Preparación Químico-mecánica del Tercio Apical en Micro-Cirugía Endodóntica. Una Revisión

Elizabeth Joya-Grajales, Rafael Fernández-Grisales


El control micro-biológico y el selle tridimensional del conducto radicularson factores escenciales para alcanzar el éxito del tratamiento endodóntico.Actualmente la tasa de éxito para la micro-cirugía endodóntica es acercadel 92% cuando esta es realizada con el uso del microscopio como coadyudanteen los procedimientos de conformación quimico-mecánica y selledel tercio apical. En consecuencia, el objetivo de este articulo fue hacer unarevisión actualizada de todos los procedimientos clínicos retropreparacióny desinfección del conducto radicular en micro-cirugía endodóntica, lacual fue soportada con la mejor evidencia disponible a la fecha.


Chemical-Mechanical Preparation of the Apical Third inEndodontic Micro-Surgery. A Review

The micro-biological control and three-dimensional sealing of the root canalare the determining factors to achieve the success of endodontic treatment.Currently, the success rate for endodontic microsurgery is 92% when usingthe microscope as a coadjuvant in the processes of chemical-mecanicalpreparation and filling of the apical third. Consequently, the objective of thisarticle was to update all the clinical procedures of retropreparation and disinfectionof the root canal in endodontic microsurgery, which was supportedwith the best evidence available to date.

Keywords: Root anatomy, laser, endodontic microsurgery, retropreparationand ultrasonic instrument.

Palabras clave

Anatomía radicular, laser, microcirugía endodóntica, retropreparación, ultrasonido.

Texto completo:



Khabbaz MG, Kerezoudis NP, Aroni E, Tsatsas V. Evaluation of different methods

for the root-end cavity preparation. Oral Surg Oral Med Oral Pathol Oral Radiol

Endod 2004; 98(2): 237–242.

Von Arx T, Walker WA. Microsurgical instruments for root-end cavity preparation following

apicoectomy: a literature review. Endod Dent Traumatol 2000;16(2):47–62.

Song M, Chung W, Lee S-J, Kim E. Long-term outcome of the cases classified as

successes based on short-term follow-up in endodontic microsurgery. J Endod

; 38(9): 1192–1196.

Liu Z, Zhang D, Li Q, Xu Q. Evaluation of root-end preparation with a new ultrasonic

tip. J Endod 2013; 39(6): 820–823.

Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S. Outcome of Endodontic Surgery:

A Meta-analysis of the Literature—Part 1: Comparison of Traditional Root-end Surgery

and Endodontic Microsurgery. J Endod 2010; 36(11):1757–1765.

Camargo Villela Berbert FL, de Faria-Júnior NB, Tanomaru-Filho M, Guerreiro-

Tanomaru JM, Bonetti-Filho I, Leonardo R de T, et al. An in vitro evaluation

of apicoectomies and retropreparations using different methods. Oral Surg Oral

Med Oral Pathol Oral Radiol Endod 2010; 110(4): 57-63.

Gutmann JL, Saunders WP, Nguyen L, Guo IY, Saunders EM. Ultrasonic root-end

preparation. Part 1. SEM analysis. Int Endod J 1994; 27(6):318–324.

Gilheany PA, Figdor D, Tyas MJ. Apical dentin permeability and microleakage associated

with root end resection and retrograde filling. J Endod 1994;20(1): 22–26.

Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review.

J Endod 2006; 32(7): 601– 623.

Andreasen JO, Munksgaard EC, Fredebo L, Rud J. Periodontal tissue regeneration

including cementogenesis adjacent to dentin-bonded retrograde composite

fillings in humans. J Endod 1993(3); 19(3):151–153.

Carr GB. Ultrasonic root end preparation. Dent Clin North Am 1997; 41(3):541–554.

Rud J, Andreasen JO. A study of failures after endodontic surgery by radiographic,

histologic and stereomicroscopic methods. Int J Oral Surg 1972; 1(6): 311–328.

Friedman S. Management of post-treatment endodontic disease: a current concept

of case selection. Aust Endod J J Aust Soc Endodontology Inc 2000; 26(3):104–109.

Cohen S, Burns RC. Pathways of the Pulp, 8th ed. St Louis: CV Mosby, 2002.

Kim S, Pecora G, Rubinstein R. Comparison of traditional and microsurgery in

endodontics. In: Kim S, Pecora G, Rubinstein R, eds. Color atlas of microsurgery

in endodontics. Philadelphia: W.B. Saunders, 2001: 5–11.

Carr G. Advanced techniques and visual enhancement for endodontic surgery.

Endod Rep 1992; 7: 6–9.

Stropko JJ, Doyon GE, Gutmann JL. Root-end management: resection, cavity preparation,

and material placement. Endod Top 2005; 11(1):131–151.

Gutmann JL. Surgical endodontics. 1st ed. Chennai: All India Publisher & Distributors,

Abedi HR, Van Mierlo BL, Wilder-Smith P, Torabinejad M. Effects of ultrasonic

root-end cavity preparation on the root apex. Oral Surg Oral Med Oral Pathol Oral

Radiol Endod 1995; 80(2): 207–213.

Batista de Faria-Junior N, Tanomaru-Filho M, Guerreiro-Tanomaru JM, de Toledo

Leonardo R, Camargo Villela Berbert FL. Evaluation of ultrasonic and ErCr:YSGG

laser retrograde cavity preparation. J Endod 2009; 35(5): 741–744.

De Lange J, Putters T, Baas EM, van Ingen JM. Ultrasonic root-end preparation in

apical surgery: a prospective randomized study. Oral Surg Oral Med Oral Pathol

Oral Radiol Endod 2007;104(6): 841– 845.

Layton CA, Marshall JG, Morgan LA, Baumgartner JC. Evaluation of cracks associated

with ultrasonic root-end preparation. J Endod 1996; 22(4): 157–160.

Waplington M, Lumley PJ, Walmsley AD. Incidence of root face alteration after

ultrasonic retrograde cavity preparation. Oral Surg Oral Med Oral Pathol Oral

Radiol Endodontology 1997; 83(3): 387–392.

Rainwater A, Jeansonne BG, Sarkar N. Effects of ultrasonic root-end preparation

on microcrack formation and leakage. J Endod 2000; 26(2): 72–75.

Ishikawa H, Sawada N, Kobayashi C, Suda H. Evaluation of root-end cavity preparation

using ultrasonic retrotips. Int Endod J 2003; 36(9): 586–590.

Engel TK, Steiman HR. Preliminary investigation of ultrasonic root end preparation.

J Endod 1995; 21(9): 443–445.

Frank RJ, Antrim DD, Bakland LK. Effect of retrograde cavity preparations on root

apexes. Endod Dent Traumatol 1996; 12(2):100–103.

Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: a review

of the literature. J Endod 2007; 33(2): 81–95.

Brent PD, Morgan LA, Marshall JG, Baumgartner JC. Evaluation of diamond-coated

ultrasonic instruments for root-end preparation. J Endod 1999; 25(10):672–675.

Gondim E, Gomes BPFA de, Ferraz CCR, Teixeira FB, Souza-Filho FJ de. Effect of

sonic and ultrasonic retrograde cavity preparation on the integrity of root apices

of freshly extracted human teeth: scanning electron microscopy analysis. J Endod

; 28(9):646–650.

Peters CI, Peters OA, Barbakow F. An in vitro study comparing root-end cavities

prepared by diamond-coated and stainless steel ultrasonic retrotips. Int Endod

J 2001; 3(2):142–148.

Mehlhaff DS, Marshall JG, Baumgartner JC. Comparison of ultrasonic and highspeed-

bur root-end preparations using bilaterally matched teeth. J Endod 1997;


Wong WS, Rosenberg PA, Boylan RJ, Schulman A. A comparison of the apical seals

achieved using retrograde amalgam fillings and the Nd:YAG laser. J Endod 1994;


Bader G, Lejeune S. Prospective study of two retrograde endodontic apical preparations

with and without the use of CO2 laser. Endod Dent Traumatol 1998;


Esen E, Yoldas O, Kürkçü M, Doğan MC, Seydaoğlu G. Apical microleakage of root-end

cavities prepared by CO2 laser. J Endod 2004; 30(9): 662–664.

Goya C, Yamazaki R, Tomita Y, Kimura Y, Matsumoto K. Effects of pulsed Nd:YAG

laser irradiation on smear layer at the apical stop and apical leakage after obturation.

Int Endod J 2000; 33(3): 266–271.

De Moor RJG, Hommez GMG. The long-term sealing ability of an epoxy resin root

canal sealer used with five gutta percha obturation techniques. Int Endod J 2002;

(3): 275–282.

Torabinejad M, Khademi AA, Babagoli J, Cho Y, Johnson WB, Bozhilov K, et al. A

new solution for the removal of the smear layer. J Endod 2003; 29(3):170–175.

Torabinejad M, Handysides R, Khademi AA, Bakland LK. Clinical implications of

the smear layer in endodontics: a review. Oral Surg Oral Med Oral Pathol Oral

Radiol Endod 2002; 94(6):658–666.

Huggins CB, Urist MR. Dentin matrix transformation: rapid induction of alkaline

phosphatase and cartilage. Science 1970; 167(3919):896–898.

Bang G, Urist MR. Bone induction in excavation chambers in matrix of decalcified

dentin. Arch Surg Chic Ill 1960. 1967; 94(6):781–789.

Bang G, Urist MR. Recalcification of decalcified dentin in the living animal. J Dent

Res 1967; 46(4):722–730.

Cheung GS. Endodontic failures--changing the approach. Int Dent J. 1996;


Peciuliene V, Reynaud AH, Balciuniene I, Haapasalo M. Isolation of yeasts and

enteric bacteria in root-filled teeth with chronic apical periodontitis. Int Endod J

; 34(6):429–434.

Hancock HH, Sigurdsson A, Trope M, Moiseiwitsch J. Bacteria isolated after unsuccessful

endodontic treatment in a North American population. Oral Surg Oral

Med Oral Pathol Oral Radiol Endod 2001; 9(5): 579–586.

Portenier I, Waltimo TMT, Haapasalo M. Enterococcus faecalis- the root canal

survivor and “star” in post-treatment disease. Endod Top 2003; 6(1):135–159.

Leonardo MR, Tanomaru Filho M, Silva LA, Nelson Filho P, Bonifácio KC, Ito IY.

In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating

solution. J Endod 1999; 25(3):167–171.

Martin MV, Nind D. Use of chlorhexidine gluconate for pre-operative disinfection

of apicectomy sites. Br Dent J 1987 20; 162: 459–461.

Basrani B, Lemonie C. Chlorhexidine gluconate. Aust Endod J J Aust Soc Endodontology

Inc 2005; 31:48–52.

Vianna ME, Gomes BPFA, Berber VB, Zaia AA, Ferraz CCR, de Souza-Filho FJ. In

vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97(1): 79–84.

Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral

Med Oral Pathol 1984; 58(5): 589–599.

Fernández R, Cadavid D, Zapata SM, Álvarez LG, Restrepo FA. Impact of Three

Radiographic Methods in the Outcome of Nonsurgical Endodontic Treatment: A

Five-Year Follow-up. J Endod 2013; 39(9):1097–1103.

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.



CES Odontología/ ISSN 0120-971X Electrónico 2215-9185

Facultad de Odontología, Universidad CES.

Calle 10A No. 22 - 04, Medellín, Colombia

Publicada desde 1987.