Comparison of clinical outcomes following periapical surgery in endodontics versus extraction with implant placement.

Persistent periapical lesions challenge clinicians between periapical surgery and extraction-implant, yet long-term comparative outcomes remain limited. Hence, this retrospective cohort followed 166 patients (78 per group) for ≥24 months, comparing success rates, clinical/ radiographic outcomes, satisfaction, cost and duration after failed endodontics. Periapical surgery achieved 89.7% success, compared with 92.3% for implants (p=0.571), with comparable survival, satisfaction and periapical healing; surgery excelled in shorter duration with lower cost. Both modalities yield reliable long-term results without significant differences in efficacy. Thus, patient and tooth-specific factors are needed over modality superiority in decision-making.