Endodontic microsurgery is a vital treatment modality for teeth with persistent periradicular pathoses that have not responded to nonsurgical retreatment. The principle is to determine the reason for failure, completely eliminate the infection and promote periapical healing. Within recent years, endodontic microsurgery has evolved to become standardized and presents with a high success rate. However, its outcome is still influenced by many factors, including anatomy, periodontal condition, crown-to-root ratio, occlusion, the type of periradicular lesion, and prosthesis. Moreover, endodontists always concentrate on “the apex”, paying little attention to the general preoperative evaluation, accurate diagnosis, and comprehensive treatment plan. This article reviews the latest literature on these issues and the clinical experience of our research group and discusses the correlation between endodontic microsurgery and other oral disciplines, including periodontology, prosthodontics, oral implantology, oral and maxillofacial surgery and orthodontics. The oral interdisciplinary assessment should be made with comprehensive consideration of the root canal system, periradicular lesion, adjacent anatomical relationships, periodontal condition, occlusion, and esthetic rehabilitation. Based on these findings, the continuity of treatment will be optimized, and the best treatment plan will be proposed to provide clinical strategies for the diagnosis and treatment of complex periradicular diseases.

Aging skeletons display decreased bone mass, increased marrow adiposity, and impaired bone marrow mesenchymal stem cells (MSCs). Apoptosis is a programmed cell death process that generates a large number of apoptotic vesicles (apoVs). Dysregulated apoptosis has been closely linked to senescence-associated diseases. However, whether apoVs mediate aging-related bone loss is not clear. In this study, we showed that young MSC-derived apoVs effectively rejuvenated the nuclear abnormalities of aged bone marrow MSCs and restored their impaired self-renewal, osteo-/adipo-genic lineage differentiation capacities via activating autophagy. Mechanistically, apoptotic young MSCs generated and enriched a high level of Ras-related protein 7 (Rab7) into apoVs. Subsequently, recipient aged MSCs reused apoV-derived Rab7 to restore autolysosomes formation, thereby contributing to autophagy flux activation and MSC rejuvenation. Moreover, systemic infusion of young MSC-derived apoVs enhanced bone mass, reduced marrow adiposity, and recused the impairment of recipient MSCs in aged mice. Our findings reveal the role of apoVs in rejuvenating aging-MSCs via restoring autolysosome formation and provide a potential approach for treating age-related bone loss.