Success After Endodontic Microsurgery: A Critical, Time- and Modality-Dependent Interpretation

Background/Objectives: Meta-analyses of endodontic microsurgery (EMS) report pooled success rates of 90–94%, which is now a reference point for clinical decisions. These estimates are often applied beyond the follow-up intervals and imaging conditions in which they were derived. This review defines the temporal and imaging boundaries within which such a rate can be applied with confidence. Methods: We reviewed the core meta-analyses establishing these benchmarks, together with primary studies comparing periapical radiography (PA) and cone-beam computed tomography (CBCT) within the same cohort or across follow-up intervals. Sources from MEDLINE, Embase, and the Cochrane Library were selected purposively, not by systematic screening. Results: Reported success varied with both imaging modality and follow-up time. In within-cohort comparisons, PA consistently yielded higher success than CBCT, being less sensitive to residual cancellous defects; in one cohort, CBCT found a defect in 28% of sites PA had judged healed. A long-term meta-analysis reported 91.3% success in randomized trials but 78.4% in prospective cohorts over 2 to 13 years, with 5 to 25% of early successes later reverting. Conclusions: Success after EMS is neither temporally stable nor modality-neutral. Meta-analytic estimates are valid within their stated follow-up and imaging context; applying them outside that context risks misclassification with direct consequences for clinical decision-making.