For molars that cannot be successfully treated with non-surgical procedures, endodontic microsurgery may offer a promising alternative. This approach relies on technology, such as the operating microscope, ultrasonic instruments, and filling materials, but equally important is a structured approach. This process includes a thorough diagnostic workup, including a cone beam computed tomography scan, a sequence of planned treatment steps, and appropriate outcome assessment. In the hands of a skilled operator, endodontic microsurgery enjoys high success rates.