Surgical Endodontics Flashcards
Name the 5 types of endodontic surgery?
- Apicectomy
- Root resection
- Surgical perforation repair
- Surgical management of root resorption
- Intentional reimplantation
Name the 6 challenges for endodontics?
- Large area of bone loss will reduce likelihood of success
- Overextended GP will be challenging to remove
- Separated instruments in aspical 1/3 with associated AP
- Short obturation and position of GP suggests ledge
- Pattern of bone loss and proximity of GP suggests strip perforation
- Pattern of bone loss and proximity of restoration suggests perforation
What is the definition of an apicetomy?
The removal of the root tip, curettage of
infective & granulation tissue as well as any
foreign bodies from the surrounding peri-
radicular tissues and placement of a
retrograde root end restoration
Name the 5 post-treatment clinical/radiographic symptoms that suggest endodontic failure?
- presence of clinical signs and/or symptoms
- swelling, sinus, tenderness to pressure or
percussion, pain of endodontic origin - enlargement of existing peri-radicular
radiolucent lesion - development of new peri-radicular radiolucent
lesion - persistence of peri-radicular radiolucent
lesion in a tooth that had root-canal treatment
at least 4 years previously.
What occurs of there are no signs or symptoms but with persistent periapical radiolucency?
Absence of signs and symptoms of periapical disease but a persistence of a periapical
radiographic radiolucency may indicate either healing by repair with fibrosis or persistent chronic
inflammation.
Time and/or acute exacerbation will identify persistent chronic inflammation.
Prevalence of periapical radiolucency?
- 58% of root filled teeth had periapical
radiolucency. - 77% of teeth with post retained crowns
had periapical radiolucency. - 41% of patients has at least one non-root
filled teeth with periapical disease.
Of the 28,881 endodontically treated
teeth, 36% had periapical radiolucencies.
* Of the 271,980 untreated teeth, 2% had
periapical radiolucencies.
Name the 3 treatment options following diagnosis of endodontic failure?
- Orthograde re-root treatment (non-surgical).
- Surgical management via periradicular tissues.
- Extraction +/- prosthetic replacement unit.
Describe the outcome differences between orthogreade re-root treatment vs apicectomy?
- Endodontic surgery offers more favourable
initial success, but non-surgical retreatment
offers a more favourable long-term outcome.
At 2 - 4 years significantly higher success rate
was found for endodontic surgery of 78%
compared with nonsurgical retreatment of 71%.
* At 4 - 6 years significantly higher success rate
with non-surgical retreatment of 83%
compared with 72% for endodontic surgery.
What treatment is GS for post-treatment diagnosis of failed endodontic treatment?
In most cases of failed root treatment
non-surgical orthograde re-root
treatment is the treatment modality of
choice.
* Periradicular surgery must only be
considered in select circumstances
Name the 6 indications for surgical endodontics?
- Re-RCT can’t be completed due to persistent exudation despite repeated chemo-mechanical debridement.
- RCT has been carried out to guideline standards but symptomatic or progressing periradicular disease is associated with an optimally root-filled tooth.
- Symptomatic or progressing periradicular disease associated with a well root-filled tooth and in which root canal retreatment:
» may be detrimental to the structural integrity of the tooth
» would be destructive to a restoration or fixed prosthesis
» would involve the removal of a post with a high risk of root
fracture. - Symptomatic or progressive periradicular disease associated with a tooth in which iatrogenic or developmental anomalies prevent orthograde root canal treatment.
- Biopsy of periradicular tissue is required.
- Visualisation of the periradicular tissues and tooth root is required if perforation or root fracture is suspected.
Name the 10 contraindications for surgical endodontics?
- Primary disease has not been stabilised
- Poor coronal seal
- Unrestorable tooth
- Combined periodontal–endodontic lesion
- Prognosis of the tooth is limited by
compromised bone support or crown: root ratio - Root fracture
- Insufficient access to the root end and the
associated lesion is difficult or risk of access
greater than the potential advantages - Patient unable to tolerate or co-operate
- Operator does not have the prerequisite skills,
experience, equipment or materials. - Medically compromised.
When is re-endodontics surgery as possible tx option?
Lower probability of periapical healing after a second surgical procedure.
Reason for failure of the first surgical procedure should
be determined
R vs B balanced
Root perforation prognosis - What is good? What is bad?
Good: fresh, small and apical
Bad: old, large and crestal
Describe a Class A endodontic microsurgical case?
absence of a periapical lesion, no mobility and normal
pocket depth, but unresolved symptoms after non-surgical
approaches have been exhausted.
Clinical symptoms are the only reason for the surgery
Describe a Class B endodontic microsurgical case?
presence of a small periapical lesion together with
clinical symptoms.
The tooth has normal periodontal probing depth and no mobility.
The teeth in this class are ideal candidates for microsurgery