Surgical endodontics is often a last resort when nonsurgical retreatment is impractical or unlikely to improve on a previous result. In particular, only surgical intervention might resolve cases involving a persistent lesion that is related to a periapical cyst or complex canal anatomy. In recent years, modern techniques that include the use of magnification tools, micro-instruments, ultrasonic instruments, and more biocompatible filling materials have been introduced. Current EMS techniques entail the use of an operating microscope to better identify canals, fractures, and isthmuses angled ultrasonic root-end preparation instruments facilitating accurate root-end preparation along the long axis of the root canal without blocking visibility; and new root-end filling materials, such as mineral trioxide aggregate (MTA), that have improved leakage resistance, biocompatibility, antimicrobial properties, and moisture tolerance. The ultrasonic technique healing success of 95% was compared with 65% success with the traditional techniques.