7. Esthetic Complications in Endodontic Surgery

The leading measure of successful outcomes in endodontic surgery relies heavily on the ability of the endodontic surgeon to provide conditions that promote resolution of persisting periradicular pathosis. Prevailing criteria for success depend on the preservation and continued function of teeth and radiographic parameters to assess healing (Orstavik, Scand J Dent Res 96:108–11, 1988). However, in an era of high patient expectations, the esthetic consequences of surgical treatment are of paramount concern. Esthetic outcomes are comprised of the natural or idealized shape, color, position, and juxtaposition of teeth to gingival tissues. Esthetic complications of endodontic surgery are best addressed before treatment by careful endodontic diagnosis and periodontal evaluation. This should be followed by adherence to the principle and practice of endodontic microsurgery both at the treatment planning stage and during the surgical procedure. In addition, appropriate surgical management of soft tissues and underlying bony structures is important as persistent endodontic infections are a risk factor for continued marginal attachment loss following endodontic surgery (Jansson et al., Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:596–601, 1997). While classical measures of success may suggest the positive outcome of a case, failing to achieve an esthetic outcome results in an unhappy patient.