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Module 7 > ENDO surgery > Flashcards

ENDO surgery Flashcards

1
Q

what are the 4 aims of endodontic tx?

A

access, clean and disinfect the root canal system
reduce the number of microorganisms
remove necrotic tissue
seal the system to prevent infection

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2
Q

what are the 5 causes of persistent PA radiolucency in endo treated teeth?

A

intraradicular infection
extraradicular infection
foreign body reaction
true cyst
fibrous scar tissue

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3
Q

how do you differentiate cystic and non-cystic periradicular lesions?

A

cannot do it clinically with radiographs
must be histopathologically

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4
Q

what are the 2 types of periradicular cysts?

A

true cyst - cavity completely enclosed in epithelial lining
pocket (bay) cyst - epithelium-lined cavities that are open to the root canal

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5
Q

what are the indications for endo surgery?

A

failure of previous endo tx - if retreatment not possible
anatomical deviations - that prevent cleaning and obturation
procedural errors - ledges, blocks, perforations, file breakages, overfills
exploratory surgery - identification of root fractures

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6
Q

what are the contraindications to endo surgery?

A

anatomical factors - proximity to neuro bundles, thick cortical bone, difficult access
inadequate periodontal support
non-restorable tooth
medical history - blood disorders, recent MI, cancer tx
skill and ability of surgeon

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7
Q

where do you find thick cortical bone?

A

lower molar region

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8
Q

what lens system do loupes use?

A

convergent lens system (Greenough system) - users eyes must converge

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9
Q

what is the magnification on a microscope detrmined by?

A

power of the eyepiece
focal length of the binoculars
magnification changer factor
focal length of the objective lense

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10
Q

what is the range of magnification in a microscope?

A

x3 - x30

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11
Q

what are the preoperative medications for endo surgery?

A

anti inflammatory agents - ibuprofen
antibacterial rinses - chlorhexidine
premedication - 5mg diazepam (if pt very nervous)

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12
Q

why do we tell pts to take ibuprofen prior to endo surgery?

A

it inhibits cyclo-oxygenase, preventing the formation of inflammatory mediators

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13
Q

when do we tell pts to rinse with chlorhexidine prior to endo surgery?

A

morning of and 30 mins before appt

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14
Q

what is the purpose of LA during endo surgery?

A

prevents pain
obtains presurgical haemostasis

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15
Q

what are the flap design rules for endo surgery?

A
  1. flap never crosses bony defect
  2. releasing incisions over concave bone surfaces and not convex
  3. end of the vertical incision at gingival crest should curve 90 degrees to gingival contour
  4. the other end should not enter the mucolabial fold
  5. base must be as wide as its free edge and vertical relieving incisions and follow vascularisation network
  6. periosteum must be raised with the flap
  7. retractor must rest on bone and not soft tissue
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16
Q

what does a full mucoperiosteal flap include?

A

mucosa, connective tissue and periosteum

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17
Q

when is a flap known as intrasulcular?

A

when the horizontal incision involves the papillae and sulcular epithelium

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18
Q

describe a papilla based incision?

A

a shallow first incision at the base of the papilla and a second directed to the crestal bone

intrasulcular incision at cervical area of tooth

x2 relieving incisions

19
Q

what is the benefit of papilla based incisions?

A

prevents gingival recession
good healing

20
Q

what are the 6 types of surgical blades?

A

CK 1 - buccolingual incisions
CK 2 - all incisions
CK 3 - all incisions
CK 4 - mucogingival incisions
CK 5 - posterior
CK 6 - palatal

21
Q

what instrument is used for flap elevation and how is it placed?

A

Prichard periosteal elevator
placed at the junction of the horizontal and vertical incisors, concave surface against the bone, beneath the gingivae at line angle

22
Q

when elevating flaps, how do we prevent bleeding and speed up healing?

A

reflect the whole periosteum, apically with a slow, firm motion

23
Q

what is a osteotomy?

A

removal of cortical plate to expose root end

24
Q

during an osteotomy, what instruments are used to remove granulation tissue, foreign bodies and bone particles?

A

curettes

25
Q

during an osteotomy, when can you clean out the lingual aspect?

A

after root resection

26
Q

during an osteotomy, how do you know all tissue has been removed?

A

bleeding will stop

27
Q

how is granulation tissue removed?

A

curettage

28
Q

what is preop haemostasis?

A

LA

29
Q

what are intraoperative haemostatic agents?

A

epinephrine pellets
ferric sulfate
calcium sulphate
surgical wax, thrombin, gelfoam, collagen (not as effective)

30
Q

what does root end resection aim for?

A

to create an environment conductive for regeneration of periodontium, alveolar bone, PDL and cementum

31
Q

how much root is resected?

A

3mm perpendicular to long axis of tooth

32
Q

how do you examine to ensure resection is complete?

A

use dye (1% methylene blue) - PDL shows colour

33
Q

what instrument is used for root resection?

A

impact air surgical handpiece 45 degree - Lindemann bur

34
Q

what is the aim of ultrasonic retrocavity prep?

A

aims to create a clean, well conformed type 1 cavity into the sectioned root

35
Q

how deep should the retrocavity be?

A

3mm

36
Q

what type of ultrasonic is used for retrocavity prep?

A

Piezo ultrasonic units and KiS tips - tips coated in diamond and zirconium nitride

37
Q

what is the advantage of using ultrasonic tips for retrocavity prep?

A

better access
ultrasonic cleaning
preps follow canal anatomy
isthmus prep
parallel walls - superior retention

38
Q

what materials can be used for root end filling?

A

amalgam
zinc-eugenol
MTA - best option

39
Q

how long does MTA take to set?

A

3 hours

40
Q

if a pt returns with post-op pain following endo surgery what do you do?

A

provide ibuprofen
instruct to continue with pain med for 48 hours

long term pain as a result of damage to peripheral nerves occurs rarely

41
Q

post op instruction for swelling?

A

intermittent application of cold dressing (20 mins on 20mins off)

42
Q

post op instruction for bruising (ecchymosis)?

A

reassure pt, self limiting resolves within 2 weeks

43
Q

how long may paraesthesia last following endo surgery?

A

4 weeks

Module 7 (52 decks)

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