Dr. Malek - Periradicular Surgery for D3.docx

Matthew Malek, DDS Diplomate, American Board of Endodontics Director of the Advanced Education Program in Endodontics NYU College of Dentistry Peri-radicular microsurgery: Treatment or direct evaluation of the peri- radicular pathosis through a surgical approach with the use of a dental microsco...

Matthew Malek, DDS Diplomate, American Board of Endodontics Director of the Advanced Education Program in Endodontics NYU College of Dentistry Peri-radicular microsurgery: Treatment or direct evaluation of the peri- radicular pathosis through a surgical approach with the use of a dental microscope. Long/wide posts Canal calcifications Irretrievable foreign objects (intra- or extra-radicular) Non-negotiable ledges, zips, strips, or transportation Perforations Large lesions Infection not responding to non-surgical treatments Exploratory Biopsy 1- Posts that may cause damage if removed (long, cast, ... Asymptomatic Apical Periodontitis Immediate post op Failed RCT Immediate post op One Year follow up 2- Calcified Canals Calcified canal with PAP 2 years follow up 3- Irretrievable foreign objects (internal) Pre-op Immediate Post-op 12 months follow up 3- Irretrievable foreign objects (external) 4- Non-negotiable ledges, zips, or transportations. Pre-op Immediate Post-op Non-surgical post-op Surgical post-op 6 months follow up 5- Perforations Pre-op 1 month later RCT post op Surgery post op year follow up year follow up Pre-op Non-surgical post-op Surgical Post-op 8-month follow up Pre-op Intentional Replant post op 2 year follow up Pre-op Intentional Replant post op 10-month follow up 8- Exploratory Pre-op Post-op Post-op 7 months follow up Apical surgery Extracted tooth Central Giant Cell Granuloma  Medical factors, including:  Recemt history of treatment with IV bisphosphonates ⃰  Radiotherapy  Hemostasis difficulty  Disorders  Medications  Tooth related Factors, including:  When a non-surgical treatment is feasible  Non-restorable tooth  Leaky restorations, or restorations with underlying recurrent caries  Unfavorable crown-to-root ratio  Uncertain periodontal status  Anatomic Factors … Anatomic Considerations Mental Foramen Mandibular Canal Maxillary Sinus Floor of the Nose Decision –making requires a certain level of expertise #9 – tender to percussion Apical surgery 6 months later RCT was performed by an endodontist Surgical utlrasonic tip for retrograde preparation. The level of root-end resection (notice 90-degree) Adequate room for retrograde filling  Peri-radicular (Endodontic) Microsurgery:  Ultrasonic devices (early 90s)  Improved cleaning  Maintaining root canal morphology  Ability to perfrom 90-degree root-end resections  Surgical microscope (late 90s)  Improved visualization  Surgical Endoscopy (early 2000)  Improved visualization  Advanced materials such as MTA and Geristore (early 2000)  Better seal  More biocompatible or even bioactive  Cone-Beam Computed Tomography (late 2000s)  Improved treatment planning and decision making. Outcome of Surgical Endodontics:  Setzer et al. Outcome of Endodontic Surgery: A Meta-analysis of the Literature— Part 1: Comparison of Traditional Root-end Surgery and Endodontic Microsurgery. J Endod, 2010. 36: 1757-65  21 studies qualified for the study (12 for TRS [n = 925] and 9 for EMS [n = 699])  59% positive outcome for TRS (95% confidence interval, 0.55–0.6308) and 94% for EMS (95% confidence interval, 0.8889–0.9816).  This difference was statistically significant (P < .0005).  The relative risk ratio showed that the probability of success for EMS was 1.58 times the probability of success for TRS. The results of this study suggests that the outcome of endodontic microsurgery is comparable to endodontic non-surgical procedures.