A new cleaning protocol in minimally invasive endodontic surgery: RUA (“retro irrigant activation”)

Surgical endodontics refers to the branch of dentistry concerned with diagnosing and treating lesions of endodontic origin that do not respond to conventional orthograde treatment. This case report introduces a novel retrocleaning protocol applied during endodontic surgery. A 52-year-old female patient presented to our clinic with pain in tooth #2.2. A preoperative cone-beam computed tomography (CBCT) scan with high resolution (75 μ) revealed incomplete endodontic treatment and a large periapical radiolucency associated with tooth #2.2. The diagnosis was incomplete root canal treatment and symptomatic apical periodontitis. The CBCT showed complete calcification of the apical third of the tooth, and endodontic surgery was indicated as orthograde retreatment was not feasible. The patient's condition presented a complex case, as the calcification obstructed the endodontic space, making traditional orthograde retreatment useless. This situation necessitated the development and application of a new retrocleaning protocol. This case report demonstrates the successful healing of periapical disease achieved through the application of a novel three-dimensional retrocleaning technique in conservative endodontic surgery. This protocol's promising outcomes offer optimism and inspire further exploration of its potential to improve clinical success rates in endodontic surgery significantly.