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Conventional endodontic therapy failure may happen due to bacterial load which is a potential etiology for the apical pathosis seen in the non-healing orthograde endodontic cases.The apical third root canal anatomy can be even more challenging to shape and clean due to multiple portals of exit that can leave the root at sharp angles with small radii of curvature. In addition, apical resorption may alter apical anatomy making the root end more difficult to effectively treat nonsurgically.Endodontic surgery was considered a procedure of last resort, filled with negative connotations because of lack of experience and understanding of the merits of the procedure. It is a facet of comprehensive root canal treatment, which can manage problems that cannot be eliminated by nonsurgical techniques.Advances over the past decades, supported by ongoing research, have led to a refinement of these techniques, materials and instruments. These advancements are centered on the use of the surgical operating microscope and even sometimes dental loupes provide unsurpassed magnification and illumination for all phases of the treatment process.
