Endodontic lesions may result in significant bone destruction. Orthograde endodontic treatment, when done properly, will result in the regeneration of large bony defects. However, there are times one must resort to endodontic surgery when healing does not take place. A new approach for the treatment of large endodontic lesions will be discussed using the GTR approach and the innovative use of piezo surgery.
Today with the advent of CT and CBCT scans, we are supplied with much more information than the traditional two-dimensional radiographs. The proposed endodontic surgery may then develop several therapeutic possibilities and increase significantly the percentage of positive outcomes.
Piezo surgery (including the repositioning of the bone), new resorbable membranes and bone grafting materials, can broaden our extent of treatment to regenerate original structures, particularly in endo-perio lesions, extensive bony defects and sinus surgery. This treatment modality is documented by 30 years of CT scans and, more recently, the Cone Beam CT scan.