Apicoectomy and Retreatment Flashcards
What hypothesis was apicoectomy based on? (2) What is an additional benefit? (1)
biggest problem with endo is periapical granuloma, solution is to surgical remove it
the apical delta (branching of small accessory canals/minor foramina near some apices) which can contain bacteria is cut off as well
Apicoectomy steps? (4)
- localise apex from laterally
- semicircular incision (2-3cm) or incision at gingival margin
- open bone with drill, remove apex and infected tissue
- suture
3 types of apicocectomy procedures ***
- pre-operative endodontic re-treatment with good obturation
- perioperative obturation of pre-shaped root canal
- apicoectomy with retrograde filling (when coronal access is not possible)
Nowadays 1 or 3 done most commonly
What is a big difference between how apicoectomy is done nowadays vs before (same with all endodontics)
SOM to see better
(surgical operation microscope)
Which type of apicoectomy is shown?
option 3
root filling through apex
Additional q’s not in slides for knowledge
Indications of re-treatment (2)
What are NOT indications? (2)
- patient has pain
- LEO growing in size
NOT when ‘RCF doesnt look good’ or tooth is basis for restorative tx
Reasons for re-treatment (10)
- incomplete cleaning and scaling
- retained microorganisms in RC
- complicated canal anatomy undetected in first procedure
- narrow or curved canals not treated in initial procedure
- placement of final resto/crown after endo delayed
- new decay exposing RCF to bacteria causing new infection in tooth
- loose, cracked or broken crown or filling causing new infection
- inoperable canals because of calcification or unusual anatomy
- tooth sustains a fracture
Steps for removing old RCF (7)
- Informed consent
- Access pulp chamber → rubber dam & SOM
- Local canal entrances (especially GP points)
- Find a way between GP point and canal wall (use K file down a few mms)
- Corkscrew technique
- Dressing
- Obturate
What should you inform the patient of prior to re-treatment? (3)
- high risk of instrument seperation and perforation
- high cost and lengthy sessions
- long term success questionable
Corkscrew technique (5)
(what is used -2 , how -1, what you should/should NOT do -2)
- H file (ISO #20 or 30) used to turn into GP and act like a corkscrew
- do not overturn the files (risk fracture)
- work your way to the apex bit by bit
Other than Corkscrew technique, describe 3 methods can be used to remove GP?
- chloroform (limited use - eucalyptus oil is alternative but dissolves less, generally dissolves GP)
- rotary instruments (risks fractures)
- warm instruments (may condense bad RCF further into apex)
Procedure for removing fractured instrument. (6)
- Informed consent
- Localise instrument
- Create a path along the instrument (use u/s tip to vibrate against file to wiggle it free)
- Remove with speciality kit (e.g. IRS)
- Dressing
- Obturation
Kits for removing fractured instruments (2)
IRS kit: hollow instrument w conical tip that can grab file
Maserann kit
How does location of broken file affect removal?
lower ⅓: almost impossible unless straight canal
middle: have a chance
coronal: easy to grab
What the black shown in this image
sealer material or bacteria
