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Endotontics > Microsurgery Management of Apical Periodontitis > Flashcards

Microsurgery Management of Apical Periodontitis Flashcards

1
Q

microsurgery success

A

93%

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2
Q

traditional surgery success

implication?

A

59%

the microsurgery provides higher success rates

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3
Q

endodontic success into three categories

A

clinical
radiographic
histo- no inflammation

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4
Q

rationale for tx

A
  1. treat persistent infection/ inflammation
  2. when non-surgical treatment or re-treatment can not be performed
  3. surgery should only be performed by skilled specialist equipped
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5
Q

Failure of NSRCT

A

cannot always be completed

  • maybe missed anatomy
  • true extra-radicualr infections and presence of BIOFILM
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6
Q

describe biofilm

A

sessile cells attached to solid substrates as well as each other and are embedded in EPS (85% of biofilm)

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7
Q

most common cause of failed endo SURGERY

A

apical leakage

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8
Q

T/F microscope required?

A

YES

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9
Q

why difficult

A
  1. small operating field
  2. anatomic structures i.e. neuro-vascular bundle
  3. lack of understanding of apical root canal anatomy
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10
Q

microscope training mandatory?

A

YES

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11
Q

incision and drainage

A

START ROOT CANAL TX FIRST - because dont want to have I&D

to treat teeth with acute apical abscess of pulpal origin

  • primary drainage thru the tooth must be attempted first
  • fluctuation swelling is incised and blunt dissection is followed to establish drainage
  • pressure is relieved
  • provides good pain control
  • environment is changed to an AEROBIC environment
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12
Q

drain is placed how many hours?

A

48-72 hours to prevent closure of the incision site

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13
Q

drain is placed how many hours?

A

48-72 hours to prevent closure of the incision site

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14
Q

Indications for PEriradicualr surgery

present in?

A
  1. elimination of extra-radicualr infection

present in cysts and abscesses only NOT IN GRANULOMAS
- actinomyces and propionibacterium

  1. elimination of the un-debrided canal space
  2. NSRCT or RCRT are not feasible
  3. explaratory surgery
  4. BIOPSY - WHEN DONT KNOW WHAT IS GOING ON
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15
Q

potential contra-indications of peri-radicualr

A
  1. proximity of neurovascualr bundle

2.

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16
Q

contra-indications of peri-radicualr

A
  1. poor perio health

2. surgeons skill

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17
Q

anatomic problems an indication for surgery?

A

YES

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18
Q

procedural mis-adventures reason for surgery?

A

yes

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19
Q

separated insturmnets decrease prognosis by?

A

14%

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20
Q

why is there a larger decrease in prognosis from healthy PDL vs teeth with CAP (chroninc apical)

A

because already better if healthier?

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21
Q

incidence of fractured instruments?

A

3%

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22
Q

incidence of fractured instruments?

A

3%

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23
Q

isthmus definition

A

a narrow connection between two root canals , usually containing pulp types

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24
Q

complete isthmus

A

a definite / full conection between the two main canals

incomplete – stop/ go not all the way through

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25
Q

MB root of max first molar - isthmus?

A

100% of the time

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26
Q

biopsy reason for surgery?

A

YES

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27
Q

biopsy reason for surgery?

28
Q

grafting and GTR indicated?

size? implication on prognosis?

A

in through and through defects or perio-endo lesions

size of the bony crpty is NOT indicative of prognosis but prognosis is DEPTH of the bony access

29
Q

two requirements for resoprtive defects

A
  1. inflammation

2. loss of the protective pre-cemental / dentin layer

30
Q

etiology of resorptive defects

A
  1. ortho
  2. trauma
  3. bleaching
  4. idiopathic

some sort of trauma

31
Q

treatment for resorptive defects

A

90% TCA (tri-chloro-cetic acid) application , curettage, restoration with Geristore (resin-modified glass ionomer) – only one that allows long-junctional epithelial attachement -so soft tissue can grow back on it

32
Q

repair of resorptive defects is indication for surgery?

33
Q

perforations an indication for surgery?

34
Q

perforations prognosis? *** best when

A

sooner better

smaller the better

more apical in bone the better the prognosis

35
Q

perfs in contact with have worst prognosis?

A

oral fluid

36
Q

strip perforation due to

A

over-preparation of the tooth

37
Q

exploratory surgery? relevant?

A

YES – but less now with CBCT’s

38
Q

situations where peri-radicualr surgery may NOT be advisible

A
  1. medically compromised
  2. indiscriminant use of surgery
  3. unidentified / indiscriminant use of surgery
  4. skill not there
39
Q

anatomic factors where surgery may not be good

A

maxillary sinus connection

13% of max post ter

40
Q

which tooth is closest to sinus **

A

MB root of max 2nd molar closest to the sinus and the buccal root of max 1st premolar is the farthest

41
Q

mental and IAN with surgery not advisible

A

mental foramen is

42
Q

most crucial aspect to good surgery outcome

A

how good the procedure went/ so basically the skill?

43
Q

most crucial aspect to good surgery outcome

A

how good the procedure went/ so basically the skill?

44
Q

what to worry about with palatntine access

A

greater palantine vessles (anatomic factor that could be a factor for no surgery)

45
Q

pain control with surgery

A
  1. pre appointment ibuprofen will decrease post-op pain
  2. anesthesia and hemostasis
    - regional block with marcaine preferred for oain control and longer duration anesthesia
46
Q

Local infiltration in surgery?

A

with 1:50K epi for hemostasis in oral mucosa and away from skeletal muscles

47
Q

average blood loss is? factors?

A

9.5 ml and time is the biggest factor

50% less blood loss when using 1:50K vs 1:100L epi

48
Q

regional block with?

A

marcaine (with local infiltration of 1:50K epi – stll can use in cardio patients becauase it is local)

49
Q

types of flap designs

A
  1. semi-lunar – NEVER INDICATED
  2. USE FULL THICKNESS- MUCOPERIOSTEAL
    - intra sulcular
    - submarginal mucogoingival flap
    - 2 mm above and below!!
  • papillary based incision
50
Q

flap we like

A

submarginal

51
Q

osteotomy

A

5mm

removal of cortical and cancellous bone

52
Q

root end resection dimension

53
Q

root end resection bevel

A

zero degree bevel allows for less leakage and

maintain more tooth structure

54
Q

dye and inspection used?

A

looking for additional canals or cracks present

55
Q

root resection importance **

A

When resect - at least 3mm – and know why and we retroprep in 3mm so effectively we treat 6mm of a tooth with surgery
So we can treat 6 with only taking out 3m

56
Q

retroprep **

A

3mm cavity prep

57
Q

use what in retro-prep

A

ultrasonic tips proposed but RETROFILLS PROVIDE HIGHER SUCCESS RATE

crack formation is a function of

  • time
  • power
  • thickness
58
Q

retrofill materials

A
  1. MTA - basically still the standard
  2. Super EBA
  3. Geristore
  4. AMALGAM IS NOT STANDARD OF CARE
59
Q

WHY NO AMALGAM

A

dimensionally unstable – can expand in root envronemtn and can cause cracks and long term failure
- breaks seal by expanding

60
Q

WHY NO AMALGAM

A

dimensionally unstable – can expand in root envronemtn and can cause cracks and long term failure
- breaks seal by expanding

can see inflammation

61
Q

MTA advantages

A
  1. hydrophilic
  2. more biocompatible
  3. sealing abilities
  4. margin adaption
  5. not adversely function with blood
62
Q

sutures use?

A

6-7.0

more zero’s – more fine

63
Q

absorbable sutures

A
  1. vicryl
    - least inflammation when compared to silk and prolene (non-absorbable)
  2. monocryl
  3. chromic gut
64
Q

non-absorbable sutures

A
  1. silk - not ideal because of wicking

2. prolene

65
Q

post op if sinus exposure

A

augmentin 875 mg bid for 10 days

.5% neosynephrine or OTC nasal decongestants

66
Q

remove sutures when

A

2-3 days which promotes better healing

67
Q

remove sutures when

A

2-3 days which promotes better healing

Endotontics (21 decks)

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