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SURGICAL ENDODONTICS
OBJECTIVE
To ensure the placement of the
proper seal between periodontium and
root canal foramina.
Surgical procedure permits visual
and manipulative control of the area and placement of seal.
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INDICATIONS
Any condition or obstruction that prevents duct access to the
apical third f the canal
Iatrogenic or resorptive perforation that cannot be treated
with calcium hydroxide
Periradicular disease associated with foreign body
Incomplete apexogenesis with blunderbass canals or other
apices that do not respond to apexification procedure and
are inadequately sealed with orthograde filling.
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Abscess formation necessitating incision and drainage Horizontally fractured root tip with periradicular disease
Periodontal lesion with furcation involvement that do not
respond to periodontal treatment thus necessitating
radiosectomy Replantation of avulsed teeth
Intentional extraction and replantation
Predictable failure
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CONTRAINDICATION
GENERAL
Medically compromised or brittle patient that is a patient with
an active systemic disease
Emotionally disturbed patient ,ie a patient unable
psychologically to withstand or cope with any surgical
procedure
Limitations in the surgical still and experience of the operator
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LOCAL
Localized acute inflammation
Anatomic consideration
Inaccessible surgical site
Teeth with poor prognosis
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CLASSIFICATION
SURGICAL DRAINAGE
incision and drainage
cortical trephination
PERIRADICULAR SURGERY
Curettage
Biopsy
Root end resection
Root end preparation and filling
Corrective surgery
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1)perforation repair
2)root resection
3)hemisection
REPLACEMENT SURGERY
extraction\ replantation
IMPLANT SURGERY
Endodontic implant
Root from osseintegrated implant
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RETROGRADE FILLING
A retrograde filling is placed in the apically resected root
when the canal is poorly sealed from the surounding tissue.
Technique used depends on accessibility of root tip in
operative site,the presence of hazardous anatomic structures
surrounding the surgical site
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MATERIALS USED
Zinc and zinc free amalgam
Zinc oxide eugenol
Cavit
Polycarboxylate cement
GIC
Composite filling
Silver cones
Gold foils
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APICAL SEAL
The filling of the interface of the canal andperiapical tissue should seal the root canal fromsurrounding tissue
TECHNIQUE
The cavity in the beveled surface of the root isprepared for a retrograde filling with small, round
burs followed by inverted cone burs The ideal preparation has the smallest exposed
surface of the apex while encompassing allforamina and extends about 2mm inside the root
canal. 1) debride the operative site, dry the root tip with
sterile cotton pellets to prevents any seepage intothe wound during packing and condensation
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2) place varnish over the prepared cavity. pack the amalgaminto the cavity the cavity using a retrofilling amalgam carrier
3)wipe and adapt the margins of the amalgam to dentin with a
moist cotton pellet
4) remove all pellets surrounding the root apex cautiously toprevent amalgam particles trapped in the cotton from falling
into the surrounding tissue.
5) irrigate the wound with sterile saline or anesthetic solution
and aspirate the solution to debride the wound site
6)examine the root tip ,filling and surrounding tissue , bothvisually and radiographically to that the canals have been
properly sealed
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RADIOSECTOMY/ROOT RESECTION
It denotes the removal of one or more roots of the molar
INDICATION
When endodontic treatment of one root is technically
impossible or when such treatment has failed.
When untreatable furcation involvement is present andremoval of the root with facilitate oral hygiene in that area.
When extensive bone loss has occurred around one root of an
upper molar
When a fractured root of upper molar is present. CONTRAINDICATION
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Gum Tissue Opened
Tissue Removed
Root End Resected
Root End Filled Bone Healed
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When loss of bone involves more than one root and the
remaining root would have inadequate support
When roots are fused
TECHNIQUES
1) administration of local anesthesia
2)probe the area to determine the extend and outline of
alveolar bone destruction around the root to be removedelevate the mucoperiosteal flap
4)with the contra angle hand piece and cross cut bur
severe the root where it joins the crown and remove the
root.
5) with a stone or diamond point smooth the resected
stumps and contour the tooth.
6) clean the area and replace the flap and suture
7)remove the packing and suture after 1 week
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HEMISECTION
Is a procedure in which one root and its corresponding
portion is cut and removed. INDICATIONS
When the periodontal involvement of the root is severe.
When loss of bone is extensive in the furcation area when
caries involves much of the roots CONTRAINDICATIONS
Similar to radisectomy
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TECHNIQUE
It involves the same technique as that is used for root resection
In this procedure ,half of the crown is removed along with one
of the roots of mandibular molar
The retained mesial and distal halves serves as abutment for
prosthesis or restoration
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BICUSPIDISATION
Bisection
Molar is cut into separate mesial and distal portion without
the removal of an part of the crown or root
It is performed when the mandibular molars exhibit proper
anatomic form and stability
Molars with divergent roots and bone loss restricted to furcal
areas are ideal for bicuspidisation
The portion of the teeth will require crown
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APICOECTOMY Removal of root tip
INDICATIONS When the anatomy of the canal system has not been conductive to non
surgical treatment
When iatrogenic perforation or ledges prevent apical sealing
When the root tip is resorbed or fractured
PROCEDURE
Radiograph is taken to determine the level at which root should be
amputated
Design the mucoperiosteal flap
Now the flap is raised.
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control hemorrhage within the defect by crushingbleeding points in the bone by pressure or by cottonpellets dipped in epinephrine
Suture the mucoperiosteal flap and maintain firmpressure the area for 10 minutes
Obtain an immediate post operative radiograph to check
the level of root amputation and future comparison 21
Make an opening into periapical
Bony defect is removed using surgical bur or chiselExtend the opening into the labial plate to obtain good
accessto thelimits of the defect
Then with a fissured cylindrical bur amputate the root at the
appropriate level
Apical foramen is sealed either by retrograde filling or sealing
the guttapercha into the canal
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