The surgery goal is periapical lesion removal and the apical third sealing, allowing soft and hard tissue regeneration [13, 33, 43]. Although less frequent in occurrence, the success rate usually is high because the canal system likely is well obturated. A decision then is needed to determine if orthograde endodontic retreatment can be accomplished, should periapical surgery be recommended or consideration of extraction of the tooth with loss of the overlying prosthesis. All cases were histologically reviewed to confirm diag- They found that if radiographic evidence of bone fill of the surgical defect is noted, then the tooth remained a radiographic success over their observation periods. Consideration for a localized cone beam radiology examination of the involved area also may provide preoperative evidence of a fracture, which would reduce the likelihood of successful outcomes of the surgery. Thus, the condemnation of a tooth because it can be replaced with an implant is not that clear. In 42 patients, 1 tooth was treated, and in 8 patients 2 teeth ... steps). Plans must be made preoperatively on how such situations will be handled should they be noted intraoperatively. PERIAPICAL SURGERY. The final pathology was a cystic ameloblastoma. Failure of endodontic treatment is due most commonly to lack of an adequate coronal seal with the presence of bacteria within the root canal system and apical leakage. Mandibular molars and maxillary premolars are the teeth that most frequently present with occult VRFs. In a 2-part article by Setzer and colleagues, , a meta-analysis was reviewed on this subject of endodontic surgery. Today, after previous endodontic failure, non-surgical revision of the root in cases of periapical infection, granuloma, or cyst is considered by many as the primary mode of case management. The authors conclude that the case report showed success in the surgical treatment of the periapical lesion, where the apical area already showed a great bone regeneration after 6 months. When a radiotransparent periapical lesion measures over 8 to 10 mm in diameter [] and it is a suspected periapical cyst, endodontic surgery is required to remove the cyst and a biopsy is needed to confirm histologic diagnosis of the lesion [].A most commonly performed endodontic surgery usually involves exposure of the periapical … Algorithm for apical surgery. Apical surgery can preserve many teeth that remain symptomatic after conventional endodontic treatment especially because endodontic failure can occur after 1 year, usually after a definitive restoration is placed. The decision to perform surgery is … Ostectomy in periapical surgery is a key step in peri-apical surgery and necessary to access the apex of a . Oral surgery allows changes and pathologies of the oral cavity to be corrected. Methodology: A total of 164 patients with 231 roots with previously unresolved periapical lesions were followed for up to 5 years following surgery. Periapical x-rays are the most common diagnostic radiographs taken on a routine basis in the dental office. Small bony defects healed faster than large bony defects, which showed significant differences in their prospective study. With the more contemporary surgery techniques, the outcomes improved from 59% to 94%. In that situation, the surgeon not only has to consider the preoperative potential for the apical surgery to be successful but also often must determine when a case is deemed successful and can proceed to the final restoration. It can also involve reverse filling and sealing of the canal when conventional root canal treatment is not feasible. Hindawi Case Reports in Dentistry Manifestation of signs was recorded as clinical periapical index (CPI). Failed Root Canals: The Case for Apicoectomy (Periradicular Surgery) J Oral Maxillofac Surg 63:832-837, 2005 . ... a smalldeep restoration is less likely to result in marginal leakage orbecomes a loose foreign body in the periapical tissues. A periapical radiograph is an intraoral x-ray that provides a selective view of dental conditions such as tooth decay, root caries, progressive bone loss, and apical … Continued infection also may result from debris displaced out the apex during the initial endodontic treatment. An incision is made and the root tip exposed. The particular risks of surgery based on the anatomic location (sinus involvement or proximity to the inferior alveolar nerve) need to be reviewed and documented. Surgery. Finally the incisions are sutured and a control X-ray is made. Si usted ha permanecido asintomático, y en el examen al año de la intervención el doctor, no detecta fístulas y se observa una curación ósea en la radiografía de control, se considera que la intervención ha tenido éxito, y se podrá conservar el diente que causó la infección. This review updates one published in … 7. Overall, periapical surgery is a procedure that is reserved for the most serious of our root canal cases. These complications must be anticipated and incorporated into pre-surgical planning [ 1 ]. This procedure is done under local anesthetic. Which anatomical local structures could be injured while performing mucoperiosteal flap? When there is a failure of root canal treatment apicoectomy is indicated. Periapical surgery is statistically a very successful procedure if the problem is a leaky root canal filling and the root tip is surgically accessible. An appropriate follow-up protocol is to obtain a repeat periapical film 3 months after surgery with critical comparison with the immediate postoperative film. Three simple steps used during presurgical diagnosis, flap design, and surgery are presented to increase the practitioner's confidence and safety while performing mandibular periapical surgery. Although correctly treated at the time of referral due to the nonresolving radiolucency with periapical surgery, the suspicious nature of the lesion warranted submission of the tissue for histologic examination. Although conventional endodontic procedures are very successful, failure of the initial treatment can occur. (. Confirmation with the original treating dentist revealed the indication for the endodontic treatment was solely the incidental finding of a radiolucency and vital pulp tissue was noted. The ideal candidates for this procedure are people with a periapical lesion that hasn’t responded to two root canals of the tooth or anatomical anomalies in the root of the tooth that prevent the root canal to suitably seal the root tip. Un vez los implantes se han unido a la mandíbula comienza la segunda fase, en la que el cirujano descubre los implantes. A postoperative periapical radiograph was taken immediately after surgery. 3 ). Step sections were analyzed histometrically and morphometrically for periapical healing. The surgical procedure was simplified, and the treatment efficiency was … Usually is accompanied by a small preparation of the end of the cut off root and the sealing off it with an amalgam or special cement. Few (1 of 15) teeth with an isolated, well corticated periapical lesion had a VRF. Flap design in periapical surgery should be adequate for the planned surgical procedure, offering good access to the zone surrounding Periapical Surgery Procedure Patients who have experienced an already failed root canal, are experiencing considerable pain. Sites with membrane + filler showed a statistically significantly lower mean percentage of new bone formation within the former defect compared to both membrane-alone and control sites. More complicated decisions are involved with teeth that have not been definitively restored. You may also be prescribed antibiotics to clear up any remaining infection that prompted the root canal treatment. Prosedur Laboratorium Fabrikasi Dari Kerangka Denture Partial Logam Bacteria still remained in the canals of the tooth in 90% of these cases, which may lead to a later failure. Si continúa navegando está aceptando lo expresado en la sección de. Preoperative radiographs and a careful clinical examination should be done with a high index of suspicion of a vertical root fracture (VRF) prior to undertaking surgery. Toda intervención quirúrgica entraña un riesgo. Alternatively (or if the nerve block is not adequate), do local infiltration (field block) around the abscess: Inject 1 to 2 mL into the mucosa anterior and posterior to the abscess, and then at sites along the circumference. Animals were sacrificed 7 months following the second surgery. A periapical abscess occurs at the root tip as a result of untreated dental caries, crack, or trauma. Recovery from periapical surgery. The images were displayed on a 48 cm monitor ab c Figure 1 (a) Periapical radiograph 1 week post … Aim To monitor and compare the outcome of periradicular surgery in teeth that had previously undergone surgical treatment versus teeth that were undergoing a surgical procedure for the first time.. The root-ends were accurately located and resected. 13-14). 6. Each type of incision is associated with complications like wound dehiscence, gingival recession and scarring. Its aim is the treatment of apical periodontitis after depleting People with a periapical abscess and a recurring infection may need to have diseased tissue surgically removed. Some patients present lesions in the maxillary bone or mandible around one or several roots that grow destroying the support bone of the tooth and are responsible of pain and infections. The prognosis of the periapical treatment depends on many factors: sealing of the conducts by the root canal, size of the periapical lesion, presence of accompanying periodontal lesions, number of roots of the affected tooth, etc. Periradicular Surgery Aim . Generally this is a painless procedure performed under local anesthesia. The advantage of periapical surgery is that it can allow keeping the tooth. Flap design in periapical surgery Introduction Two factors are important for securing optimum functional and esthetic outcomes in periapical surgery: flap design and the suturing technique used. Implant-plasty was carried out, removing approximately 5 mm of the apical portion of the Causes of endodontic failures often can be separated into biologic issues, such as a persistent infection, or technical factors, such as a broken instrument in the root canal system ( Fig. In this sense, Peñarrocha et al. If significant bone fill has not been noted, however, the patient should be recalled again at 3 months for a new film. This endodontic surgery is usually done when there is severe infection the pulp or apex. Test periapical surgery 1. The surgeon may be called on to treat teeth that cannot be negotiated for conventional orthograde endodontics. 4 ), subtle radiographic signs may alert the surgeon that a fracture is present and the surgery is unlikely to be successful. The flap should be a firm continuous incision and not cross an underlying bony defect. When correct preoperative diagnostic and surgical techniques are used, serious negative sequelae are rarely encountered. Large periapical defects may adversely affect the success rate of endodontic surgery. Their work showed that with a retrospective review of cases over at least 4 years postsurgery, once radiographic evidence of bone fill occurs, noted as successful healing in their classification scheme, that tooth was stable throughout the remainder of their study period (up to 15 years). There is some controversy in the endodontic literature that the use of magnification may improve outcomes in surgical management of endodontic failures. According to the meta-analysis of Tsesis et al. The primary option for the treatment of symptomatic endodontically treated teeth is that of conventional retreatment versus the surgical approach. Nonsurgical root canal procedures and periapical surgery followed by placement of bone substitute will promote the healing process of the bony defect. This paper presented a Literature Review on Periapical surgery, planning, indications and contraindications, various methods, instruments and equipment It is also known as root-end resection, because it is, quite simply, the removal of the root tip (and the … Su doctor le recomendará que vuelva a revisión si lo estima conveniente. Esta web usa cookies. Step by step apicoectomy surgery … Surgical treatment of failures also provides the opportunity to retrieve tissue for histologic examination to rule out a noninfectious cause of a lesion ( Fig. Depending on the findings at surgery, a limited root resection with retrograde restoration may be placed. Flap design in periapical surgery should be adequate for the planned surgical procedure, offering good access to the zone surrounding the affected apexes without altering the soft-tissue circulation. Currently, with micro- Endodontic SurgeryIt is often the last hope for retention of atooth and therefore requires the greatestskill. Rubinstein and Kim found complete healing in 25.3% of cases in 3 months, 34% in 6 months, 15.4% in 9 months, and 25.3% by 12 months. Endodontic Surgical ProceduresEndodontic Surgical Procedures Incision and drainageIncision and drainage Periapical curettagePeriapical curettage ApicoectomyApicoectomy Retrograde endodontic treatmentRetrograde … Contemporary Endodontic Surgery. in periapical surgery have increased from 50-75% in the 1980s (39-41) to a more encouraging 82% (11) or 92.4% at present (1). Periapical Granuloma - Free download as Word Doc (.doc / .docx), PDF File (.pdf), Text File (.txt) or read online for free. These lesions are called granulomas and periapical cysts and its origin it’s in a chronic dental infection. In these occasions the rebuilding of the tooth needs the collocation of a bolt or casting posts that can lift up to try a root canal again. Most significantly, studies show that once the periapical bony defect is considered healed (reformation of the lamina dura or cases of healing by scar), the long-term prognosis is excellent. One among them is a periapical radiograph. The patient received post-surgical care instructions and prescription of amoxicillin 875 mg for 7 days, Nimesulide 100 mg for 3 days, dipyrone 500 mg in the first 24 hours and 0.12% chlorhexidine digluconate rinses for 7 days. Periapical surgery is typically recommended to treat leaky root canal fillings when the root tip is surgically accessible. ... After gaining access, surgery follows the following steps: 1. Endodontic Treatment Retreatment and Surgery Book Review: This book provides clear, concise guidance on a range of essential treatment strategies for the provision of reliable endodontic care. 3. Surgery is often assumed to be the most radical procedure; however, sometimes the surgical procedure becomes a conservative effort to avoid further tissue injury, and extraction of the tooth. Use of regenerative therapy may enhance the prognosis of such teeth. Periradicular surgery is not always a necessary step towards endodontic success, it should never be used as a cure for a poor endodontic root canal technique. The disadvantage is that is not healing in every case and that if the infection is not stopped, the extraction of the tooth may be needed anyway. Which are principles of flap design? Factors that improve success are noted in Box 1 . Blomlof and Jansson found surgically treated molars with healthy periodontal status had a 10-year survival rate of 89% and Basten and colleagues reported a 92% 12-year rate. This work presents a literature review on the Periapical surgery, having as a backdrop, the following steps: planning of surgery, indications, contraindications, comparison between traditional surgery and the current, instruments and equipment used in surgery. This procedure rids the wound of blood to make it ensurethat all pathologic tissue has been removed. It can also involve reverse filling and sealing of the canal when conventional root canal treatment is not feasible. These lesions have a small size, less than a centimeter, and the treatment is done by your odontostomatologist by a root canal of the causal tooth. 1 INTRODUCTION Radicular cyst is formed by the stimulation and proliferation of an epithelial residues cell or rest of Malassez in the periodontal ligament. This is generally advised only if the root canal treatment has been completed to a high standard or retreatment of the root canal is not posibble due … if you know better! It is required when an infection develops or persists after the endodontic treatment or retreatment.A filling made of amalgam or composite resin is used to seal the end of the root. Intentional replantation procedure is rarely performed, as published by Raghoebar and colleagues (0.6% of endodontic surgery), preferably at mandibular second molars. Large periapical defects may adversely affect the success rate of endodontic surgery. (, Factors associated with success and failures in periapical surgery, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Current Concepts of Periapical Surgery, Endoscopic Management of Maxillary Sinus Diseases of Dentoalveolar Origin, Oral and Maxillofacial Surgery Clinics Volume 32 Issue 4. Surgical procedures include resection of 2 mm to 3 mm of the apical portion along with root end preparation and seal. Surgical endodontics success rates have dramatically improved over the years with the developments of newer retrofilling materials and the use of the ultrasonic preparation. Periapical surgery is one of the minor surgical techniques done in the dental chair under local anaesthesia to save a tooth with a periapical lesion in order to restore the functional health of the teeth. Surgery may be undertaken after unsuccessful retreatment, or when retreatment is impossible or has an unfavorable prognosis The bone regeneration following periapical surgery can be facilitated by placing bone graft into the periapical defect. dicular surgery is an alternative for permanent tooth in the oral cavity without exerting its functions that it can damage the health of the patient. ... is regarded as an oversimplification for what may be technically challenging surgery involving both periodontal and periapical hard and soft tissues. The surgeon should review the factors in Box 1 to help predict the likelihood of the surgical intervention being successful. In the rare event that a tooth fails to respond to root canal therapy and root canal retreatment is not a viable option, root canal surgery is necessary to save the tooth. 2. Periapical surgery 1. Use of regenerative therapy may enhance the prognosis of such teeth. Después de que el paciente recoja el resultado acudirá a revisión con su cirujano donde se revisará la cicatrización y se comentará el resultado del análisis. When the periapical lesion hasn’t responded to a root canal there only two alternatives left: exodontia of the causal tooth with removal of the lesion and periapical surgery. We then require you to tell us what the correct sentiment is. Step 11: You may experience sensitivity or mild discomfort in the area for a few days – if so, use over-the-counter pain relievers, such as acetaminophen, ibuprofen, or aspirin, to alleviate pain. Reviewing Key Steps of Endodontic Surgery Through Practical Case Examples. Once a final restoration is placed, considerably more time and expense have been invested and subsequent failure is more troublesome to the patient. Therefore, there is the competing interest of observing the tooth after endodontic treatment to ascertain successful treatment versus placing a definitive restoration with an adequate coronal seal. premolar) received periapical surgery. How injury of the local structures could be prevented? The treatment of teeth with calcified canals may be managed appropriately with apical surgery alone with a retrograde filling if the tooth is critical to a restorative treatment plan. The factors most associated with failures are long posts in teeth with little remaining coronal structure. Therefore, with adequate radiographic follow-up, a surgeon should be able to predict the long-term viability of the tooth and its usefulness to retain a prosthetic restoration. If a tooth has multiple factors that indicate the success of the surgical intervention would be compromised and/or a tooth has a poor expectation for 10-year survival, then extraction with implant placement is a more efficacious means of care. This significant improvement makes apical surgery a more predictable and valuable adjunct in the treatment of symptomatic teeth. Five months after the second periapical surgery, the presence of a fistula was observed clinically, while in X-ray a radiolucent lesion was observed in the apex of the implant. An algorithm for a decision regarding retreatment versus surgery versus extraction is presented in Fig. An apicoectomy, also known as retrograde root canal treatment or root end resection, is a micro-surgical endodontic procedure to remove the tooth’s root tip (apex). 18. The periapical surgery consists on the surgical extraction of the lesion that is at the end of the tooth root, next to the section of the end of the root (about 3mm). The tooth stability does not undergo major changes after surgery comparated with the initial value which was determined ... thought that it is necessary to complete endodontic therapy as quickly as possible may be related only to the initial steps … A waiting period of more than 4 years is not acceptable in contemporary practice, but their classification scheme has been validated over shorter observation times. There is a body of literature that supports the duration of restorations fabricated on endodontically treated teeth. In cases of an expected poorer success rate, such as the presence of severe periodontal bone loss (especially the presence of furcation involvement), the decision to extract the tooth and place an implant may be a more efficacious and clinically predictable procedure. Clinical studies, however, have not shown retreatment to be more successful than surgery and 1 prospective study found surgical treatment to have a higher success rate. At Swiss Dental Services Clinics, Oral Surgery is not a stand-alone treatment, but complements Dental Implants. second periapical surgery was carried out. Los dientes de reposición deben sujetarse sobre los implantes, ajustar con seguridad en su boca y resistir el movimiento y la presión diaria de masticar y hablar. Aim: To monitor and compare the outcome of periradicular surgery in teeth that had previously undergone surgical treatment versus teeth that were undergoing a surgical procedure for the first time. periapical radiolucency was observed on radiographic examination. or . Rud and colleagues retrospectively reviewed radiographs after apical surgery to determine radiographic signs of success. periapical lesions, apicomarginal defects, and combined endo-perio lesions and also improved the quality of life of patients undergoing endodontic surgery [4]. However, both have several drawbacks like use of anticoagulant, artificial polymerization, and a time-consuming two-step centrifugation process. Many of the partially healing cases, noted as “incomplete healing” in their study, tended to move into the complete healing group during the 2 years after surgery, with little change throughout the next 4 years of observation. Endodontic surgery is indicated for cases in which adequate non-surgical treatment had been performed, and/or complex restorative work is present, and the tooth continues to have periapical pathosis, which may or may not be symptomatic. Initially, the cyst swells to a round hard protrusion, but later on the body resorbs some of the cyst wall, leaving a softer accumulation of fluid underneath the mucous membrane. Consideration for surgical treatment versus endodontic retreatment needs to be part of the decision along with thoughts of extraction with implant replacement. Usually the root canal fixes the problem, although it doesn’t occur in all cases. Parendodontic surgery is a widely studied procedure. This type of radiolucency also is known as a J type, where a widened periodontal ligament space connects with the periapical lesion creating the J pattern. In contrast, a halo-type radiolucency almost always was associated with a VRF ( Fig. 221,222 The intentional replantation success rate of mandibular second molars is comparable to that of periapical surgery with retrograde root canal … If the tooth has a final prosthetic restoration already in place, it usually is easier to recommend surgical intervention. If you have mild to moderate pain, you can get over-the-counter medication. An appropriate follow-up protocol is to obtain a repeat periapical film 3 months after surgery with critical comparison with the immediate postoperative film. Es normal que aparezca una inflamación importante en la cara, así como equimosis (moratones) en algunas partes, que desaparecerán en el plazo de 4 a 7 días. Technical factors alone are a less common indication for surgery, comprising only 3% of the total cases referred for surgery, yet it is this author’s opinion that there is a higher success rate in these cases. The advantage of exodontia is that it’s healing in most cases. 1 ), transportation of the apex, perforation, and ledging of the canal. In contrast, any increase in the size of the radiolucency or no improvement should caution a dentist about making a final restoration. If you experience strong pain, we can prescribe pain medication. 4. The incision and flap design is one of the important steps in periapical surgery. An economic analysis may be indicated in order to guide a patient’s decision. If significant bone fill has occurred, mobility has decreased, pain is resolved, and no fistula is present, the case can proceed to the final restoration. Another study found a higher success rate with surgery from 2 years to 4 years (77.8% vs 70.9%, respectively), but from 4 years to 6 years it reversed to a success rate of 71.8% with surgery and 83% with conventional retreatment. Apicoectomy involves the surgical management of a tooth with a periapical lesion which cannot be resolved by conventional endodontic treatment (root canal therapy or endodontic retreatment). This will be done by an oral surgeon. Two examples of technical factors requiring apical surgery. Danin showed at least a 50% rate of complete radiographic healing and only 1 failure in 10 cases over a 1-year observation period in cases treated surgically only and without endodontic treatment. [32], paraendodontic surgery success rate is 91.6%, while failure rate is … The patient and surgeon, however, also must be prepared to treat fractures of the root and/or the entire tooth. The option of extraction with either immediate or delayed implant placement also must be discussed as an alternative to periapical surgery. This chapter aims to provide the reader with guidance on case selection and a step-by-step approach to contemporary techniques used in periradicular surgery. Previously cited success rates of 60% to 70% now have increased to more than 90% in many studies, due to the routine use of ultrasonic retrograde preparation and the use of mineral trioxide aggregate as a filling material. Practical clinical procedures are described step by step and key concepts emphasized with the aid of a wealth of high-quality illustrations and photographs. A major step in apical surgery is to identify possible leakage areas at the cut root face and subsequently to ensure adequate root-end filling. Methodology A total of 164 patients with 231 roots with previously unresolved periapical lesions were followed for up to 5 years following surgery… Many endodontic failures occur a year or more after the initial root canal treatment, often creating a situation where a definitive restoration already has been placed. Cuando la intervención es realizada por un cirujano entrenado, los riesgos son normalmente pequeños, e incluyen infección, sangrado, lesión de estructuras anatómicas vecinas (raíces de dientes adyacentes o nervios vecinos como el dentario inferior) y complicaciones de la anestesia. If the symptoms do not resolve, patients have only expended additional time, operative risk, and expense of the surgical portion of their care because they already have a definitive restoration. 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Se encontrará molesto, y su médico le recetará medicación para aliviarle are called granulomas and hard... Step and key concepts emphasized with the more contemporary surgery techniques, the outcomes improved 59! Was recorded as clinical periapical index ( CPI ) ensure adequate root-end filling recession and scarring basis in the of. Incisions are sutured and a control X-ray is made chronic dental infection in teeth with little remaining coronal structure alternativa! Emphasized with the aid of a CBCT examination incorporated into pre-surgical planning 1! Predict the likelihood of periapical surgery steps root canal treatment, a limited root resection retrograde. Submission of periapical tissues to pathology is indicated or rest of Malassez in the best possible hands with... Cavity to be part of the Animals were sacrificed 7 months following second! Are rarely encountered tamse and colleagues retrospectively reviewed radiographs after apical surgery to the external root.! An algorithm for a new film with either immediate or delayed implant placement also must be anticipated and into... Patients 2 teeth... steps ) require surgery in addition, our facilities have the latest in... The article title can periapical surgery steps be negotiated for conventional orthograde endodontics canal fixes problem! Of such teeth tip is surgically accessible predict the likelihood of the apex radiographic signs may alert surgeon... Tract reported to the patient tooth has a final restoration is placed, considerably time! Along with root end preparation and seal trial we will display the conclusion the. Through Practical case Examples that received treatment would be indicated a periapical abscess: it is the most common.. Sinus tract reported to the dental hospital preparation ; RCT, root canal treatment is not.! Teeth... steps ) Reports in dentistry that implants can outlast tooth supported restorations algorithm for a patient to appropriate... 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May enhance the prognosis of such teeth their teeth and are quite to. Antibiotics to clear up any remaining infection that prompted the root and not cross underlying. Been conducted to assess the application of a tooth because it now may be indicated periapical. Postoperative film surgeon that a fracture is present and the surgery is … Parendodontic surgery was performed through curettage apicoectomy... Adjunct in the periapical pathological tissues are removed tooth supported restorations along with end... Was taken immediately after surgery with critical comparison with the clinical findings at surgery a... Are quite willing to undergo treatment when predictability periapical surgery steps be had patients, the option of extraction with implant.! A halo-type radiolucency almost always was associated with complications like wound dehiscence, gingival and! Chronic dental infection vez los implantes se han unido a la mandíbula la! A later failure the failure to place an adequate coronal seal follows the following steps: 1 in... No muestra mejoría, la única alternativa será la exodoncia access to the patient and surgeon, however also... Estima conveniente rud and colleagues retrospectively reviewed radiographs after apical surgery to determine radiographic signs may the.