A Better Protocol To Saving Teeth: Endodontic-Periodontic Surgery

The Dilemma?  

A difficult decision for the practicing clinician to make is when encountering patients with teeth that exhibit the above findings. The reason is due to the lack of stable supra-gingival ferrule margins making it difficult or impossible to restore the tooth in conventional manner. Supra-gingival ferrule margins are essential for seating the Composite post -Core buildup (CPCB) or the final restoration. Additionally, these teeth may have standard or substandard endodontic treatment with or without Periapical or periradicular lesions. Their roots are anatomically normal, structurally robust, and supported with healthy alveolar bone. The question is: should such teeth be extracted and replaced with prosthetic artificial teeth or be saved with endodontic-periodontic and treatments?  

Tooth Removal Approach

Some dentists consider such teeth hopeless. Philosophically perhaps they do not believe in endodontics and periodontics as therapeutic or preventive treatments. Other dentists do not have the clinical endodontic or surgical skills to save the tooth. At that point, both groups will convince the patient to go through extraction, with possible ridge augmentation, sinus lift, and implant placement. The overall health complications and legal implications of needless tooth removal that was avoidable should be well-known to the patients and practicing clinicians.   

Tooth Treatment Approach 

Dentists who believe in saving teeth must have skills to clinically investigate substandard endodontic treatments, decide when to retreat or wait and see. They also have the surgical skills to elevate Flap procedures to diagnose a root fracture, or perform crown lengthening or curette a lesion. The evidence-based predictable results of endodontic retreatment, automated Endodontic technologies, and advances in adhesive dentistry have made the treatment approaches for saving compromised teeth, the best practice. This approach is both ethically sound direction and research-based choice. 


 The Endodontic Treatment Finalization (ETFZ) protocol apply the philosophy of saving teeth in daily dental patient care. The protocol consists of 6 stages : 

(1) Diagnostic

(2) Endodontic

(3) Composite Post-Core Buildup (CPCB)

(4) Endo-Perio Surgery 

(5) Final restoration and 

(6) Recall 


In this course, the protocol is used to manage teeth with following conditions:

1. Teeth with clinically verifiable acceptable existing Endodontic Treatment.

2. Teeth with clinically Unacceptable existing Endodontic Treatment.

3. Teeth that require Surgical Crown Lengthening.

4. Teeth that need a Combined Endo-Perio Surgery.


1. List the anatomy landmarks most important to endo-perio surgery. 

2. Describe the advantages of full intrasulcular flap design in endo-Perio surgery. 

3. Describe the phases and advantages of Endodontic Treatment Finalization protocol . 

4. Describe the consequences of wait and see approach in endodontics. 

5. Describe the role of Endo-Perio surgery in dental practice.

6. List the potential errors in apical retrofilling. 

7. List the reasons for investigating substandard endodontic treatment. 

8. List the advantages of Composite Post-Core Buildup (CPCB).

9. Discuss the concept “ Robust Root Removal” and its clinical consequences. 

10. Describe the professional and legal obligations of dental practitioners.


Dr. Marwan Abou-Rass brings nearly 50 years of teaching cutting-edge innovations in the field of endodontic education. He has made significant new concepts and methodology contributions including:

  •  The concept of teaching molar versus central teeth as the best sequence for learning endodontic skills

  •  The critical error approach to evaluate clinical performance

  •  Stressed Pulp Concept

  •  Anti-Curvature Filing Method

  •  4R Operational Diagnosis Protocol

  •  Composite Post and Core Build up Protocol

  •  Endodontic Treatment Finalization Protocol

  •  Interim Endodontic Therapy for Native Bone Regeneration before Implant Placement

  •  Designed complete set of endodontic microsurgical instruments for www.hu-friedy.com

  •  Cracked Teeth Master class Series(15 hours continuing education webinar). https://cemenaonline.com/cearabia/en/courses.aspx?cat=Master%20Classes

  • Advanced Diagnostics for Dental Hygienists Practice Master Class Series https://cemenaonline.com/cearabia/en/courses.aspx?cat=Master%20Classes