Fig. 1

 

Preoperative X-ray

Fig. 2

Flap steps 

Fig. 3

Periosteal elevator (SIE3+FG V). 

Double-curved periosteal elevator – two different sizes on each endused for a sharp dissection of periosteal tissue, without any tissue damage.

Fig. 4

apex identification

Fig. 5

Surgery phases retrogade ultrasonic preparation

Fig. 6

Obturation

Obturation video

Fig. 7

Postoperative X-ray

Fig. 8

4 years control  X-ray

Conclusions

Micro apical surgery could be more conservative in many cases when we have heavy coronal restorations ,

 The procedure should be done with high magnification under microscope and right tools for precise and better outcome . 

Bibliography

1-H.M. Eriksen, L.L. Kirkevang, K. Petersson. Endodontic epidemiology and treatment outcome: general considerations. Endod Topics, 2 (2002), pp. 1-9
 2-C. Barone, T.T. Dao, B.B. Basrani, N. Wang, S. Friedman. Treatment outcome in endodontics: the Toronto study—phases 3, 4, and 5: apical surgery. J Endod, 36 (2010), pp. 28-35

3- S. Friedman. The prognosis and expected outcome of apical surgery. Endod Topics, 11 (2005), pp. 219-262

4- T. von Arx, M. Penarrocha, S. Jensen. Prognostic factors in apical surgery with root-end filling: a meta-analysis. J Endod, 36 (2010), pp. 957-973