Peri-Radicular Surgery Flashcards
What makes up surgical endodontics?
Emergency procedures (e.g. incision and drainage)
Peri-radicular surgery (micro-surgical endodontics)
Corrective surgery (root resorption)
Surgical re-treatment)
Regenerative procedures
Why do surgical endodontics?
Elimination of apical periodontitis, retaining the tooth, where this cannot be achieved by non-surgical means
Why may you get recurrent apical periodontitis after RCT?
Persistent intra-radicular infection
Persistent extra-radicular infection
Foreign body reaction to exogenous materials in peri-apical tissues
Cholesterol crystal accumulation leading to peri-apical irritation
True cystic lesions
Scar tissue formation
Indications of surgical endodontics?
Persistent disease where non-surgical RCT or re-RCT cannot be undertaken, is not feasible or has failed (e.g. post crown dismantling = risk of root fracture)
Correction of iatrogenic errors not amenable to a non-surgical approach (e.g. apically extruded filling material or fractured instrument removal)
Direct visual examination or corrective measures require a surgical approach)e.g. perforation repair
As a combined approach with non-surgical treatment or re-treatment or in conjunction with procedures such a root amputation or hemi-section
Where pt factors dictate that surgical tx would be more expedient than non-surgical treatment
Contraindications of surgical endodontics?
When non-surgical endodontic treatment or re-treatment is feasible
4 yr success rate of non-surgical endo re-tx = 86%
Tooth with inadequate periodontal support
Non-restorable tooth
Poor surgical access
Serious underlying medical conditions e.g. bleeding disorders/MRONJ risk or psychological problems
Limited skill of operator
Surgical endodontics prognosis?
5 yr success rate
- Traditional root end surgery: 59%
- Modern micro-surgical techniques: 94%
Objectives of surgical endodontics?
Remove diseased peri-radicular tissue
Debride canal system as far as possible from root tip to crown
Seal root end cavity (prevent possible edgress of residual intra-canal micro-organisms into the peri-radicular tissue)
Allow healing/regeneration of normal PDL apparatus around apical portion of root
Surgical endodontic prerequisites?
Pt's informed consent Skilled operator/nurse Detailed knowledge of anatomy of surgical site Check MH Correct equipment/materials Light and magnification
Surgical endodontic sequence?
Pre-op NSAIDs/corsodyl mouth rinse LA Incision/flap Osteotomy Curettage of peri-radicular lesion Ultrasonic prep of root end cavity Haemostasis Inspection, drying and filling root end cavity Suturing Post op instructions and aftercare
What is the muco-gingival junction?
Margin between Non-keratinised oral mucosa and attached gingvae
Incisions for surgical endodontics?
Intra-sulcular 2 sided incision (along gingival margin with a relieving incision)
Intra-sulcular 3 sided incision - along gingival margin with a couple of relieving incisions
Sub-marginal incisions - slightly above gingival margins - good for veneers/crowns (as will not cause recession)
Papilla base incisions
Why does a surgical air rotor need to be used and not a normal air rotor?
Blow air and water into surgical site = contamination
Surgical air rotor is more tilted = more vision and access
Root end cavity - what instruments are used for this?
Ultrasonic handpiece with micro-surgial ultrasonic tips
How to achieve moisture control with surgical endodontics?
Racellet = adrenaline cotton wool pellet packed into base of cavity
Filling materials used for surgical endodontics?
Ethoxy benzoic acid cement Intermediate restorative material Mineral Tri-oxide aggregate (MTA) Glass ionomer cement/composite resin Bioceramic materials e.g. biodentine
