Endodontic Surgery Dr. Azmeel Mazlee Bin Anuar BDS (Malaya), MDS (OMFS Hong Kong)
Nov 29, 2015
Definition
Surgical resection of the root tip of a tooth and
its removal together with the pathological periapical lesion
Indications
• When conventional tx or retreatment has failed
• Teeth with active periapical inflammation, despite the presence of a satisfactory endodontic therapy
Indications
• Teeth with periapical inflammation and unsatisfactory endodontic therapy, which cannot be repeated because of:
– Completely calcified root canal. – Severely curved root canals. – Presence of posts or cores in root canal. – Breakage of small instrument in root canal or the presence of irretrievable filling material
Indications
• Teeth with periapical inflammation, where completion of endodontic therapy is impossible due to:
– Foreign bodies driven into periapical tissues. – Perforation of inferior wall of pulp chamber. – Perforation of root. – Fracture at apical third of tooth. – Dental anomalies (dens in dente)
Indications
• When biopsy or investigation is required. Sometimes a biopsy of periradicular tissue is required or direct visualization of the periradicular tissues and tooth root is needed in order to assess a perforation or to confirm the presence of root fracture or cracking. Foreign material that has been extruded from the root canal and appears to be associated with an inflammatory reaction or infection should be removed
Indications
• Anterior teeth with periapical lesion for aesthetic reason
• Very sound condition of the crown despite having active periapical lesion and having good occlusion with opposing teeth
• Patient’s preference (must discuss thoroughly about pro’s & contra’s)
Contra-indications
• All conditions that could be considered contraindications for oral surgery concerning the age of the patient and general health problems, such as severe cardiovascular diseases, leukemia, tuberculosis etc.
• Teeth with severe resorption of periodontal tissues (deep periodontal pockets, great bone destruction)
Contra-indications
• Teeth with short root length• Teeth which apices have a close relationship
with anatomic structures (such as maxillary sinus, mandibular canal, mental foramen, incisive and greater palatine foramen) and if causing injury to these during the surgical procedure is considered probable.
General surgical technique
• Perform RCT on the tooth either few days earlier/at the same time
• Designing of flap.• Localization of apex, exposure of the periapical
area and removal of pathological tissue.• Resection of apex of tooth.• Retrograde filling, if deemed necessary.• Wound cleansing and suturing