Endo 15 - Surgical Endodontic Treatment (Dr. Zaganjori)

To eliminate the etiology of pulpal disease

What is the goal of root canal therapy?

Root canal treatment

The biological aim of ___________ is to prevent or cure apical periodontitis by controlled asepsis or disinfection of the root canal system, thus creating an environment in which the periradicular repair can occur.

Endodontic retreatment

What treatment should be considered first: Endodontic retreatment or surgery?

1. Coronal microleakage

2. Untreated canals

3. Poorly instrumented canals

4. Root fractures

What are 4 reasons root canals fail?

1. Incision and Drainage

2. Apical curettage

3. Apicoectomy: with/without retrograde filling

4. Intentional Replantation

5. Root Amputation

6. Hemisection

6 types of surgical endo procedures

incision and drainage

ID the surgical procedure:

- To allow the release of pus and toxins

- To alleviate pain

- Fluctuant swelling

1. Microscope

2. Surgical instruments

3. Ultrasonic tips

What is 3 parts of the armamentarium for incision and drainage?

apical curettage

What is the treatment for a lesion that has walled itself off from body's defenses?

- Biofilms, Cysts

- Resistant bacteria (Actinomycosis (sulfur granules))

apical curettage

ID the surgical procedure:

NO ... By sealing off routes of microbial escape, stop the ability of bacteria to continue to grow and multiply

When doing RCT, do we completely elimate bacteria in the RC system?

apicoectomy

ID the surgical procedure:

- Aim: To create an environment that is conducive to regeneration of the periodontium

- 1st objective: To remove the etiologic factor (via root end resection)

- 2nd objective: To prevent recontamination of PA tissues (via root end prep and fill)

apicoectomy

ID the surgical procedure:

- Root end resection

- Root end preparation

- Root end filling

1. root end resection

2. root end preparation

3. root end filling

R P F

3 steps of an apicoectomy

Root end resection

ID the surgical procedure:

- Remove diseased root tip (many will have resorptive defects)

- Iatrogenic complications prevent adequate apical debridement and seal (ledge/transportation)

- Resect the entire root end up to 3mm to eliminate most accessory canals.

- Crown to root ratio

- Minimal bevel (0-20%)

Root end resection

ID the surgical procedure:

3mm

During a root end resection, resect the entire root end up to ___mm to eliminate most accessory canals

perpendicular (includes most apical ramifications and visualizations for any cracks)

During a root end resection, the ideal cutting plane is ________ to the root

3mm

During a root end resection, after the apical portion is resected, how much in mm of the remaining canal is prepped and filled?

E) Minimum 5mm (should be 3mm)

Which of the following is incorrect about a root end preparation?

A) Clean and shape the apical canal

B) Allows isthmus cleaning

C) Allows placement of the filling material into the root end

D) Provides an apical seal

E) Minimum 5mm

Root end preparation

ID the surgical procedure:

C) Be toxic (should be NONtoxic)

Which of the following is incorrect about root end materials?

A) Seal canal in three dimensions

B) Be well tolerated with no inflammatory reaction

C) Be toxic

D) Not promote, and preferably inhibit, the growth of pathogenic microorganisms

E) Stimulate the regeneration of normal periradicular tissues  

F) Not be affected by moisture

C) Should NOT corrode or be electrochemically active

Which of the following is incorrect about root end materials?

A) Not be absorbable within the confines of the tooth, but excess should be resorbable

B) Be dimensionally stable

C) Corrode or be electrochemically active

D) Not stain the tooth or tissues

E) Be easily distinguishable on radiographs

F) Adhere or bond to the tooth without undercuts

1. MTA (Mineral Trioxide Aggregate)

2. BC Putty (Bioceramic Root Repair Material)

What are the 2 most commonly used root end materials?

1. to create apical plugs during apexification

2. repairing root perforations during RCTs

3. internal root resorption

4. pulp capping

4 indications for MTA use

1. resorptions

2. root perforations

3. pulp capping

4. apexification

5. retrograde fillings

6. dentin replacement

6 indications for BC use

true

t/f: The clinical applications for using MTA vis BC putty are very similar/the same

MTA

Which one commonly stains teeth: MTA or BC Putty?

15-20 minutes on, 15-20 minutes off

How long should a patient ice after surgery?

Endodontic microsurgery

All of the following are characteristics of what?

- Microscope with illumination

- Small Osteotomy (<5mm)

- 0 bevel angle, 3mm

- Retroprep w/ untrasonic tips

- Retrofill w/ MTA (Precise)

- High Success Rate (94%)

75-97%

What is the success rate of a root canal?

F) Proper obturation

All of the reasons are why root canals FAIL except:

A) Persistent radiolucency or pain

B) Calcified canals

C) Procedural errors

D) Presence of posts/ Irretrievable Materials

E) Resorption Repair

F) Proper obturation

1. persistent radiolucency/pain

2. calcified canals

3. procedural errors

4. presence of posts/irretrievable materials

5. resorption repair

5 indications for endo surgery

Persistant radiolucency

ID the reason for RC failure:

- Host defenses cannot eliminate true cysts

- Extraradicular microorganisms may form colonies and establish biofilms

- - Actinomycosis (sulphur granules)

Infected silver point (Retreatment should be attempted first)

What is the cause of this apical radiolucency?

Locate canal

Before surgery on a calcified canal, what should always be attempted first?

calcified/non-negotiable canal

What is the cause of this apical radiolucency?

Iatrogenic complications (prevents adequate apical debridement and seal)

ID the procedural error:

- Instrument separation

- Perforation repairs

- Nonnegotiable ledging

- Transportation

- Over-instrumentation with symptomatic overfilling

separated instrument

ID the procedural error:

perforation

ID the procedural error:

symptomatic overfilling

Define the following:

- Pain not due to overextended material but due to inadequate apical seal

- Tugback and searing GP 5-7mm from apex to allow GP to fill in 3-D

- Fenestration

Post too large

ID the procedural error:

Post too long

ID the procedural error:

Post too large (with apical debris)

ID the procedural error:

1. Internal Resorption: Communicating externally

2. External Resorption

3. Apical Resorption

What are the 3 types of resorption repairs?

internal resorption

ID the indication for endo surgery:

(Communicated externally on the DB surface)

Invasive Cervical Root Resorption (ICRR)

What treatment is indicated?

Invasive Cervical Root Resorption (ICRR)

What treatment is indicated?

if the lesion is endo related

What does a biopsy indicate for endo?

1. Open flaring apex

2. Porcelain crowns

3. Fixed bridges

What are 3 false indications for an apicoectomy?

B - should say INADEQUATE perio support

All of the following are contraindications for endodontic surgery EXCEPT

A) When retreatment can be done first!

B) Adequate perio support

C) Tooth is hopeless

D) Poor access

E) Anatomy

F) Non-restorable (caries, not enough tooth structure)

G) Medical reasons

Mental foramen

What anatomical structure is interfering with the ability to do surgery?

Looks for cracks and PDL

Why is the dye used here?

intentional replantation

ID the surgical procedure:

- Performed when surgery is indicated, but access is impossible:

1. Atraumatic extraction

2. Apicoectomy with retroprep and retrofil

3. Irrigate socket with saline

4. Replantation and splint

root amputation

ID the surgical procedure:

Removal of root that is unsound

1. Periodontal

2. Resorption

3. Vertical Root Fracture

What are 3 reasons you might do a root amputation?

root amputation

ID the surgical procedure:

True (might be an unexpected root amputation!!)

T/F: Always take your own start film!

hemisection

ID the surgical procedure:

- Defective root + overlying coronal tooth structure is removed

- Bicuspidization - Mand molar is separated into mesial + distal halves due to furcational defect.

Check if missed MB2

RCT 10 years ago thru bridge

Sinus tract 3 years ago...apicoectomy done

Sinus tract returned.

What do we do?