The goal of this randomized clinical trial is to determine whether selective curettage combined with cyanoacrylate tissue adhesive improves clinical outcomes in endodontic microsurgery compared with the conventional approach. The study purpose is to evaluate the postoperative healing associated with this conservative surgical protocol.

The main questions it aims to answer are:

Does selective curettage with tissue adhesive reduce postoperative pain, swelling, and complications compared to complete curettage with suturing?

How does selective curettage affect clinical and radiographic healing of persistent periapical lesions?

Researchers compared complete lesion curettage with suturing to selective curettage (40-70% lesion removal) with cyanoacrylate tissue adhesive closure to assess differences in healing and patient-related outcomes.

Participants :

Underwent endodontic microsurgery using one of the two surgical protocols Attended follow-up visits at 1, 3, and 7 days for clinical evaluation of pain, swelling ,Discomfort , Bleeding , Local reaction and Wound Dehiscence

Attended follow-up visits at 3, 6, and 12 months for clinical and radiographic evaluation of periapical healing using 2D radiographs and CBCT

Inclusion Criteria:

1. Age 18 years and older consenting to the surgical procedure as well as agreeing to preoperative and at least 1 follow-up CBCT evaluation.
2. Noncontributory medical history (American Society of Anesthesiologists class I, II).
3. Teeth with periapical lesions that had been previously treated or retreated but symptoms persist or recurrent.
4. Radiographic presence of true endodontic lesion close to vital critical structure.

Exclusion Criteria:

1. Nonconsenting patients and patients younger than 18 years of age.
2. Medical history with the American Society of Anesthesiologists class III to V.
3. Insufficient coronal restoration.
4. Nonrestorability or traumatized teeth.
5. Mobility > 1.
6. Vertical root fracture.