Peri-Radicular Surgery Flashcards
When is surgical endo undertaken?
Emergency procedure Peri-radicular surgery Corrective surgery Surgical re-tx Regenerative procedure
Aim of surgical endo?
Elimination apical periodontitis, retain the tooth where this can’t be achieved by non-surgical means
When is surgical endo indicated?
Persistant disease when non-surgical or re-rct can’t be undertaken
correction of iatrogenic error not amenable to non-surgical approach
attempted all forms non surgical tx
What are contraindications to peri-radicular surgery?
Medical condition - general contraiondication alveolar surgery (bleeding/MRONJ) Poor surgical access Non-restorable Tooth inadequate periodontal support Non-surgical tx favoured
Diff in prognosis of traditional surgery vs modern surgery?
Tradition root end surgery = 59%
Modern micro-surgery = 94%
What are the surgical objectives?
Remove diseased peri-radicular tissue
Debride canal system
Seal end root cavity
Allow healing/ regeneration PDL
What are prerequisites for Edno surgery?
Informed consent Skilled operator Detailed knowledge anatomy MH checked Light and magnification Material/ equipment
What is the sequence for endo surgery?
- Pre-medication - NSAID/ corsodyl to reduce microbial load
- LA
- Flap reflection
- Osteotomy
- Currettage of lesion
- Ultrasonic prep root-end cavity
- Hamostasis - moisture control bony crypt
- Filling cavity
- Suture
- POI
What is the attached gingiva?
Band of keratinised tissue extending base of gingival sulcus down to mucogingival junction
What is mucogingival junction?
Junction between attached and sulucular mucosa
What incisions can be used in peri-radicular surgery?
Semi lunar
Intra sulcular
Submarginal
Papilla base
What is a semi lunar incision?
Horizontal slash in sulcular epithelium
What is risk with semi lunar incision?
Bleeding tendency
Diff to reflect and access
Risk lying over cavity - incision needs to be over solid bone for healing
What is a intra-sulcular incision?
2 sides and triangular
Incision extended around gingival sulcus of tooth and extend onto adjacent tooth
Doesn’t disturb papilla and leave gingiva around tooth
What is benefit of relieving incision when doing intra-sulcular?
Helps retract flap adequately giving good access
When is submarginal incision used?
If pt has restorative work - crowns/ veneers
Why are submarginal incisions beneficial is those with restorative work?
If reflect flap on teeth potential for recession - margins of restorative work
Benefit of submarginal incision?
Minimise chance of recession
What is needed for submarginal incision?
Adequate width of keratinised tissue, 5mm+
What is papilla base incision?
Combination intra-sulcular - instead following sulcus around papilla goes across papilla
Why does papilla base incision seem risky?
Breaks rule of having broad based incision which leaves tissue with adequate blood supply - only use of pt w/o perio
Why is osteotomy required?
Gain access to lesion and apex
Why can’t use normal air rotor for osteotomy?
Blows air and water - risk of emphysema
How is root end cavity prepared?
Prepared using ultrasonic handpiece
Allows GP to be removed to clear cavity of existing material
Cut circumference of apex of tooth
