**9. Periapical exposure**

Periapical exposure must be achievedafter full thickness flap elevation by using a sterile round surgical burr. Mostly the cortical bone overlying the apex has been resorbed due to underlying apical pathosis, exposing a soft tissue lesion. If the opening is small, it is enlarged, until approximately half the root and the lesion are visible. With a limited bony opening, radio‐ graphs are used in conjunction with root and bone topography to locate the apex. Regardless of the handpiece used, there should be copious irrigation with a syringe or through the handpiece with sterile saline solution. Enough overlying bone should be removed to expose the area around the apex and at least half the length of the root. Good access and visibility are important; the bony window must be adequate. The clinician should not be concerned about the bone removal because once the infection resolves, the bone will reform. The exposure of the root is done before resecting the root to avoid the potential of blending the root in with the bone and losing surgical orientation. This is especially critical in the mandible where the bone is dense. Lower incisor roots are carefully exposed because the proximity with adjacent teeth could lead to treatment of the wrong apex. Fig:4

**Figure 4.** Periapical exposure

### **10. Curettage**

Granulomatous, inflamed tissue around the periradicular area should be removed to gain access and visibility of the apex, to obtain a biopsy for histologic examination (when indicated), and to minimize hemorrhage. If possible, the tissue should be enucleated with a suitably sized sharp curette. Fig:5
