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By using state-of-the-art equipment, instruments and materials that match biological concepts with clinical practice, it is believed that microsurgical approaches produce predictable outcomes in the healing of lesions of endodontic origin. Today, endodontic surgeons are able to render a level of service with confidence and great precision that 20 years ago would have seemed unattainable by any standard. With the development of a sophisticated armamentarium, groundbreaking techniques, and the willingness to embrace them is the future of the specialty, the next 20 years should eclipse anything previously dreamt of, if the last 20 are any barometer of things to come. The introduction of SOM in dentistry, particularly in endodontics, has been a significant addition to the profession's armamentarium. The increased magnification and illumination have enhanced the treatment possibilities in surgical and nonsurgical procedures. Treatment modalities that were not possible in the past have become reliable and predictable. Endodontic microsurgery is now considered a predictable treatment option to save a tooth with apical pathology that cannot be managed by nonsurgical endodontics.