Endodontic Surgery Overview

Ascertain cause of failure, rule out non surgical retreatment, check who performed the nonsurgical treatment, check quality of the endodontic treatment, check coronal seal/redo RCT, evaluate the restorability of the tooth, bone support, CBCT

Approximate length of the root, number of roots, degree of curvature, size & type of lesion, adjacent anatomical structure e.g. ID canal, Mental foramen, floor of sinus, distance of root apex from structures, space between root tips in the anterior teeth. If cannot ascertain this with 2D then do 3D

<p>Surgical treatment of apical periodontitis is indicated to remove the infection from the root canal when this is not possible or practical via the normal root canal treatment or retreatment. When the endodontic retreatment fails or when the endodontic retreatment is not practical, it is therefore more sensible to surgically remove the part of the root where the bacteria are likely to be growing rather than destroying the tooth while doing the retreatment.</p> Signup and view all the answers

<p>True (A)</p> Signup and view all the answers

<p>The question does not provide specific information on the locations where bacteria can hide in the apical third of the root. Further information is needed to answer this question.</p> Signup and view all the answers

<p>When non surgical re-treatment not possible, treatment of choice when all other options ruled out, when surgical approach is more conservative, failure of previous endodontic therapy e.g. periapical cyst present, anatomical deviations e.g. S or C-shaped canals, horizontal root fracture, inaccessible root canals due to procedural errors e.g. ledge, blocked canal, perforation</p> Signup and view all the answers

<p>At least 1 yr after treatment and subsequently as required</p> Signup and view all the answers

<p>Absence of pain, swelling, &amp; other symptoms, no sinus tract, no loss of function, radiological evidence of normal PDL space around the root</p> Signup and view all the answers

<p>If radiographs reveal that a lesion has remained the same size or only diminished in size, the outcome is considered uncertain</p> Signup and view all the answers

<p>It's advised to assess the lesion further until it has resolved or for a minimum of 4 years</p> Signup and view all the answers

<ol> <li>The tooth is associated with signs and symptoms of infection, 2. A radiologically visible lesion has appeared subsequent to treatment or a pre-existing lesion has increased in size, 3. A lesion has remained the same size or has only diminished in size during the 4 year assessment period, 4. Signs of continuing root resorption are present</li> </ol> Signup and view all the answers

<p>It's advised that the tooth requires further treatment. Exception: An extensive radiological lesion may heal but leave a locally visible, irregularly mineralised area. This defect may be scar tissue formation rather than a sign of persisting apical periodontitis. The tooth should continue to be assessed</p> Signup and view all the answers

<p>Factors that may lead to new disease &amp; thus jeopardise endodontic treatment include: recurrent caries &amp; coronal leakage, caries extending into the root canal or furcation, root fracture, root perforation, extending marginal periodontitis</p> Signup and view all the answers

<p>The communication between an infected endodontic space and periradicular tissues</p> Signup and view all the answers

<p>Foreign body reaction. Fractured files, sealer materials extruded from root canal, etc. could lead to a foreign body reaction. However, this foreign body reaction is not exactly the cause of endodontic infection, rather it is an inflammatory response.</p> Signup and view all the answers

<p>Apical pocket cyst- epithelial-lined cystic cavity is in communication with the root canal system (should heal with RCT). Apical true cyst- epithelial lining has no communication with root canal (less likely to heal with RCT, will probs need surgery)</p> Signup and view all the answers

<p>It can weaken the tooth, especially if the crown to root ratio is not high</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>Periodontal probing- a deep isolated pocket is indicative of a root fracture as well as a J shaped radiolucency around the root of the tooth</p> Signup and view all the answers

<p>Medical history (uncontrolled diabetes, Warfarin - check INR, bleeding disorders that may influence the treatment, IV bisphosphonates, immunocompromised etc), Periodontal disease/inadequate periodontal support, Restorability of tooth, Anatomical factors e.g. neurovascular bundle, sinus, Inadequate operator ability/skills/knowledge</p> Signup and view all the answers

<p>False (B)</p> Signup and view all the answers

<p>The question does not provide specific information on the types of C-shaped canals. Further information is needed to answer this question.</p> Signup and view all the answers

<p>Increase of crown at expense of root. Results in: NORMAL clinical and anatomic crown, Elongated body (enlarged pulp chamber w/o constriction of CEJ), Furcation and pulp chamber displaced apically (so very SHORT ROOTS), increased dimension between CEJ and furcation</p> Signup and view all the answers

<p>Confirm medical history, Informed consent (pain, swelling, bleeding, bruising, recession, failure, scar tissue), Corsodyl MW, Analgesics (Ibuprofen 600mg stat+ 2 days only if patient feels pain), Antibiotics (case selection)</p> Signup and view all the answers

<p>Papilla preservation flap (B), Mucogingival flap (D), Sulcular full thickness flap (E)</p> Signup and view all the answers

<p>The question does not provide specific information on the appearance of the sulcular full thickness flap. Further information is needed to answer this question.</p> Signup and view all the answers

<p>The question does not provide specific information on the appearance of the mucogingival flap. Further information is needed to answer this question.</p> Signup and view all the answers

<p>Preserve papilla to reduce risk of recession, 45 degree bevel to cortical plate to give wide cutting surface and minimise scarring, Vertical relieving incision parallel to each other, Rounded edges at the corner of the flap, Decreases the risk of recession, post operative pain/swelling and better aesthetics</p> Signup and view all the answers

<p>Periosteum and overlying gingiva elevated with sharp elevator, Release the papillae with small flat plastic, Walk the elevator along the attached gingiva and then apically, Elevator firmly on bone and at a 45 degree angle, Peel the gingiva, mucosa and periosteum slowly and firmly. Do not want to slip or tear the flap</p> Signup and view all the answers

<p>Intact cortical plate with apical lesion (A), Fenestration of cortical plate around the apex (B), Intact cortical plate with small or no apical lesion (C)</p> Signup and view all the answers

<p>Needs to be large enough to allow access. 4mm to allow ultrasonic tips in.</p> Signup and view all the answers

<p>Ascertain root length and guess where the apex will be, Use a sharp probe to explore the area &amp; perforate if possible, If thick bone, use small round bur to remove bone where apex is anticipated</p> Signup and view all the answers

<p>Try to peel off crypt wall in one piece, Removal will reduce bleeding, Soft tissue must be sent for histology, If bleeding (Adrenaline gauze pack, Inject LA at the base)</p> Signup and view all the answers

<p>3mm resection, 0 degree bevel, thin long tapered diamond bur, Aim to remove apical ramifications, lateral canals (3mm resection removes 98% apical ramifications, 93% lateral canals), Bevel angle perpendicular to the long axis of the tooth, Exposes fewer dentinal tubules &amp; prevents excessive leakage</p> Signup and view all the answers

<p>If previous MTA plug then no need to retro plug (Need to ensure at least 6mm MTA plug to leave 3 mm behind), Use ultrasonic, Minimum 3mm deep, if have longer tips (6- 9mm) go as far down as possible, sweeping motion</p> Signup and view all the answers

<p>Use a flat plastic to pack down the material (has a putty-like consistency), scrape it onto the surface</p> Signup and view all the answers

<p>Cavit (zinc oxide and calcium sulphate) (A), Diaket (calcium chelate reinforced with polyvinyl resin) (B), Mineral trioxide aggregate (C), Glass ionomer cement (D), Composite resin (E), Super EBA (F), Zinc oxide eugenol (G)</p> Signup and view all the answers

<p>MTA (C), SUPER EBA (D), IRM (E)</p> Signup and view all the answers

<p>Vicryl (Absorbable - Synthetic) (A), Prolene (Non-absorbable - Syntheticmonofilament) (B)</p> Signup and view all the answers

<p>After 2-4 days</p> Signup and view all the answers

<p>First introduced by Farrar over 100 years ago to manage perio-endo lesions</p> Signup and view all the answers

<p>RCT treatment, Fill the root that will be resected with MTA, Then, resect/amputate the root, Ensure smooth surface cleanable area, Check radiograph</p> Signup and view all the answers

<p>Around 60-78%</p> Signup and view all the answers

<p>Around 60-70%</p> Signup and view all the answers

<p>And the tooth must be restorable</p> Signup and view all the answers

1. Apical surgery 2. Resorption repair 3. Root resection 4. Premolarisation 5. Intentional replantation

Ascertain cause, rule out nonsurgical options, check prior treatment quality, evaluate restorability, bone support, and perform CBCT.

Assesses root length, number of roots, curvature, size/type of lesion, adjacent structures, and distance from apex.

Indicated when non-surgical retreatment fails or is impractical, allowing for direct infection removal.

In rare cases, surgery is the sole solution for bacteria colonizing the root surface.

Include inability for nonsurgical retreatment, failure of therapy, anatomical deviations, and inaccessible canals.

Evaluate RCT outcomes at least one year post-treatment and then as needed.

No pain or swelling, no sinus tract, normal function, and radiological evidence of healthy PDL space.

Identified when lesions remain unchanged or only slightly decrease in size during follow-up.

Continue monitoring the lesion until resolution or a minimum of four years.

Include signs of infection, new lesions, unchanged size during assessments, or ongoing resorption.

Further treatment is generally required, with an exception for certain irregularities that may not indicate infection.

Recurrent caries, root fractures, perforations, and marginal periodontitis may lead to new diseases.

Infection can spread from the endodontic space to periradicular tissues, leading to treatment failure.

Pocket cyst communicates with root canal; true cyst does not and is less likely to heal with RCT.

It can weaken the tooth, particularly with low crown to root ratios.

Utilize periodontal probing and radiography for deep isolated pockets and J-shaped radiolucencies.

Include medical issues, inadequate periodontal support, restorability, anatomical challenges, and operator skill levels.

Typically removed within 2-4 days after surgery.

Success rate ranges from 60% to 78% depending on the procedure.

Sutures may be absorbable (Vicryl) or non-absorbable (Prolene).

First introduced by Farrar over 100 years ago to address perio-endo lesions.

Replantation yields success in approximately 60-70% of cases.