Peri-radicular surgery Flashcards
What does surgical endodontics encompass? (7)
• emergency procedures (e.g. incision & drainage)
• biopsy / EUA
• peri-radicular surgery (micro-surgical endodontics)
• corrective surgery
(perforation repair / root resection / hemi-section)
• surgical re-treatment
• regenerative procedures
• decompression (large cysts)
Aim of surgical endodontics (1)
Elimination of apical periodontitis where this cannot be achieved by non-surgical means
The causes of apical periodontitis (6)
•persistent intra-radicular infection
•persistent extra-radicular infection
•foreign body reaction to exogenous materials in
peri-apical tissues
•cholesterol crystal accumulation leading to periapical irritation
•true cystic lesions
•scar tissue formation
Indications for surgical endodontics (5)
•persistent intra-radicular infection
•persistent extra-radicular infection
•foreign body reaction to exogenous materials in
peri-apical tissues
•cholesterol crystal accumulation leading to periapical irritation
•true cystic lesions
•scar tissue formation
•As a combined approach with non-surgical treatment
or re-treatment (e.g. persistent exudate / open apex), or in conjunction with procedures such as root
amputation or hemi-section
•Where patient factors dictate that surgical treatment would be more expedient than non-surgical
treatment
Contra-indications to surgical endodontics (6)
•When non-surgical endodontic treatment or retreatment is feasible
•Tooth with inadequate periodontal support
•Non-restorable tooth (including root fractures)
•Poor surgical access
•Serious underlying medical conditions (e.g. bleeding
disorders / G.A. risk) or psychological problems
•Limited ability / skill of operator
Prognosis (4-year success rates) for non-surgical re-RCT (1)
86%
5-year success rates for traditional root end surgery (1)
59%
5-year success rates for modern micro-surgical techniques (1)
94%
Surgical objectives of surgical endodontics? (4)
• remove diseased peri-radicular tissue
• debride canal system as far as possible (retro-grade
approach)
• seal the root-end cavity (prevent possible egress of
micro-organisms into the peri-radicular tissues)
• allow healing / regeneration of normal pdl
apparatus around apical portion of root
Surgical prerequisites (6)
• patient’s informed consent
• skilled operator / nurse
• detailed knowledge of anatomy of surgical site
• check medical history carefully
(care with anticoagulants / bleeding disorders)
• correct equipment / materials
• light and magnification
Surgical sequence (10)
- pre-op NSAIAs / Corsodyl mouth rinse
- local analgesia
- incision / flap reflection
- osteotomy / 90 degree root end resection
- curettage of peri-radicular lesion
- ultra-sonic preparation of root-end cavity
- haemostasis (moisture control of bony crypt)
- inspection, drying & filling root-end cavity
- suturing
- post-operative instructions & aftercare
Incisions (6)
Semi-lunar Intra-sulcular 2-sided (triangular) Intra-sulcular 3-sided (rectangular) -intra-sulcular incision with SM63 blade Sub-marginal Papilla-base Flap reflection
Bone removal by (4)
Normal air-rotor
Surgical air-rotor
Bone removal
Root-end resection
Root-end cavity with (2)
Ultra-sonic handpiece
KiS micro-surgical-surgical ultra-surgical tips
Filling materials (5)
- Ethoxy Benzoic Acid cement (super EBA)
- Intermediate Restorative Material (IRM)
- Mineral Tri-oxide Aggregate (MTA)
- glass ionomer cement / composite resin
- (Biodentine)
