surgical tics

8/8/2019 Surgical tics

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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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