Periradicular Surgery Flashcards
What are the aims of periradicular surgery?
- Achieve apical seal
2. Remove existing infection
What are the indications of periradicular surgery?
Failure of endodontics
- Obstruction to instrumentation (calcification, broken instrument, root dilaceration, root #)
- Root filler error/ problem (under/over-filled, open apex)
- Miscellaneous (lateral root canals, poor host tissue response, poor natural drainage of infection)
Other
- Pathology (apical cyst)
- Post-crowned teeth w endo failure
- Lateral perforation
- Exploration surgery
What are the available flap designs for access of an apicectomy?
- Semi-lunar
- Triangular (2 side)
- Rectangular (3 side)
- Obschenbein-luebke (sub-marginal)
Describe the process of an apicectomy
- Flap is raised (ensuring the full thickness of gingivae come away to reveal white bone, if it is purple it is the periosteum which is not good)
- Mitchell’s tool to for ‘radiolucency’
- Bone is removed with a round bur, being as conservative as poss
- Resection 3mm of apex is done with a tapered fissure bur (straight surgical handpiece)
- Enucleation of any granulation tissue (for homeostasis to be easily achieved)
- Apex prepared with ultrasonic tip and canal sealed with RM-ZOE/ MTA
- Suture flap back to its original position (anatomical closure)
What are the advantages and disadvantages of a semi-lunar flap?
ADVANTAGES
- Good for apical access
- Less gingival recession
DISADVANTAGES
- Reduced access
- Scarring
- Dysaesthesia
What materials are used for a retrograde seal following an apicectomy?
- Am (poor)
- RM-ZOE
- MTA
What are the advantages and disadvantages of RM-ZOE?
ADVANTAGES
- Cheap
- Easy to use
- Radiopaque
- Bacteriostatic
DISADVANTAGES
- Moisture sensitive
- May resorb
- Doesn’t induce cementogenesis
What are the advantages and disadvantages of MTA?
ADVANTAGES
- Moisture resistant
- Promotes cementogensis
- Gives a good seal
DISADVANTAGES
- Expensive
- Long setting time
- Difficult to use
What are the causes of failure of an apicectomy?
INADEQUATE SEAL (poor technique)
- Extra root
- Too little apex removed
- Incorrect seal shape
- Lateral perforation
- Displacement of seal
- Lateral canal
INADEQUATE SUPPORT of tooth
- Too much apex removed
- Poor perio status
- Excessive occlusal loading
- Apical third #
MISCELLANEOUS
- Longitudinal root split
- Poor healing response
- Exposure of root apex
When would a patient be reviewed CLINICALLY following an apicectomy?
- 1 week
- 3-6 months
- 6mths - 4yrs
When would a patient be reviewed RADIOGRAPHICALLY following an apicectomy?
- Intra-op (varies)
- Immediately post-op (for baseline)
- 1-12 weeks
What are the contra-indications of periradicular surgery?
- Anatomical factors = nerves
- Inadequate perio support
- Non-restorable tooth
- MH = leaukaemia, neutropaenia, recent heart surgery/ cancer
- Ability of operator –> REFER
What are the classification of healing following surgery?
- Healed
- Incomplete healing (scar)
- Uncertain healing
- Failed
