peri radicular surgery

Question 1

aims of PR surgery

Answer 1

1. achieve apical seal
2. remove existing infection i.e. excision of apex / curettage

Question 2

indications for PRS

Answer 2

failure of endo
1. obstruction - calcification / broken instrument / root dilaceration / root #
2. root filler error or problem - under or over filled / open apex
3. other - lateral root canals, poor host tissue response, poor natural drainage of infection
4. pathology - cyst
5. post crown teeth - endo shortcomings / problem with post
6. lateral perforation

Question 3

causes of failure of PRS

Answer 3

1. inadequate seal - extra / bifid root, too little apex removed, seal of incorrect shape, lateral perforation problem, displacement of seal, lateral canals
2. inadequate support - too much apex removed, poor perio status, excessive occlusal loading, apical 1/3 #
3. other - longitudinal root split, poor healing response, exposure of root apex

Question 4

options for retrograde root filling

Answer 4

1. amalgam - disadv = amalgam tattoo
2. ZOE - calzinol; works well & cheap
3. MTA - very good but very expensive

Question 5

process

Answer 5

access flap
remove bone
remove 3mm apex
remove 3mm of GP inside tooth
retrograde root sealer
close flap
note - apicectomy is part of peri radicular surgery process