The initial search yielded 4.586 documents. After applying the inclusion and exclusion criteria, merging the bibliographic data, and removing the duplicates, the final sample for the bibliometric analysis consisted of 1.988 eligible publications dating from 1935 to September 2023.

Annual scientific production

The overall scientific production rate has increased since 1935 with changes in productivity fluctuating from year to year (Fig. 2). In the initial stages, there was minimal but consistent research interest in the topic until 1970. During the next period and until 1994, a moderate increase in publications was observed (35). After 1995, researchers have continued to devote significant attention to surgical endodontics, leading to a notable increase in publication productivity. This trend continued until 2009, when the number of publications exceeded 50 per year. In the last stage from 2020 until now, an exponential growth in publications has been observed with the number of publications surpassing 100 per year. The oldest article published in 1935 performed histopathologic analysis on the root-end and the periapical tissues of treated maxillary incisors [14]. The most recent articles were a case report on the management of a cystic lesion perforating the lingual plate [15] and a case-series studying the use of a 3D-printed surgical guide about [16].

Fig. 2

Annual scientific production

Author analysis

A total of 4890 authors have contributed to the published research on periapical surgery. Among them, 12 authors wrote more than 20 papers, while 48 authored 10 or more publications. Additionally, there were 243 documents with a single author. The average number of co–authors per publication was 3.87. The most productive author was Von Arx T. with 66 publications, followed by Kim S, and Taschieri S. with 39 publications, each. Considering the number of total citations, Torabinejad M. ranked first with 30 publications and 5110 citations, followed by Kim S. (2360 citations), Von Arx T. (2340 citations), and Taschieri S. (1121 citations).

Countries, organizations and journal analysis

A total of 62 countries contributed to surgical endodontics. The USA was the leading country with a total of 330 publications (Fig. 3a), followed by India and Brazil with 182 and 166 published documents, respectively.

Fig. 3

A Countries’ scientific production. b Corresponding authors’ countries, SCP single country publications, MCP multiple country publications

Considering the corresponding author’s country, the USA led again the ranking with 251 documents, followed distantly by Brazil (n = 135), India (n = 134), and China (n = 99) (Fig. 3b). The University of Bern in Switzerland published the highest number of documents, followed by the University of Pennsylvania and the Loma Linda. It is worth noting that most publications resulted from authors affiliated with a single country. Only 13 publications were the result of international collaborations. The USA received the highest number of citations (n = 9152) followed by Switzerland and Italy with a total of 2942 and 2874 citations, respectively.

Overall, 391 journals published 1988 manuscripts. More than half of the literature (n = 1060) was published in 20 journals. The Journal of Endodontics appeared in the first place with 416 articles, followed by the International Endodontic Journal (n = 183), and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (n = 134). Among the journals with the highest production, the first two also had the highest impact factor and received 19,584 citations (h-index 68) and 5233 citations (h-index 43), respectively.

Keyword co-occurrence analysis and thematic map evolution

A topic keyword analysis revealed the most prevalent topics and issues within the research field. A visual representation of the 2197 author keywords extracted from the included documents can be seen in Fig. 4. The different colors represent various keywords, while the difference in font size indicates their frequency. “Apicoectomy” is the most frequent keyword with 168 occurrences. Without considering the descriptors used for the search strategy, “mineral trioxide aggregate” (n = 119) with its acronym “MTA” (n = 86) and “cone-beam computed tomography” (n = 57) may be identified as prominent areas of research or research hotspots within the discipline of surgical endodontics. A topic keyword analysis for the years 2014–2023 revealed that “endodontic microsurgery” was the most frequently used keyword (Fig. 5). “Mineral trioxide aggregate” and “cone-beam computed tomography” were two of the most frequent keywords used even in this time frame.

Fig. 4

Word cloud based on author keywords. The different colors represent various keywords while the difference in font size indicates their frequency

Fig. 5

Word cloud based on author keywords in the years 2014–2023

As shown in Fig. 6, a title term thematic map was created to identify research directions and themes, and present their evolution. Three clusters on the first quadrant (top right) are mainly focused on “root-end filling materials and mineral trioxide”, “scanning electron, cavity and root-end preparation”, and “computed tomography, posterior teeth and cone beam”. The cluster of “endodontic surgery, endodontic microsurgery and periapical surgery” was identified as motor and basic theme. Similarly, the cluster of “surgical endodontic, endodontic treatment and intentional replantation” was recognized as a basic and declining theme. “Dynamic navigation, maxillary central, central incisors, dens invaginatus and lateral incisors” are three independent clusters belonging to the same area of emerging themes. The cluster of “root canal, root resection and apical periodontitis” corresponds to highly developed and isolated themes in the main area being considered as niche themes.

Fig. 6

Thematic map analysis based on title terms. In a strategic diagram, each theme is defined by two parameters, density and centrality. Based on the values of these parameters, themes are placed in the corresponding quadrant(s). The top right quadrant contains well-developed motor themes, and the top left quadrant includes highly developed and isolated themes. Weakly developed, either emerging or disappearing, marginal themes are included in the bottom left quadrant, while important themes are presented in the bottom right quadrant

Content analysisStudy design

Regarding the document type of the included publications, 1749 original scientific articles and 327 reviews were identified. From the original articles, there were 795 basic research, 773 observational studies, and 181 clinical studies of which 132 were randomized clinical trials (RCTs) and 49 were non-RCTs. Specifically, in vitro studies made up approximately one-third of the total sample (27%), while case reports ranked second (17%). Prospective or retrospective cohort studies represented 12%, while RCT accounted for 6% of the published papers. The percentage of reviews published, including narrative, systematic, or meta-analysis, totaled 14%.

Field of study

Approximately one-third of the analyzed studies (31%) focused on material research, 19% investigated techniques used in clinical practice, and 14% of the studies evaluated outcome. Case reports accounted for 10% of the published studies. Other fields of study in smaller numbers considered the impact of various factors on treatment plan development (5%) or potential prognostic factors in surgical endodontics or causes of failure (4%). Histological studies made up 5% of the included publications. Many studies had more than one field examined, with the most common combination that of success–failure evaluation and type of incision technique.

A complementary subdivision analysis was performed for materials, techniques, and outcomes that represented the top three study fields. Analysis of studies evaluating surgical endodontic materials revealed that sealing ability (27%), type of grafting materials together with GTR techniques (17%), and biocompatibility/cytotoxicity assays (11%) were the main topics addressed. Less commonly examined characteristics involved the influence of the materials on pH and ion release (8%), bioactivity (6%), as well as marginal or interfacial material adaptation (6%).

Regarding periapical surgery techniques, most studies focused on apical cavity preparation (18%), the use of ultrasonics (17%), and evaluation of parameters related to apical resection length and angle or different types of instruments (15%). The use of navigation systems was examined in 14% of the publications. Less commonly studied topics included the use of lasers (11%), the impact of enhanced visualization (5%), and various aspects of the surgical procedure, such as osteotomy, flap design, incision techniques, anesthesia, and hemostasis.

The third largest field of study group focused on evaluating outcomes with 35% of studies primarily assessing the materials used and 24% of them the predisposing factors. Outcome has been shown to be related to the type of tooth investigated (anterior posterior), the follow-up period, and the success criteria utilized in each study. 14% of the articles studied the outcome in molars, 4% in posterior teeth (premolars and molars), and 50% of them examined tooth type as a possible prognostic factor. Outcome in these clinical studies was mostly evaluated through clinical examination and the radiographic criteria of Rud and Molven (71%). The follow-up period ranged from 6 months to 23.5 years and the overall success rate from 44 to 93.1%. Nearly three-quarters of the clinical studies that performed statistical analysis mentioned that there was no significant difference in the success rate between the various tooth types. From the studies that found a significant difference, 84.6% of them mentioned a more favorable outcome for anterior teeth.

Citation analysis

A citation analysis was performed to investigate the most important documents. The top 10 most cited articles on surgical endodontics in the years 2014–2023, based on data from the Web of Science database, are presented in Table 1. Nearly half of the top 10 most cited papers centered around the characteristics of calcium silicate cements. Three studies explored 3D printing and imaging applications in clinical practices, such as guided endodontics, while another study compared 2D and 3D healing assessment. Additionally, a case report examined the osteo-inductive growth factors for enhancing bone regeneration and a systematic review and meta-analysis investigated the management of failed root canal treatments through retreatment or apical surgery.

Table 1 Top 10 most cited papers in the years 2014–2023