Rationale for the management of complex, borderline cases in endodontics

The triad of success in modern clinical endodontics is magnification, 3D radiographic visualisation and microsurgery. These, along with the most recent technological advancements in instrumentation, antimicrobial disinfection as well as the modern bioceramic sealing materials, can turn cases with a guarded prognosis into success. A correct diagnosis based on CBCT and a careful case selection can lead to a predictable healing for lesions of endodontic origin. At the same time, under certain anatomical or biological circumstances and/or after iatrogenic interference, conventional endodontic treatment or retreatment might not result in a positive outcome. This may necessitate the execution of surgical retreatment. This comprehensive lecture aims to highlight the clinical approach for challenging cases with previous failed endodontic intervention, iatrogenic mishaps and persistent periradicular pathology. A rationale for the management of this kind of cases will be thoroughly discussed.

Learning objectives:

• Understanding the reasons for failure and persistence of apical pathology in complex endodontic cases.
• Developing a strategy for management of challenging cases by selecting non-surgical or surgical endodontic treatment or a combination thereof.
• Comprehending the rationale for proper case selection in the treatment of lesions of endodontic origin