For molars that cannot be successfully treated with nonsurgical procedures, endodontic microsurgery may offer a promising alternative. This approach relies on technology, such as the operating microscope, ultrasonic instruments, filling materials, knowledge and manual skills on microsurgery, and guided bone regeneration techniques, all in a structured approach. This process includes a thorough diagnostic workup including a CBCT scan, a sequence of planned treatment steps, and appropriate outcome assessment. In the hands of a skilled operator, endodontic microsurgery enjoys high success rates.