Principles of endodontic surgery

7/25/2019 Principles of endodontic surgery

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PRINCIPLES OF

ENDODONTIC SURGERY


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DEFINITION:

Endodontic surgery is the management or prevention of

periradicular pathosis by a surgical approach.

It includes:

Abscess drainage

Periapical surgery

Corrective surgery

Root removal


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RATIONALE:

To remove the causative agents of periradicular pathology.

To restore the periodontium to a state of biologic and

functional health.

OBJECTIVE:

To ensure the placement of a proper seal between the

periodontium and the root canal foramina.


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PERIAPICAL SURGERY


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1. Anatomic po!"#m$ p#%#ntin& comp"#t# '#!i'#m#nt(

o!t)ation

a. Calcified bloc!ed" canals

b. #evere root curvatures

c. Constricted canals

*. R#$toati%# con$i'#ation$ t+at compomi$# t#atm#nt

a. Presence of a crown

b. A tooth that has been restored with post and core

,. -oionta" oot /act)# 0it+ apica" n#co$i$

I$%ICATI&$#


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'. Irretrievable material preventing canal treatment or

retreatment

(. Procedural errors during treatment overobturation"

. La p#iapica" "#$ion$ t+at 'o not #$o"%# 0it+ oot

cana" t#atm#nt

). *ollowing completion of endodontics+ if symptoms are

associated with the tooth chronic fistula and drainage+ pain

and sudden onset of a vestibular space infection".


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Contraindications or cautions" for periapical

surgery

,. -nidentified cause of root canal treatment failure

. /hen conventional root canal treatment is possible

0. /hen retreatment of a treatment failure is possible

'. #imultaneous root canal treatment and apical surgery

(. Anatomic structures e.g.+ ad1acent nerves and vessels" are in

close pro2imity

3. #tructures interfere with access and visibility

). Poor crown4root ratio

5. #ystemic complications e.g.+ bleeding disorders"


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STEPS IN PERIRADICULAR SURGERY

A. Anesthesia

6. Incision and flap reflection

C. Periapical e2posure

%. Periapical curettage

E. Root7end resection

*. Root end preparation

8. Root7end restoration

9. *lap repositioning and suturing

I. Post surgical care


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I2 FLAP DESIGN

A properly designed and carefully reflected flap

results in good access and uncomplicated

healing

The incisions most commonly used are:

a. #ubmarginal curved semilunar"

b. #ubmarginal +and

c. *ull mucoperiosteal sulcular"


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a. #emilunar incision

#lightly curved half7moon horiontal incisionin the alveolar mucosa

Advantage:

Easy access and ;uic! access to the

periradicular structures

8ingival attachment is not disturbed %isadvantage:

*ull root surface not seen

Root resection difficult

#low healing

E2cessive hemorrhage #carring

-#nc#3 contain'icat#' /o mo$t

#n'o'ontic $)


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b. #ubmarginal incision


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Advantages:

Esthetics less incidence of gingival recession"


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C. *ull mucoperiosteal flaps#ulcular incisions"

,. Triangular flap

I$%ICATI&$#: >a2illary incisors and posterior teeth.

&nly recommended flap for mandibular posterior teeth.


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A%?A$TA8E#:

@ 8ood wound healing

@ Ease of flap re7appro2imation with minimumnumber of sutures

%I#A%?A$TA8E#:

@


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. Rectangular flap

I$%ICATI&$#: Anterior teeth

>ultiple teeth

Teeth with long roots li!e ma2illary canines


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A%?A$TA8E#:

@ Increased surgical access to root ape2

@ Reduces retraction tension

@ *acilitates repositioning

%I#A%?A$TA8E#:

a.%ifficulty in re7appro2imation of flap margins

b.8ingival attachment violated

recession+ crestal bone loss and dehiscence.


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0. Trapeoidal

#imilar to rectangular e2cept the vertical incisions intersect

the horiontal incision at an obtuse angle so as to create abroad based flap with the vestibular part wider than the

sulcular portion


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F"ap #/"#ction *lap reflection is the process of separating the soft tissues

gingiva+ mucosa+ and periosteum" from the surface of the

alveolar bone.


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II2 P#iapica" #5po$)#

A soft tissue lesion is seen

fre;uently+ after flap reflection

If the opening is small+ it is

enlarged using a large surgical

round bur+ until appro2imately half

the root and the lesion are visible

Radiographs are used in

combination with clinical findings

to locate root ape2


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III2 P#ia'ic)"a C)#tta

A surgical procedure to remove

diseased tissue from alveolar bone

in the peri radicular area or lateral

region surrounding a pulpless

RCT" tooth

A suitably sied sharp curette is

used for enucleation of the lesion

-sually+ remnants of tissue remain+which is not a problem

9emorrhage control to be achieved


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IV2 Root #n' #$#ction

Indicated because it removes

the region that most li!ely had

the poorest obturation

70 mm of the root is resected

6evel of resection

B7,B degrees


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V 2 Root #n' p#paation an'

#$toationPurpose:

To create a cavity to receive a root7end

filling.

The filling seals the canal system+ so

that no bacteria or bacterial by

products can enter or leave the canal

Instruments -sed:

#mall round or inverted cone bur

-ltra sonic tips


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RETROGRADE ROOT END RESTORATIVE 6ATERIALS

Amalgam

Glass ionomer cement

Zinc oxide eugenol cement

Intermediate restorative material (IRM) Super ethoxybenzoic acid (!A)

Gutta percha

Mineral trioxide aggregates (MTA)


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INSPECTION AT VARYING 6AGNIFICATIONS


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PRINCIPLES INVOLVING RETRO PREPARATION AND RESTORATION

@0mm: root resection+ B7,Bobevel

@0mm of retrograde restoration

Provides 3mm of seal from original ape2 thus sealing all

accessory and lateral canals


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VI2 SOFT TISSUE REPOSITIONING AND

CO6PRESSION The elevated mucoperiosteum is gently replaced to its original

position with the incision lines appro2imated as closely as

possible.

Ti$$)# comp#$$ion:

-sing a surgical gaue moistened with sterile saline+ gently apply

firm pressure to the flapped tissue for to 0 minutes ( minutes

for palatal tissue" before suturing.


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VII 2 SUTURING

P)po$#:

To appro2imate the incised

tissue and stabilie the flapped

mucoperiosteum until

reattachment occurs.

#ling suture is demonstrated in

the picture.


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Principles of endodontic surgery

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