pical periodontitis is predominantly managed by non-surgical root canal treatment with predictably high success rates.1,2 The presence of signs and symptoms such as pain, swelling and periapical radiolucency post-treatment may indicate persistence of microbial infection.

In these cases, periradicular surgery may be required. Root-end resection and retrograderoot-filling facilitate access and potential elimination of apical anatomical complexities.

The evolution in contemporary periradicular surgery has been fuelled by a greater understanding of the disease process, an appreciation of the limitations of non-surgical root canal treatment and the adoption of technological advances. Contemporary techniques allow us to address the biological concerns of intra-canal contamination and root-end sealing.

These guidelines are not a formal systematic review as such but provide a consensus document based upon best available evidence considered by a multidisciplinary group. They aim to take into account the range of current best practice and parameters of care for the guidance of patients, health care providers, and commissioners. Appendix 1 summarises the evidence. Tables 2–5denote treatment outcomes.

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Photo courtesy of Scotti et al. 2014