Surgical and nonsurgical management of complex endodontic cases

Factors such as complexity of root canal anatomy, the presence of periapical lesions, perforation, radicular resorption can complicate endodontic treatment. The modern technologies as operative microscope, cone beam computed tomography, ultrasonic tips, devices to activate irrigation and bioactive material can be very helpful when practician is faced with difficult cases. The option of surgical management is considered when unsuccessful outcome of nonsurgical treatment or retreatment occurs. It is essential to evaluate surgical cases on the basis of preoperative clinical and radiographic findings to obtain a predictably high success rate. In this work, we will present successful management of very challenging cases with long-term follow-up.