EVALUATION OF THE EFFECTIVENESS OF RETROGRADE BIOCERAMIC FILLING IN THE COMPREHENSIVE TREATMENT OF APICAL PERIODONTITIS
DOI:
https://doi.org/10.32782/3041-1394.2026-2.4Keywords:
apical microsurgery, retrograde filling, bioceramic materials, apical periodontitis, cone-beam computed tomographyAbstract
Introduction. Apical microsurgery is a tooth-preserving option for persistent apical periodontitis when orthograde retreatment is technically unfeasible or carries a substantial risk of damaging the tooth or an existing prosthetic restoration. Calcium silicate-based bioceramic materials are used for root-end filling because of their biocompatibility, handling properties, and performance in a moist surgical field; however, clinical outcomes also depend on microsurgical technique and the initial clinical condition. Aim. A clinical and radiographic characterisation of early outcomes after apical microsurgery with retrograde bioceramic filling in a series of five clinical cases, with consideration of the indications for the surgical approach. Materials and Methods. Five clinical cases involving six teeth were presented: five teeth with apical periodontitis and one tooth with resorption of the mesiobuccal root. The procedures were performed at Professor Vesova Dental Surgery Clinic as part of routine clinical practice. Five teeth underwent apical microsurgery with root-end filling using BC Putty, while the resorptive defect of tooth 16 was sealed with EndoSequence BC Liner. The protocol included treatment under a dental operating microscope, visual assessment with methylene blue, ultrasonic root-end preparation, irrigation with 2% chlorhexidine, and haemostasis control. Clinical findings and cone-beam computed tomography (CBCT) were used for follow-up at 3–8 months. No inferential statistical analysis was performed because of the descriptive case-series design. Results. Asymptomatic apical periodontitis was documented in cases 1, 3, and 4, whereas symptomatic apical periodontitis was documented in cases 2 and 5. Case 1 additionally involved resorption of the mesiobuccal root of tooth 16. Indications for surgery included root posts and crowns associated with a risk of tooth damage during orthograde access, complex root canal anatomy, and the location of a resorptive defect. Follow-up imaging in all five cases showed favourable early radiographic changes without documented deterioration; the follow-up interval ranged from 3 to 8 months. Conclusions. This case series illustrates the use of bioceramic materials as part of apical microsurgery in clinically challenging situations and documents favourable early radiographic changes. The absence of a control group, the small number of cases, heterogeneous follow-up intervals, and the lack of standardised quantitative outcome criteria preclude conclusions regarding the comparative or long-term effectiveness of a specific material.
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