Title: Magnifying to be minimally invasive: Optimizing the success of parendodontic surgery in the microsonics concept
Conventional apical surgery was originally indicated as the last alternative for endodontic reintervention, for unsuccessful situations after retreatment or, exceptionally, when retreatment was made impossible by the presence of prostheses and posts. In order to increase the success predictability and indicate apical surgery as the first option in some situations when root canal retreatment is contraindicated, many aspects of its execution have been improved. This whole protocol is possible with the Microssonics concept, which combines the magnification and illumination provided by the operating microscope or magnifying glasses and photophores and the use of piezoelectric ultrasonic, used from the cutting bone to the root end preparation and filling. With the improvement of lighting and visibility provided by the magnification equipment, the incision extension and osteotomy are reduced, resulting in less invasive and more comfortable procedures for the patient. In addition, the magnification provides the necessary visibility for the proper inspection of the apex, from the root resection in its total extension at zero angle, visualization of areas not touched by endodontic instruments at the cut root surface, such as constrictions and flattenings in maxillary premolars, mesiovestibular roots of maxillary molars and mesial roots of lower molars, microcracs, fractured instruments, among others. For minimally invasive, safe access and with reduced tissue trauma, piezoelectric ultrassonic has come to complete the microsurgery technique. For that, many equipments with intelligent waves and adjustable power offers precise cutting of hard tissues, without traumatizing soft tissues, providing a safe and minimally invasive surgical environment. Finally, the use of sealers with biocompatible and bioactive characteristics, such as repairing bioceramics, offer excellent apical sealing, in addition to potent antimicrobial properties, derived from its alkaline pH. Therefore, apical microsurgery under the microsonics concept has a high predictability of success, and should be performed when conventional root canal retreatment is contraindicated due to difficulties in access, for resolution of iatrogenesis or due to the impossibility of adequate cleaning of the apex.