visualization, illumination, and surgical precision, while advances in ultrasonic tips have enabled more conservative and accurate root-end preparation. These technological developments have transformed endodontic surgery into a highly predictable procedure, with reported success rates now exceeding 90%.

The use of bone grafting materials has further enhanced the prognosis of endodontic microsurgery, particularly in complex clinical situations such as large periapical lesions, through-and-through defects, and cortical bone loss. Bone grafting promotes more complete and faster healing and allows the preservation of teeth that would previously have been considered hopeless.

The first part of the course will review the principles and recent advances in endodontic microsurgery and will provide practical clinical tips for molar surgery. Particular emphasis will be placed on managing anatomical challenges, optimizing access, flap design, hemostasis, and microsurgical strategies specifically adapted to posterior teeth.

The second part of the course will focus on bone grafting in endodontic microsurgery. Different grafting materials will be discussed with regard to their biological properties, indications, and clinical applications, with special attention to their use in large defects, through-and-through lesions, and compromised cortical plates.