The finding that healing rates can be higher for cases treated surgically as compared to those treated non-surgically, at least in the short term, is based on two RCTs only. A single RCT reported that in the medium to long term healing rates for the two procedures are very similar. There is currently scarce evidence for a sound decision making process among alternative treatments for the re-treatment of a periradicular pathosis. More well-designed RCTs should be performed with follow up of at least 4 years, and with a consistent sample size, to detect a true difference in the long term between the outcomes of the two alternative treatments, if any exist.
Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment.
This prospective randomized study compared the outcome of retreatment and surgical intervention in root canal treated teeth with nonhealing periradicular pathosis.
                One such tooth from each of 38 patients was randomly allotted to retreatment or root-end resection and root-end filling. Treatment outcome after 1 year was evaluated and compared clinically and radiographically.
                The success rate for surgery was higher than for conventional retreatment, but the difference was not statistically significant.
                For management of nonhealing periradicular pathosis associated with root canal treated teeth, surgical intervention should be considered as an alternative to retreatment. In cases with a similar prognosis for both modes of treatment, the choice should be governed by consideration of intrinsic and extrinsic factors.