Week 9- Apicoectomy and Retreatment

Question 1

What is the solution for periapical granuloma?

Answer 1

Remove surgically. The apical delta, which can contain bacteria will be cut off as well.

Question 2

What is apicectomy?

Answer 2

Surgically removing apical granuloma/abscess and apex of root

Question 3

What is the procedure for apicoectomy?

Answer 3

• Localise apex laterally
• Semicircular incision (2-3cm) or sulcular incision
• Raise flap
• Open bone with drill (remove apex and infected tissue)
• Use ultrasonic at apex
• Place cotton pellets in crypt to reduce bleeding
• Place MTA at apex
• Remove cotton and excess MTA and irrigate
• Suture

Question 4

What are 3 different procedures for apicoectomy?* (exam q)

Answer 4

• Pre-operative endo (re)treatment with good obturation
• Perioperative obturation of preshaped root
• Apicoectomy with retrograde filling

Question 5

What can be used to improve visibility for apicoectomy

Answer 5

SOM (surgical operating microscope)

Question 6

Who should we refer to for apicoectomy?

Answer 6

Oral surgeon

Question 7

What are reasons for endo retreatment?

Answer 7

• Incomplete cleaning and sealing
• Retained bacteria in root canal
• Complicated canal anatomy undetected in 1st procedure
• Narrow/curved canals not treated initially
• Placement of crown/resto was delayed follow endo tx
• New decay
• Loose, cracked, broken crown or filling
• Inoperable canals (calcified or unusual anatomy)
• Failure for tissues to heal
• Tooth fracture

Question 8

What is the indication for endo retreatment?

Answer 8

• Pt has pain
• Tooth has LEO, growing in size

Question 9

What is the procedure for endo retreatment?

Answer 9

• Informed consent
• Access to pulp chamber
• Locate canal entrances
• Remove old RCF
• Dressing
• Obturation

Question 10

What risks should the pt be informed of about endo retreatment?

Answer 10

• High risk of instrument separation and perforation
• High cost, lengthy sessions
• Long term success?

Question 11

Describe strategy for removing GP from canal

Answer 11

1. Find point between GP point and canal wall
2. Corc screw technique with H file and pull back
3. Work your way to apex

Question 12

What are other options for removing GP and their disadvantages?

Answer 12

• Chloroform (limited use, don’t breath in)
• Rotary instruments (chance of fractures)
• Warm instruments (condenses remaining material making it more difficult to remove)

Question 13

What should you do if there is fractured instrument?

Answer 13

• Localize instrument
• Create path along instrument
• Ultrasonic instrument tips to wiggle broken instrument
• Use IRS handle if in upper ⅓ of root canal

Question 14

Who should remove broken instruments in root canals?

Answer 14

Endodontists

Question 15

In what cases would coronal access to the pulp not be possible, thus requiring apicectomy and retrograde filling?

Answer 15

• If pt has crown that they don’t want removed.
• if pt has threaded metal posts (very difficult to remove)

Question 16

When do you perform pre-operative endo (re)treatment with good obturation?

Answer 16

If you have access to entrances. Afterwards, do apicoectomy. Don’t need retrograde filling with MTA.

Question 17

When is Perioperative obturation of preshaped root performed?

Answer 17

Perform apicoectomy and obturation in same operation.

Surgeon would ask endodontist to preshape root canal and leave access open to perform during surgical procedure. Used before time of MTA. No longer used much.

Question 18

When is Apicoectomy with retrograde filling performed?

Answer 18

Done when access from coronal is not possible. Doesn’t matter what is in root canal as you will do apical filling. Can be done if root canal has a post.

Question 19

What is orthograde and retrograde?

Answer 19

Retrograde: from below (through root tip)

Orthograde: from above (through crown)