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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
MB root of max first molar - isthmus?
100% of the time
26
biopsy reason for surgery?
YES
27
biopsy reason for surgery?
YES
28
grafting and GTR indicated? size? implication on prognosis?
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
two requirements for resoprtive defects
1. inflammation | 2. loss of the protective pre-cemental / dentin layer
30
etiology of resorptive defects
1. ortho 2. trauma 3. bleaching 4. idiopathic some sort of trauma
31
treatment for resorptive defects
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
repair of resorptive defects is indication for surgery?
Yes
33
perforations an indication for surgery?
yes
34
perforations prognosis? *** best when
sooner better smaller the better more apical in bone the better the prognosis
35
perfs in contact with have worst prognosis?
oral fluid
36
strip perforation due to
over-preparation of the tooth
37
exploratory surgery? relevant?
YES -- but less now with CBCT's
38
situations where peri-radicualr surgery may NOT be advisible
1. medically compromised 2. indiscriminant use of surgery 3. unidentified / indiscriminant use of surgery 4. skill not there
39
anatomic factors where surgery may not be good
maxillary sinus connection 13% of max post ter
40
which tooth is closest to sinus **
MB root of max 2nd molar closest to the sinus and the buccal root of max 1st premolar is the farthest
41
mental and IAN with surgery not advisible
mental foramen is
42
most crucial aspect to good surgery outcome
how good the procedure went/ so basically the skill?
43
most crucial aspect to good surgery outcome
how good the procedure went/ so basically the skill?
44
what to worry about with palatntine access
greater palantine vessles (anatomic factor that could be a factor for no surgery)
45
pain control with surgery
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
Local infiltration in surgery?
with 1:50K epi for hemostasis in oral mucosa and away from skeletal muscles
47
average blood loss is? factors?
9.5 ml and time is the biggest factor 50% less blood loss when using 1:50K vs 1:100L epi
48
regional block with?
marcaine (with local infiltration of 1:50K epi -- stll can use in cardio patients becauase it is local)
49
types of flap designs
1. semi-lunar -- NEVER INDICATED 2. USE FULL THICKNESS- MUCOPERIOSTEAL - intra sulcular - submarginal mucogoingival flap - 2 mm above and below!! - papillary based incision
50
flap we like
submarginal
51
osteotomy
5mm removal of cortical and cancellous bone
52
root end resection dimension
3mm ***
53
root end resection bevel
zero degree bevel allows for less leakage and maintain more tooth structure
54
dye and inspection used?
looking for additional canals or cracks present
55
root resection importance **
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
retroprep **
3mm cavity prep
57
use what in retro-prep
ultrasonic tips proposed but RETROFILLS PROVIDE HIGHER SUCCESS RATE crack formation is a function of - time - power - thickness
58
retrofill materials
1. MTA - basically still the standard 2. Super EBA 3. Geristore 4. AMALGAM IS NOT STANDARD OF CARE
59
WHY NO AMALGAM
dimensionally unstable -- can expand in root envronemtn and can cause cracks and long term failure - breaks seal by expanding
60
WHY NO AMALGAM
dimensionally unstable -- can expand in root envronemtn and can cause cracks and long term failure - breaks seal by expanding can see inflammation
61
MTA advantages
1. hydrophilic 2. more biocompatible 3. sealing abilities 4. margin adaption 5. not adversely function with blood
62
sutures use?
6-7.0 more zero's -- more fine
63
absorbable sutures
1. vicryl - least inflammation when compared to silk and prolene (non-absorbable) 2. monocryl 3. chromic gut
64
non-absorbable sutures
1. silk - not ideal because of wicking | 2. prolene
65
post op if sinus exposure
augmentin 875 mg bid for 10 days .5% neosynephrine or OTC nasal decongestants
66
remove sutures when
2-3 days which promotes better healing
67
remove sutures when
2-3 days which promotes better healing

Endotontics (21 decks)

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