W9 - Endo Apicoectomy & Re-treatment - Stoll Flashcards
Describe three different ways of performing an apicoectomy
Preoperative endodontic (re)treatment with good obturation
Perioperative obturation of preshaped root canal (obturation done from above, controlled from below)
Apicoectomy with retrograde filling (access from coronal not possible → fill from apex)
What tool is used to help visualise while performing apicoectomy
Surgical Operation Microscope (SOM)
What are some reasons for retreatment
- Incomplete cleaning and sealing
- Retained bacteria
- Complicated canal anatomy
- Narrow or curved canals
- Placement of crown was delayed after tx
- New Decay
- loose, cracked broken crow
- Tooth has fractured
- Tissues have failed to heal
Clinical indications for retreatment (2)
Pain
LEO - growing in size
What must you inform pt of before retreating (4)
High risk of instrument separation and perforating
$$$
Lengthy sessions
Long term success unknown
How to remove GP
- Find place to put file between GP point and canal wall
- Hedstrom (H) file - “Cork screw” → DONT overtwist
- Work your way down apex
Why shouldn’t chloroform, rotary instruments and warm instruments be used to retreat?
Chloroform - toxic to breathe in
Rotary - can cause fractures (but still used)
Warm - will condense the remaining material
How to remove fractured instruments? (3 ways)
Create space along the instrument and apply ultrasonic
IRS kit (pic)
Maserann Kit
When may you need to do an apicoectomy with retrograde filling?
Metal post → unable to retreat coronally without removing and fracturing tooth
What type of flap is used in anterior apicoectomy
Semi-lunar flap
General procedure of apicoectomy
Semi Lunar flap
Remove granulation tissue with curettes
Clean apex and remove more granulation tissue with Ultrasonic
Place cotton pellets at base of surgical cavity to control bleeding
Place MTA (or retreat)
Irrigate with saline
Replace flap
