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Aim: the gold standard in endodontic surgery is characterized by meticulous retrograde procedures that could be not performable in all teeth due to multiple clinical difficulties. The possibility to perform the only apical resection, when feasible, without further retrograde steps might represent a substantial clinical advantage. The present study analyzes the filling quality achieved with standard retrograde technique in comparison with alternative techniques with or without retrograde procedures. Methods: the sample size was determined using with the following parameters: α=0.05; β=0.20; δ=3.0; σ=1.5. Twenty-four single-rooted teeth were selected from a pool of freshly extracted teeth, discarding those with aberrant anatomy. Selected teeth of comparable size were decoronated to obtain 12 mm long roots. The canals were scouted with manual files and the working length acquired. After mechanical glide path establishment, canal shaping was performed with HyFlex EDM rotary files up to size 40.04 taper (500 rpm; 2.5 Ncm). The roots were analyzed with a computed microtomography scanner to identify the possible presence of dentine microcracks. Afterwards, the roots were randomly assigned to two groups: twelve canals were filled with the single cone technique (SCT) with dedicated cones and BioRoot RCS bioceramic sealer; twelve canals were filled with MTA cement (ProRoot MTA) for 6mm in the apical portion with the aid of the MAP System; the empty canal portion was backfilled with thermoplasticized gutta-percha (Obtura III Max System). After 24 h, the roots were apically resected with a carbide bur 3 mm from the apex. At this point, the two groups were randomly subdivided into two further groups of six elements each: G1, SCT and bioceramic sealer without retrograde procedures (n=6); G2, SCT and bioceramic sealer with standard retrograde ultrasonic preparation and MTA filling (n=6); G3, orthograde MTA placement without retrograde filling (n=6); G4, orthograde MTA placement and standard retrograde ultrasonic preparation and MTA filling (n=6). Lastly, the formation of internal and external voids was quantified by means of a second computed microtomographic analysis. The normality of the distribution and the equality of variance of the microtomographic datasets were tested with a Shapiro- Wilk and a Levene test, respectively; then, the volumes measured in the groups were statistically compared with the Kruskal-Wallis test and with the Mann-Withney test with Bonferroni’s correction couple comparison. Results: All groups showed minimal voids volumes formation. In the groups characterized by standard retrograde procedures, the mean voids volumes were 1.16±0.40 % (G4) and 1.87±1.49 % (G2) of the entire canal space, in the groups with the only root-end resection 0.82±0.58 % (G1) and 1.08 ± 0.50% (G3). The difference between the groups was not statistically significant. Analyzing the volume within the apical 3 mm of the canal after root resection (G1=0.06 ± 0.10%; G2=0.76 ± 0.81%; G3=2.06 ± .92%; G4=1.53 ± 1.79%) the difference between G1 and the other groups was statistically significant (p

Introduction: The importance of the retrograde cavity preparation and the material used to restore is of utmost importance to achieve successful surgical endodontics. Aim: The aim of the present study is to evaluate the apical micro-leakage of root end cavities filled with Mineral trioxide aggregate, Biodentine and light cure GIC using two different cavity preparation techniques that is conventional bur preparation and ultrasonic tip preparation. Materials and Methods: Eighty extracted single rooted human teeth (except mandibular incisors) with one canal, fully developed apices and without any major carious lesion are collected for the study. The teeth were sectioned at CEJ to standardize the length. Roots are instrumented upto master apical file 40 K size and obturated with gutta percha and AH plus sealer in lateral condensation technique. The teeth were then resected apically at 90° angle axis to the long axis of the root removing 3 mm of the apex. The teeth were divided in to four groups of 20 each- • Group I- samples restored with MTA. • Group II- samples restored with Biodentine. • Group III- (Positive control group)- samples restored with Light activated GIC. • Group IV - (negative control group)- no filling material. Each group is divided into two subgroups (a, b) of ten teeth each 1. Retropreparation done with ultrasonic retrotip. 2. Retropreparation done with conventional bur. The teeth were then immersed in 0.5% Rhodamine B dye for 48 h. The teeth were split longitudinally and the interface between the restored material and the canal wall is observed under Confocal laser scanning microscope. Depth of dye penetration was examined under stereomicroscope. Results: The statistical analysis was performed by One way ANOVA, t test. Pair wise comparision was done by Newman – Keuls multiple post hoc test. The mean values of Dye penetration for Group Ia (321.23), Group Ib (490.11), Group IIa (1065.14), Group IIb (1170.96), Group IIIa (1888.90), Group IIIb (2025.35). The samples prepared with ultrasonic retrotip showed less microleakage but it is statistically not significant. Conclusion: MTA showed significantly less microleakage when compared to Biodentine and light cure GIC and there is no statistical difference between the ultrasonic retrotip preparation and conventional bur preparation.

Provođenje endodontske i endodontsko-kirurške terapije zahtijeva kombinaciju neodvojivih komponenti kao što su umijeće, spretnost i znanost. Umijeće i spretnost obuhvaćaju poznavanje i mogućnost upravljanja tehnikama rada i postupaka potrebnih za uspješno mehaničko i kemijsko tretiranje korijenskih kanala i šireg kirurškog polja. S druge strane, znanost obuhvaća poznavanje temeljnih i kliničkih znanja o biologiji, mikrobiologiji, fizici i patologiji određenih anatomskih struktura koja vode do načela i tehnika rada poduprtih znanstvenim činjenicama (1). Kirurško endodontsko liječenje provođeno po principima modernih kirurških tehnika, specijalnim instrumentima i kvalitetnim materijalima koji su se u zadnjih 20-ak, 30-ak godina u mnogočemu unaprijedili veoma je predvidiva metoda liječenja s visokim stupnjem uspješnosti. Za retrogradno punjenje korijenskih kanala upotrebljavalo se puno različitih materijala od kojih su neki već dugo napušteni, neki su još u uporabi, a mnogo se ulaže i u razvoj novih materijala. Pogotovo se sadašnji materijali korišteni za retrogradno punjenje korijenskih kanala, kao što su MTA, Super-EBA, IRM, povezuju s odličnim rezultatima endodontsko-kirurškog liječenja. U ovome su radu pomoću dostupne literature prikazani i opisani materijali za retrogradno punjenje korijenskih kanala te je pregledno opisan postupak apikotomije s retrogradnim punjenjem korijenskog kanala. Navedeni su i razlozi za primjenu endodontske kirurgije te njezine kontraindikacije. Rad prikazuje dva klinička slučaja kirurške terapije zuba i apikotomije s retrogradnim punjenjem korijenskog kanala zbog prethodno neuspjelog konzervativnog endodontskog liječenja. U oba slučaja su se patološki simptomi periapikalnih lezija postoperativno povukli, ali nažalost, pacijenti nakon skidanja šavova nisu dolazili na kontrolni pregled pa zato nemamo podataka o dugoročnijoj uspješnosti liječenja. Performing endodontic and endodontic surgical treatment requires a combination of inseparable components such as handiness, science and skill. Handiness and skills include the knowing and ability to manage work techniques and procedures necessary for successful mechanical and chemical treatment of root canals and wide surgical field, and on the other side, science includes knowing of basic and clinical knowledge about biology, microbiology, physics and pathology of anatomic structures, leading to the principles and techniques of work, supported by scientific facts (1). Surgical endodontic treatment conducted according to the principles of modern surgical techniques, special instruments and high-quality materials that have been in the last 20-30 years really improved, is very predictable treatment method with a high degree of success. For retrograde root canal filling it has been used a lot of different materials, some of them have been abandoned for a long time, some are still in use, a lot is invested in the development of new materials. Especially the current materials used for retrograde root canal filling, such as MTA, Super-EBA, IRM, are associated with excellent results of endodontic surgical treatment. In this paper, using the available literature, are introduced and described retrofilling materials. Clearly is described the process of apicoectomy with retrograde filling of the root canal. Specified are the reasons for the application of endodontic surgery, and its contraindications. This paper presents two cases of surgical treatment of the teeth, apicoectomy with retrograde filling of the root canal due to previously failed conservative endodontic treatment. In both cases, the symptoms of pathological periapical lesions are postoperatively retreated, but unfortunately, patients after removing the stitches did not come up the control exam, and that is why we have no data of long-term treatment success.