Endo surgery

Question 1

ROOT AMPUTATION

- definition and indication

Answer 1

Definition- operation where an entire root of a multi-rooted tooth is removed, leaving the crown intact

Indications- Blocked canal, unable to instrument, contra-indicated for periapical surgery, crack

Question 2

ROOT HEMISECTION

- definition and indication

Answer 2

Definition- Division of tooth, buccal-lingually

Indications- crack, Blocked canal, unable to instrument, contra-indicated for periapical surgery

Question 3

DECORONATION

- Goals, aims, indication, prognostic factors and methods

Answer 3

Goal- is to remove the crown and the root filling while maintaining the resorbing root as a matrix for new bone development

Aim

• to preserve marginal alveolar bone level
• to create better conditions for future prosthetic

Indications- ankylosed teeth from trauma (mainly intrusive and avulsion)

Prognosic factors
-age, pre-pubertal growth spurt. 13 girls, 14.6 boys

Methods:

1. LA
2. Raise mucoperiosteal flap – could be gingival flap
3. Ankylosed tooth decoronated at CEJ level
4. Root filling, if any removed
5. Root canal fills with blood clot
6. Bone will be created in the canal
7. Suture closure

Question 4

PERIAPICAL SURGERY/MICROSURGERY

- Goals, aims, indication, prognostic factors and methods

Answer 4

Definition- microsurgery of the apical root end when there is a persistent apical periodontitis infection.

Aim is to surgically preserve a tooth that has a lesion of endodontic origin, where orthograde endodontic retreatment is contra-indicated or unsuccessful

Prognostic factor

• Re-surgery case 7-27% lower success rate (Von Arx)
• Size of crypt <10mm (Toronto), <5mm (Von Arx)
• Age of pt <45, >45 (Toronto)
• Presence of dentinal crack (Von Arx)
• Root filling quality (Toronto)
• Techniques used (Von Arx)

Methods:

1. LA
2. Flap raised
   * Handling of soft tissue must be gentle. Duration of surgery, gingival biotype, sex, marginal bone structure, soft tissue handling and closure can affect scarring
   a. Semilunar
   b. Intrasulcular flap
   c. Submarginal incision (Leubke-Oschenbein)
   d. Papilla based incision
   e. Papilla saving incision
3. Periradicular tissue curettage
4. Osteotomy
   a. Slow round bur with copious irrigation/piezo
5. Root end resection
   a. Slow round bur/piezo
   b. At least 3mm resection perpendicular to long axis of tooth
   i. 3mm because root tip has most apical deltas (De Deus)- which is usually the most likely cause of persistent infection
   ii. Also, ensures better seals and prevent leakage
   iii. Perpendicular- to ensure less dentinal tubules are exposed, providing a better seal
   c. Assess root end with methylene blue dye
   i. Dye stains organic tissues disclosing isthmus, recesses,missed canals, crack
6. Retrograde filling
   a. Retrograde-preparation made with angled ultrasonic tips
   b. Recesses and isthmus must be prepped and cleaned. This is the most important step and prognostic factor in treatment outcome
7. Wound closure
8. STO- <4 days

Question 5

PERFORATION REPAIR

Answer 5

Perforation- communication between the root canal system and the oral cavity or the periradicular tissue.
Artificial communication or pathological communication