apical surgery Flashcards
list the different names of apical surgery
- Apicectomy
- root end surgery
- Endodontic surgery
List the different classifications of Endodontics surgery
- Incision and drainage
- Periodical surgery
- Perforation/ resorption repair
- Root resection
- Diagnostic surgery
- Hemisection
- Trephinaltion
- Decompression
- Intension preimplantation
In modern day what do we usually do instead of Endodontics surgery
Give implants
What does diagnostic surgery often result in
Extraction of the tooth as a fracture is seen
way is trephination
crating a hole in the bone to encourage healing (v rare)
What are the indications fro Endodontics surgery
- to eliminate/ redice infection of Endodontics origin where this is not possible non surgically
- to repaire damage
- to assess teeth where a definitive diagnosis cannot be made without direct visual access of histological examination
What damage to root canal may we need to surgically manage
pathological eg sclerosis root
iatrogenic: instrument passed curvature of root
What carries a better prognosis: surgical or non surgical Endodontics surgery
In the vast majority of cases non-surgical (re)treatment will carry a higher prognosis
What are the contra indications for endodotnic surgery
- Operator experience
- Patient factors eg physiological and medical
- Access to surgical site
- local anatomical factors eg sinus, nerves and vessels
- poor restorative or periodontal prognosis
Which teeth are difficult to carry apical surgery on
- Lower incisors as they are slightly retroclined
- upper canines as they are Long
- Patients with high frenum
- Molars if patietn is suffering from trismus
- Palatal roots of molars due to proximity to sinuses
What considerations do we need to take when undergoing surgeries
- Soft tissue considerations
2. Hard tissue considerations
How do we manage the soft tissues
Flap design is a compromise between:
- access
- vision
- Recession
What factors affect flap design
- size and site lesions
- Presence of crowns/ veneers
- depth of sulcus
- Presence of arena, muscle attachments, bony prominences, thin tissue biotypes
Name the different types of name flap design we use
- Full mucoperiosteal flaps
2. Limited Mucoperiosteal Flaps
What shape can full mucoperiosteal flaps be
- Triangular (1 relieving incision)
- Rectangular (2 relieving incisons)
- Trapeziod (2 relieving incisons)
What does good flap design ensure
- Easy to reflect and reposition
- Easy to access the lesion
- Good healing
- Good lead to recession post op
What shape can the Limited Mucoperiosteal Flaps have
Submarginal
papilla base
What are the benefits of Limited Mucoperiosteal Flaps
- Avoids recession
2. easy reference points fro reattachement
What are the limitations of Limited Mucoperiosteal Flaps
- Technically more demanding
- Access potentially more limited
- Risk of scarring
Once the flap is raised what do we need to do
Identify the lesion and apex
What do you usually see in the bone when you’ve raised the flap
A fenestration where osteotomy can be prepared to enable removal of lesion and resection
How is root end resection usually carried out
With a burr
Which area of the tooth is hardest to clean
Apical 3mm
what angle should our bevel be at fro root end resection
90 degrees
What do we do once the root end has been resected
Retropreparation using ultrasonic tip
2-3mm GP removed
After removing GP what do we do
Pack root filling into retroprep cavity
fill with MTA or other bioceramic cement
What pre op factors do we need to consider prior to eno surgery
- Age
- Sex
- Health
- Tooth location
- Clinical signs and symptoms
- Size of lesion
- Bone loss
- Coronal restoration
- Resurgery
What INTRA operative factors can affect outcome of Endodontics surgery
- Degree of bevel
- Level of resection
- Retrograde preparation method
- Retrograde root filling / material
- Haemostatic agent
- Magnification
- Bone grafting
