Endo Surgery Flashcards
What should you keep in mind with radiographs?
- History
- If lesion has been shrinking might have been previous lesion healing
- If lesion just appeared may be failed treatment
How long does a PA lesion take to heal?
12 months on average
What should you consider in deciding to do retreatment vs surgery?
-Quality of previous endo
(if previous endo not done well then bacteria in canal probably caused re-infection wont’ respond well to surgery but may respond to retreat, if previous endo done well then likely extraradicular biofilm so vice versa)
- Quality of coronal restoration
- Any perio issues
- Restorability
What can cause PA radiolucency in previously treated tooth?
- Persistant intra-canal infection
- Extra radicular biofilm
- Scar tissue–>healed with fibrous tissue rather than bone
- Foreign body
- Cyst
What are the treatment options if see PA lesion on treated tooth?
- Monitor (if pt asymptomatic), review x-ray at 6-12 months
- After monitor may do nothing
- Extract
- Retreat
- Surgery
What are the chances of success of retreatment if intiial endo is done poorly?
82% (Farzaneh 2004)
What are the chances of retreatment if initial endo done well?
67% (Farzaneh 2004)
What should you be concerned about perio pocket on previously failed treatment?
Perio-endo
Vertical root fracture
Perforation
Generalised periodontitits
(Generally more likely to extract)
What was the success rate of surgery using traditional technique?
~60%
What is the success rate of surgery using contemporary methods?
~90%
What are the steps to surgerY/
- Flap
- Apisectomy
- Canal debridement back through end of canal
- Retrograde filling of end of canal
- Suture
What are the potential sources of bacteria?
- Extra radicular
- complex anatomy near apex
- Main canal
- leaky resto
- Dentine tubules
What are the differences between traditional vs contemporary surgery?
Traditional: straight handpiece air shunted front of drill vs contemporary contra angle high speed air shunted out the back
-Contemporary use ultrasonics to clean canal rather than straight handpiece
Traditional filled with amalgam vs contemproary filled with MTA
-Contemorary have access to microscope
What are some indications to surgerY?
- RCT tooth with clinical signs/symptoms and/or radio pathology, may have been retreated
- Retreat not possible (e.g. transported canal)
- Initial endo done well
- Preserving existing restoration
- Financial decision
What are some contra-indications to surgery?
- Non-restorable tooth
- Inadaquete perio support
- If more conservative treatment available
- Inaccessible tooth end (e.g. nerve in the way)
