Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MOS Lecture Slides > Apicectomy > Flashcards

Apicectomy Flashcards

1
Q

What is an apicectomy?

A

this is surgical procedure on root and periapical tissues of the teeth

It is the removal of the apical portion of the tooth and any infective tissue e.g. dental cyst via a mucoperiosteal flap to eradicate persistent infection of the periapical tissues.

The apex is then sealed with a retrograde filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When are apicectomy indicated?

A

when conventional endodontics has been unsuccessful or is impractical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the aim of an apicectomy?

A
  • to prevent noxious substances (bacteria) causing inflammation in the PDL and beyond
  • to achieve a satisfactory apical seal of the root canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can you decide if has had failed endo treatment?

A
  • history
  • examination
  • radiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of failed endo treatment?

A
  • pain
  • sinus
  • bad taste
  • swelling
  • ttp
  • may be symptomless
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should you include in you assessment of an endodontically treated tooth?

A
  • proximity of obturation material to the radiographic apex
  • voids within the obturation material
  • extrusion of the obturation material
  • abnormal anatomy
  • missed canals
  • fractured instruments
  • apical delta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline some signs that may indicate the fact that an endodontically treated tooth requires further treatment

A
  • tooth has signs and symptoms of infection
  • radiologically visible lesion has appeared after treatment or pre-existing lesion has increased in size
  • lesion has remained the same size or has only diminished slightly in size during a 3-4 year assessment period
  • signs of continuing root resorption are present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of radiographical lesion/defect on a previously endodontically treated tooth does not indicate the need for further treatment?

A
  • a locally visible irregularly mineralised area
  • this often occurs following the healing of an extensive radiological lesion
  • the defect may be scar tissue formation as opposed to persisting apical periodontitis

tooth should continue to be reassessed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What might you do if an endodontically treated tooth is asymptomatic with no clinical findings but has radiographic pathology?

A
  • discuss options
  • observe
  • record in patient notes
  • re x-ray in 12 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is an essential prerequiste for endodontic/apical surgery?

A

canals should be bacteria free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give instances that do not fulfil the criteria to receive apical surgery

A
  • incomplete obturation
  • poor coronal seal
  • adjacent teeth causing a problem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

According to the British Endodontic Society, what are the indications for surgical endodontics?

A
  • unresponsive pathology
  • inretrivable instrument
  • material through the apex
  • inaccessible root canal e.g. curvature
  • perforation
  • other anomalies e.g. open apex
  • clinical or radiological findings of apical periodontitis and/or symptoms continuing over a long period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What anatomical limitation may contraindicate endodontic surgery?

A

curved roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the types of perforation repair?

A
  • intra-radicular (within the root perforation? perforation outside of the canal but does not leave the root?)
  • extra-radicular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Suggest a material that can be used to carry out an intra-radicular distal repair

A

MTA- mineral trioxide aggregate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give examples of the “other anomalies” that are indications for endodontic surgery according to the British Endodontic Society

A
  • Dens in dente
  • apical delta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Dens in dente?

A

rare developmental tooth anomaly that is characterised by the invagination of the enamel into the dental papillae that begins at the crown and often extends into the root before the calcification of tissues begin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Outline some contraindications of endodontic surgery

A
  • poor restorability of the tooth
  • general state of dentition e.g. caries
  • periodontal and periapical disease of the affected tooth and rest of the dentition
  • surgical access
  • poor patient compliance
  • single tooth prognosis chart
  • systemic disease e.g. cardiovascular, metabolic, haematological e.g. bisphosphonate
  • local anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What local anatomical limitations are contraindications for endodontic surgery?

A
  • maxillary antrum
  • mental and inferior alveolar nerves
  • adjacent teeth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What factors must you consider if a referal for surgical endodontics is required?

A
  • lesion >10mm in diameter
  • multiple teeth required
  • personal experience
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What pre-op considerations are required for surgical endodontics?

A
  • if referral is indicate
  • condition of root filling present; coronal seal; prognosis
  • complications and consent explained to patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Outline the summary of the surgical endodontics procedure

A
  • control pain and anxiety
  • mucoperiosteal flap (2/3 sided, semilunar)
  • bone removal with burs
  • curettage of apical soft tissues/enucleation
  • apicectomy/apex resection
  • retrograde cavity preparation
  • control bleeding and spillage of filling materials
  • root end filling with suitable dental material (retrograde filling)
  • removal of all debris
  • wound closure
  • post operative instructions
23
Q

What is the appropriate depth for an apicectomy? Why is this the chosen depth?

A
  • at least 3mm
  • to reach the apical delta
24
Q

What is the correct orientation in order to perform an apicectomy?

A

90 degrees

NOT 45 degrees

25
Q

What flap designs can be used for endodontic surgery?

A
  • 2 sided
  • 3 sided- involving gingival margin
  • modified 3 sided flap- not involving gingival margin
  • semi-lunar
26
Q

What are the advantages of a 2 sided mucoperiosteal flap ?

A
  • preserve blood and nerve supply
  • easy to reposition
  • can modify to 3 sided
  • minimal trauma
27
Q

What are the disadvantages of a 2 sided flap ?

A
  • poor access
  • problem with large apical areas
  • gingival recession
28
Q

What are the advantages of a 3 sided flap?

A
  • best access and preserves blood and nerve supply
  • suitable for large apical areas and periodontally involved teeth
  • simple repositioning
29
Q

What are the disadvantages of a 3 sided flap?

A
  • gingival margin involvemen ca cause recession around crowned teeth
30
Q

What are the advantages of a modified 3 sided flap?

A
  • no gingival margin involvement
  • better access than semi-lunar
  • less retraction tension than semi-lunar
  • horizontal incision in attached gingival preserves a rich blood supply and encourage healing without scarring
31
Q

What are the disadvantages of a modified 3 sided flap?

A
  • prone to dishiscene (marginal bone loss)
  • requires good periodontal condition
  • harder to reposition
  • unsuitable for large apical areas
  • harder to manage expected findings
32
Q

What is a Luebke Ochsenbein flap?

A
  • this is a modified 3 sided flap that follows the contour of the gingival margin
33
Q

What is the least recommended flap for endodontic surgery?

A

semi-lunar flap

34
Q

What are the advantages of a semi-lunar flap?

A
  • poor access and visibility
  • impaired blood supply
  • heals with scarring
  • tension in flap is greater
  • difficult to reposition accurately
35
Q

Outline the steps of the apicectomy procedure itself

A
  • incision
  • reflect mucoperiosteal flap
  • locate apex
  • bone removal with bur
  • enucleate all pathological soft tissue (currettage)
  • remove apex at 90 degree angle
  • prepare retrograde cavity
  • retrograde filling
36
Q

Suggest way in which the apex can be located

A

explorative dip

36
Q

Following enucleation of suspected pathological tissue, what must you do?

A

all tissue should be biopsied to confirm that it is granulation tissue

36
Q

What can mimic an apical lesion?

A

neoplasia

37
Q

Following apicectomy, what materials can be used to fill in the dead space/bone cavity created?

A
  • ribbon gauze
  • bone wax
38
Q

Give an example of a materials that can be used for a retrograde filling

A
  • calcium silicate materials e.g. MTA
  • GI
  • composite
  • reinforced ZOE cements (e.g. intermediate restorative material)
39
Q

What can you use for debridement following surgical endodontics?

A

saline wash

40
Q

What portion of the flap should be repositioned first?

A

interdental papillae

41
Q

What is the principle constituent of MTA?

A

calcium silicate

42
Q

What are some historical shortcomings of MTA?

A
  • long setting time
  • difficult handling properties
43
Q

What attempts have been made to overcome the shortcomings of MTA?

A

Modification of the composition of the material

44
Q

What are the advantages of MTA use?

A
  • biocompatible with periradicular tissues
  • non toxic
  • non resorbable
  • minimal leakage around the margins
45
Q

What are indicated used of MTA?

A
  • apexification (non vital tooth)
  • repair of root perforation
  • root resorption
  • root- end filling (retrograde filling)
  • pulp capping
46
Q

Amalgam is no longer recommended for use as a retrograde filling material . True or false

A

True

47
Q

What is the setting time of MTA - Angelus (an endodontic cement)?

A

10-15 minute

48
Q

What are the indicated used of biodentine?

A
  • useds as a dentine substiture under composite
  • direct pulp capping
  • pulpotomy in primary molars
  • apexification
  • retrograde/root end filling material
  • perforation repair
49
Q

What are the criteria for success after an apicectomy?

A
  • uncomplicated healing of the surgical site
  • absence of persistent pain or discomfort
  • absence of soft tissue or bony infection (no sinus or drainage of pus)
  • satisfactory function of apicected tooth
  • absence of tooth mobility
  • radiographic evidence of complete bone repair
50
Q

What ways can you assess the outcome of an apicectomy?

A
  • preoperative radiograph
  • immediate post operative radiograph
  • review and suture removal after 7-10 days
  • review after 4 weeks when all swelling and tenderness has subsided
  • review after 6 -12 months and radiograph
  • further follow up as needed (every 2-3 years)
51
Q

It is claimed that 75% of surgically treated periapical radiolucencies require up to ___ years for complete resolution

A

12 years

52
Q

What complications or difficulties are associated with apicectomy?

A
  • perforation of lining of antrum
  • haemorrhage during procedure
  • pain during curretage
  • surgical emphysema (where gas enters subcutaneous tissue
  • damage to adjacent teeth/nerves
  • failure to completely apicect tooth
  • unsatisfactory placement of root end filling
  • recession at gingival margins
  • recurrent apical infection/discharge of pus

MOS Lecture Slides (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions