Selective Curettage and Tissue Adhesive in Endodontic Microsurgery

Selective curettage is a conservative approach to treat periapical lesions by removing part of the granulomatous tissue while avoiding complications and damage to the neighboring structures. It also provides the least traumatic approach with minimal post-operative complications. It had an additional advantage, which is providing tissue samples for biopsy of the lesion, especially in cases where there was a diagnostic dilemma regarding its origin . In the selective curettage technique, approximately 50-70% of the granulomatous tissue was removed while preserving the portion in close proximity to critical areas, followed by standard root-end resection and retrofilling then Clinical and radiographic assessments, including CBCT, for bone healing assesment .

Complete Periapical Lesion Curettage and Suturing is a conventional endodontic microsurgical procedure performed to manage persistent periapical pathology following root canal treatment. After administration of local anesthesia, a full-thickness mucoperiosteal flap is elevated to expose the periapical region. The periapical lesion is completely curetted and removed, followed by apical root-end resection. A retrograde cavity is prepared using ultrasonic tips and sealed with a biocompatible root-end filling material. Hemostasis is achieved, and the surgical flap is repositioned and stabilized using conventional sutures. This approach represents the standard surgical protocol for endodontic microsurgery and serves as the active comparator in this study.