(TC13) Surgical Regenerative Endodontic Therapy: A Novel Approach to Treating Post-Treatment Endodontic Disease

Regenerative endodontic treatment (RET) has been proposed as a viable treatment option for immature necrotic teeth. Despite its reported high success rates some patients still suffer from recalcitrant apical periodontitis with clinical symptoms after RET. In addition to persistent intraradicular infection this post-RET disease may also be caused by extraradicular etiologies, including extraradicular infection, foreign body reaction, and true cystic lesions. Therefore, it may be reasonable to consider surgical intervention if nonsurgical RET cannot reduce or eliminate clinical signs and symptoms in teeth with persistent periapical pathosis. However, conventional endodontic microsurgery with bioceramic root-end filling may not be ideal for immature teeth due to their thin, fragile root canal walls. A biologically based approach to induce dentin and pulp regeneration may be more beneficial than the apical plug with bioceramic materials in surgical intervention, as in nonsurgical RET. The aims of this table clinic are to aid clinicians in selecting suitable cases with post-treatment endodontic disease that may benefit from surgical RET, and to propose a protocol using a bioactive scaffold to enhance treatment outcomes. A clinical case with long-term follow-ups will be presented to illustrate the case selection, procedures, and expected outcomes of surgical RET. With this knowledge clinicians may be better equipped to prolong the longevity of immature teeth by surgically managing the intractable periapical pathology and promoting pulpal tissue regeneration.