Review

. 2025 Jan 2;17(1):2.

doi: 10.1038/s41368-024-00334-8.

Expert consensus on apical microsurgery

Hanguo Wang^#¹, Xin Xu^#², Zhuan Bian³, Jingping Liang⁴, Zhi Chen³, Benxiang Hou⁵, Lihong Qiu⁶, Wenxia Chen⁷, Xi Wei⁸, Kaijin Hu⁹, Qintao Wang¹⁰, Zuhua Wang¹¹, Jiyao Li², Dingming Huang², Xiaoyan Wang¹², Zhengwei Huang¹³, Liuyan Meng³, Chen Zhang¹⁴, Fangfang Xie⁷, Di Yang⁶, Jinhua Yu¹⁵, Jin Zhao¹⁶, Yihuai Pan¹⁷, Shuang Pan¹⁸, Deqin Yang¹⁹, Weidong Niu²⁰, Qi Zhang²¹, Shuli Deng²², Jingzhi Ma²³, Xiuping Meng²⁴, Jian Yang²⁵, Jiayuan Wu²⁶, Yi Du²⁷, Junqi Ling²⁸, Lin Yue²⁹, Xuedong Zhou³⁰, Qing Yu³¹

Affiliations

¹ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
² State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
³ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Department of Endodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
⁴ Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.
⁵ School of Stomatology, Capital Medical University, Beijing, China.
⁶ Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China.
⁷ College & Hospital of Stomatology, Guangxi Medical University, Nanning, China.
⁸ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
⁹ Department of Oral and Maxillofacial Surgery, School of Stomatology, Xi'an Medical University, Xi'an, China.
¹⁰ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
¹¹ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China.
¹² Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China.
¹³ Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China.
¹⁴ Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, China.
¹⁵ Department of Endodontics, School of Stomatology, Nanjing Medical University, Nanjing, China.
¹⁶ Department of Cariology and Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹⁷ Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
¹⁸ Department of Endodontics, School of Stomatology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
¹⁹ Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
²⁰ Department of Endodontics, School of Stomatology, Dalian Medical University, Dalian, China.
²¹ Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Endodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai, China.
²² Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
²³ Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁴ Department of Endodontics, School and Hospital of Stomatology, Jilin University, Changchun, China.
²⁵ Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China.
²⁶ Department of Endodontics, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China.
²⁷ Jinan Stomatological Hospital, Jinan, China.
²⁸ Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China. lingjunqi@163.com.
²⁹ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China. kqlinyue@bjmu.edu.cn.
³⁰ State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. zhouxd@scu.edu.cn.
³¹ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China. 2535165@qq.com.

^# Contributed equally.

PMID: 39743567
PMCID: PMC11693765
DOI: 10.1038/s41368-024-00334-8

Review

Expert consensus on apical microsurgery

Hanguo Wang et al. Int J Oral Sci. 2025.

. 2025 Jan 2;17(1):2.

doi: 10.1038/s41368-024-00334-8.

Authors

Affiliations

¹ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
² State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
³ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Department of Endodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
⁴ Department of Endodontics and Operative Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.
⁵ School of Stomatology, Capital Medical University, Beijing, China.
⁶ Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China.
⁷ College & Hospital of Stomatology, Guangxi Medical University, Nanning, China.
⁸ Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
⁹ Department of Oral and Maxillofacial Surgery, School of Stomatology, Xi'an Medical University, Xi'an, China.
¹⁰ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
¹¹ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China.
¹² Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China.
¹³ Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China.
¹⁴ Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, China.
¹⁵ Department of Endodontics, School of Stomatology, Nanjing Medical University, Nanjing, China.
¹⁶ Department of Cariology and Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹⁷ Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.
¹⁸ Department of Endodontics, School of Stomatology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
¹⁹ Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.
²⁰ Department of Endodontics, School of Stomatology, Dalian Medical University, Dalian, China.
²¹ Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Endodontics, Stomatological Hospital and Dental School, Tongji University, Shanghai, China.
²² Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
²³ Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁴ Department of Endodontics, School and Hospital of Stomatology, Jilin University, Changchun, China.
²⁵ Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University, Nanchang, China.
²⁶ Department of Endodontics, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China.
²⁷ Jinan Stomatological Hospital, Jinan, China.
²⁸ Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China. lingjunqi@163.com.
²⁹ Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China. kqlinyue@bjmu.edu.cn.
³⁰ State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China. zhouxd@scu.edu.cn.
³¹ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China. 2535165@qq.com.

^# Contributed equally.

PMID: 39743567
PMCID: PMC11693765
DOI: 10.1038/s41368-024-00334-8

Abstract

Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare no competing interests. Informed consent: Patients (or their guardians) must be informed about the details of apical microsurgery and must provide informed consent prior to the procedure.

Figures

**Fig. 1**
Schematic diagram of clinical operating procedures for apical microsurgery

**Fig. 2**
Sulcular rectangular flap with a horizontal incision in the gingival sulcus

**Fig. 3**
Submarginal rectangular flap with a horizontal incision in the attached gingiva

**Fig. 4**
Sulcular triangular flap with a horizontal incision in the gingival sulcus

See this image and copyright information in PMC

References

1. Ling, J. Q. Microscopic Endodontics. 1st edn, (People’s Medical Publishing House, 2014).
1. Su, L., Gao, Y., Yu, C., Wang, H. & Yu, Q. Surgical endodontic treatment of refractory periapical periodontitis with extraradicular biofilm. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol.110, e40–e44 (2010). - DOI - PubMed
1. Ricucci, D., Siqueira, J. F., Lopes, W. S. P., Vieira, A. R. & Rôças, I. N. Extraradicular infection as the cause of persistent symptoms: a case series. J. Endodont.41, 265–273 (2015). - DOI - PubMed
1. Ricucci, D., Lopes, W. S. P., Loghin, S., Rôças, I. N. & Siqueira, J. F. Large bacterial floc causing an independent extraradicular infection and posttreatment apical periodontitis: a case report. J. Endodont.44, 1308–1316 (2018). - DOI - PubMed
1. Signoretti, F. G. C. et al. Persistent extraradicular infection in root-filled asymptomatic human tooth: scanning electron microscopic analysis and microbial investigation after apical microsurgery. J. Endodont.37, 1696–1700 (2011). - DOI - PubMed

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Expert consensus on apical microsurgery

Affiliations

Expert consensus on apical microsurgery

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources