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). 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.

The ultimate goal of periapical surgery is the predictable regeneration of periapical tissues, including the complete repair of the osseous defects. Inadequate bone healing is caused by ingrowth of connective tissue into the bone space, preventing osteogenesis. In order to prevent this soft-tissue ingrowth, bone grafts can be used to fill the space in case of large bony defects. Because with the evidence of early osseous healing subsequent orthodontic and prosthodontics treatment can be readily performed.

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. These lesions are called granulomas and periapical cysts and its origin it’s in a chronic dental infection.

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. Usually the root canal fixes the problem, although it doesn’t occur in all cases.

When the root canal doesn’t cure the lesion, it’s recommended to repeat the root canal. If this doesn’t control the evolution of the lesion, it would be indicated a periapical surgery.

After periapical curettage, the root apex were resected and a retrograde filling with IRM given, reinforced ZOE (Super EBA and IRM) were found and be an ideal retrofilling material

The bone regeneration following periapical surgery can be facilitated by placing bone graft into the periapical defect. Different types of bone grafts are available for dental surgical procedure. These include autografts, allografts, xenografts, and alloplasts. The ideal bone replacement material should be clinically and biologically inert, noncarcinogenic, easily maneuverable to suit the osseous defect, and should be dimensionally stable. It should serve as a scaffold for bone formation and slowly resorb to permit replacement by new bone

Calcium-based ceramic materials like calcium hydroxyapatite (HA) and tricalcium phosphate (TCP) had been used popularly for alveolar ridge reconstruction and in periodontal bony defects.