（2025年）中国专家共识：根尖显微外科（英文）解读

2025ChineseExpertConsensusonEndodonticMicrosurgery:AnEnglishInterpretation

Abstract:The2025ChineseExpertConsensusonEndodonticMicrosurgery(ECEM-2025)systematicallyupdatestheclinicalguidelinesforendodonticmicrosurgerybasedonthelatestevidence-basedmedicineresearchandclinicalpracticeexperienceinChina.Thisinterpretationaimstoelaborateonthecoreviewpoints,updatedrecommendationsandpracticalimplicationsoftheconsensus,providingaclearreferenceforglobaldentalcliniciansengagedinendodonticpractice.

1.BackgroundandSignificance

Withtherapiddevelopmentofdentalmicrosurgicaltechniquesandimagingtechnologies,endodonticmicrosurgeryhasbecomeanimportanttreatmentmodalityforrefractoryperiapicaldiseases.TheECEM-2025,developedbytheChineseStomatologicalAssociation'sEndodontologyProfessionalCommittee,integratesmorethan5yearsofclinicalresearchdatainChina,fillsthegapbetweeninternationaladvancedconceptsanddomesticclinicalpractice,andstandardizesthediagnosisandtreatmentprocessofendodonticmicrosurgeryinChina.

Comparedwiththepreviousversion(2019),theECEM-2025hasexpandedthescopeofindications,optimizedthesurgicaloperationspecifications,andupdatedtheprognosisevaluationsystem,whichisofgreatsignificancetoimprovethesuccessrateofendodontictreatmentandpromotethestandardizeddevelopmentofendodonticmicrosurgeryinChina.

2.CoreRecommendationsandDetailedInterpretations

2.1IndicationsandContraindications

Theconsensusfurtherclarifiestheexpandedindicationsofendodonticmicrosurgery:

ExpandedIndications:Inadditiontothetraditionalindicationssuchasfailedrootcanaltreatmentwithpersistentperiapicallesions,rootcanalcalcificationthatcannotbemanagedbynon-surgicalmethods,androotperforation,theECEM-2025addscaseswithrootresorptioninvolvingtheapicalthird,andintentionalreplantationisnotfeasibleasindications.Thisupdateisbasedontheclinicaldatashowingthatmicrosurgicalapicalresectionandretrogradefillingcaneffectivelycontroltheprogressionofrootresorptionin85%ofsuchcases.

OptimizedContraindications:Theconsensusadjuststhecontraindications,emphasizingthatpatientswithuncontrolledsystemicdiseases(suchasseverediabeteswithHbA1c>8.5%,unstablecardiovasculardiseases)andmentaldisordersthatcannotcooperatewiththeoperationareabsolutecontraindications.Forpatientswithlocalsofttissueinfectionsintheoralcavity,thesurgeryshouldbepostponeduntiltheinfectioniscontrolled,whichreducestheriskofpostoperativeinfectionspread.

2.2PreoperativeEvaluationandPreparation

TheECEM-2025putsforwardhigherrequirementsforpreoperativeevaluation,highlightingtheimportanceofmulti-modalimagingexamination:

ImagingExamination:ConeBeamComputedTomography(CBCT)isrecommendedasthepreferredpreoperativeimagingmethod,withavoxelsizenotexceeding0.25mm.Itcanaccuratelyevaluatethelocation,sizeandrelationshipwithadjacentanatomicalstructuresofperiapicallesions,andhelpcliniciansformulatepersonalizedsurgicalplans.Forpatientswithmetalrestorations,metalartifactreductiontechniquesshouldbeusedtoimproveimagequality.

PatientPreparation:Preoperativeoralhygieneguidanceisemphasized,andpatientsshouldusechlorhexidinemouthwashfor3daysbeforesurgerytoreduceoralmicrobialload.Forpatientswithahistoryofallergytolocalanesthetics,skintestsshouldbecarriedoutinadvance,andalternativeanestheticsshouldbeselectedtoensurethesafetyoftheoperation.

2.3SurgicalOperationSpecifications

Theconsensusstandardizesthekeystepsofendodonticmicrosurgery,withdetailedoperatingguidelines:

AnesthesiaandFlapDesign:Localinfiltrationanesthesiacombinedwithnerveblockanesthesiaisrecommendedtoensurecompleteanalgesia.Theflapdesignshouldfollowtheprincipleofpreservingperiodontaltissue,andthefull-thicknessflapwitharelievingincisionispreferred,whichreducestheriskofflapnecrosisandpostoperativegingivalrecession.Theincisionshouldbe2-3mmawayfromthegingivalmargintoavoiddamagingthegingivalpapilla.

ApicalResectionandRetrogradeCavityPreparation:Theapicalresectionangleshouldbecontrolledwithin0-10degreestoavoiddamagingtheadjacentrootstructure.Thedepthofretrogradecavitypreparationshouldreach3-4mm,andthecavityshouldbeshapedintoa"retrogradefunnel"toensurethesealingeffectofthefillingmaterial.Theconsensusrecommendsusingultrasonictipswithdiamondcoatingtopreparetheretrogradecavity,whichimprovestheprecisionandefficiencyoftheoperation.

RetrogradeFillingMaterial:Bioceramicmaterials(suchasMTA,Biodentine)arerecommendedasthefirst-choiceretrogradefillingmaterials.Comparedwithtraditionalamalgamandcompositeresins,bioceramicmaterialshavebetterbiocompatibilityandsealingperformance,andcanpromotetheregenerationofperiapicaltissues.Theconsensusspecifiesthatthefillingmaterialshouldbecompactedlayerbylayertoavoidgapsandmicro-leakage.

2.4PostoperativeManagementandFollow-up

TheECEM-2025updatesthepostoperativemanagementandfollow-upsystem,emphasizingtheimportanceoflong-termprognosisevaluation:

PostoperativeMedication:Forpatientswithnosystemicriskfactors,prophylacticantibioticsarenotrecommendedroutinely.Non-steroidalanti-inflammatorydrugs(NSAIDs)canbeusedtorelievepostoperativepainandswelling.Chlorhexidinemouthwashshouldbeusedfor7daysaftersurgerytomaintainoralhygiene.

Follow-upPlan:Thefollow-uptimepointsaresetas1week,3months,6months,1yearand2yearsaftersurgery.Theevaluationindicatorsincludeclinicalsymptoms,oralexaminationandimagingexamination.Iftheperiapicallesionisreducedbymorethan50%atthe1-yearfollow-up,itisjudgedaseffective;ifthelesioniscompletelyhealedatthe2-yearfollow-up,itisjudgedascured.

3.ClinicalPracticalImplications

TheECEM-2025providesclearguidanceforclinicalpractice,helpingcliniciansimprovethesuccessrateofendodonticmicrosurgery:

StandardizationofDiagnosisandTreatment:Theconsensusstandardizesthewholeprocessfrompreoperativeevaluationtopostoperativefollow-up,reducingtheindividualdifferencesinclinicalpractice.Forexample,thecleardefinitionofindicationshelpscliniciansavoidunnecessarysurgicaltreatments,andthestandardizedoperationstepsreducetheriskofsurgicalcomplications.

PromotionofEvidence-basedPractice:Theconsensusisbasedonalargenumberofdomesticclinicalresearchdata,whichismoreinlinewiththecharacteristicsofChinesepatients.Forexample,therecommendationofbioceramicmaterialsissupportedbytheresearchresultsshowingthatthesuccessrateofretrogradefillingwithbioceramicmaterialsinChinesepatientsis92%,whichishigherthanthatoftraditionalmaterials.

TrainingandTalentDevelopment:Theconsensusemphasizestheimportanceofsystematictrainingforendodonticmicrosurgeons,includingtheoreticalstudy,simulatedoperationtrainingandclinicalpractice.Itisrecommendedthatcliniciansmustpassthestandardizedtrainingandassessmentbeforecarryingoutendodonticmicrosurgeryindependently.

4.FuturePerspectives

TheECEM-2025pointsoutthedevelopmentdirectionofendodonticmicrosurgeryinChina:

IntegrationofDigitalTechnology:Theconsensusencouragestheapplicationofdigitaltechnologiessuchas3Dprintingandnavigationsystemsinendodonticmicrosurgery,whichcanfurtherimprovetheprecisionandsafetyoftheoperation.Forex