Medical Indications and Pharmacology

Apicoectomies are a known and predictable treatment option for endodontically treated teeth with persistent inflammation or infection at the tooth apex, where both short-term success rates are above 90%. Does this high success rate change in patients who are medically compromised, or have medical conditions or habits affecting either bone or soft tissue healing? Are there any relative or absolute contraindications to endodontic microsurgery? For example, published literature reports cases of medication-related osteonecrosis of the jaws (MRONJ) in patients undergoing apicoectomy, and questions have been raised regarding healing in smokers, periapical lesions in diabetic patients, and performing surgery in patients on anti-coagulants. As patients become older and more medically compromised, endodontists performing surgery must be vigilant in identifying patients at risk for potential complications. This presentation will discuss risk factors in surgery, including a focus on the prevalence of MRONJ, and the endodontist’s role in prevention and treatment.