1

DEPARTMENT OF CONSERVATIVE DENTISTRY & ENDODONTICS

Presented By:Ashish KumarB.D.S. Final yearBatch: 2011-16

INSTITUTE OF DENTAL STUDIES & TECHNOLOGIES, MODINAGAR

ENDODONTIC SURGERYPART-1

Under guidance of: Prof. Dr. Sumeet Sharma

Dr. Rishi MananDr. Nikhil Puri

Dr. Surbhi Anand

2

CONTENTS Introduction. Historical aspect in endodontic surgery. Terminology. Objectives & rational for surgery. Indication. Contraindication. Treatment planning & presurgical notes for

periradicular surgery. Stages in surgical endodontics.

3

INTRODUCTION What is surgery? Surgery is the first

and the highest division of the healing art, pure in itself, perpetual in its applicability, a working product of heaven and sure of fame of earth.

- Sushrutra (400 B.C.) A statue dedicated to Suśruta at Haridwar.

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” - Aristotle

4

HISTORICAL ASPECT IN ENDODONTIC SURGERY:

The first recorded endodontic surgical procedure was incision and drainage of acute endodontic abcess performed by AETIUS, a Greek physician-dentist, over 1500 years ago.

5

HISTORY.. Father of endodontic

is Dr. Louis Grossman

G. V. Black in 1886, Farrar in 1884 and Grayston in 1887 also recommended for amputation of root in neglected long term abcess.

Dr. Louis Grossman

6

ENDODONTIC SURGERY Endodontic surgery is a

surgical procedure performed to remove or correct the causative agents of radicular and peri-radicular disease & to restore these tissues to functional health.

It is the LAST HOPE for retention of a tooth and therefore require the greatest skill.

7

TERMINOLOGY APICOECTOMY: removal of only apical

region and retrograde filling. RADISECTOMY: removal of a single root. ROOT END RESECTION: is used to describe

the removal of apical part of the root. ROOT END FILLING: describe the procedure

of placing a filling into a prepared apex.

8

TERMINOLOGY APICOECTOMY:

removal of only apical region and retrograde filling.

9

10

OBJECTIVES & RATIONAL FOR SURGERY

To ensure placement of a proper seal between periodontium and root canal foramina.

Now a days multiple treatment planning options are available for root treated teeth that develop recurrent periapical lesions that fail to heal following adequate root canal treatment.

“Surgery is always the second best. If you can do something else, its better”- John Kirklin (a American cardiac surgeon)

11

INDICATION Need for surgical

drainage. Failed nonsurgical

endodontic treatment1. Irretrievable root canal

filling material.2. Calcific metamorphosis

of the pulp space.3. Procedural errors. Instrument

fragmentation. Root perforation. Symptomatic overfilling.

12

INDICATION

Failure of non surgical endodontic retreatment.

Failure of previous surgery: due to lack of employing microsurgical instruments & magnification aids. Resurgery is indicated in such case.

13

INDICATION

Horizontal apical root fracture: occurs due to traumatic injury, surgical intervention is needed if apical segment become necrotic and non-surgical treatment is not possible.

Horizontal apical root fracture

Necrosed pulp

14

INDICATION Iatrogenic errors:

caused during RCT may include-

Blockage from debris.

Overfilling of canal leading to foreign body reaction.

Apical canal transportation.

15

INDICATION1. Anatomic

variations or problems:

Root dilaceration: endodontist unable to reach apical constriction due to blocked canal.

16

INDICATION Exploratory surgery and biopsy: Rare When a fracture is suspected or in a teeth

with vital pulp with radicular radiolucency as in patient with a previous history of malignancy.

17

INDICATION Periodontal

considerations: Periodontal support of

root goes beyond repair.

18

CONTRAINDICATIONS Inadequate

periodontal support & active uncontrollable periodontal disease.

Poor restorability with postendodontic restoration

19

CONTRAINDICATIONS Lesion situated

very close to important anatomical structure such as lingual nerve, inferior alveolar nerve, mental foramen,

20

CONTRAINDICATIONS Systemic

complications: Bleeding disorder. Immunocompromise

d patient. Severe heart

disease such as myocardial infarction.

21

CONTRAINDICATIONS

Practitioner’s skill and experience

22

TREATMENT PLANNING & PRESURGICAL NOTE FOR PERIRADICULAR SURGERY Proper planning is required presurgically

before deciding to subject patient to surgical endodontics.

Endodontic procedure must be carried out by-

Qualified, well trained, experienced endodontics.

Endodontics must know his/her limitations of clinical skills before performing endodontic surgery.

Informed consent is mandatory. All the surgical procedures have to explained in

details to the patient.

23

TREATMENT PLANNING & PRESURGICAL NOTE FOR PERIRADICULAR SURGERY

Case diagnosis

Preoperative surgical note

Anesthesia/hemostasis

STEPS IN ENDOSURGERY

24

CONTINUE…

Management of soft & hard tissues

Surgical access or osteotomy

Periradicular curettage

25

CONTINUE…

Access to root structure

Root-end preparation

Root-end resection

26

CONTINUE…

Root-end preparation

Root-end filling

Soft tissue repositioning & suturing

Postsurgical care

27

PREMEDICATION Necessary when patient remains overly

anxious by preoperative consultation. CLINICAL NOTE: For swelling or pain: Adv. 400 or

800 mg ibuprofen per day immediately prior to surgery & mostly advise to continue for 48 hrs postoperatively.

For anxiety: Adv. 5 mg valium on previous night of surgery & morning of surgery.

For immunocompromised patient: Adv. Antibiotics prophylaxis is mandatory. BUT generally antibiotics prescription should be avoided.

28

STAGES IN SURGICAL ENDODONTICS: MANDATORY

INVESTIGATIONS PRIOR TO SURGERY:

Clotting time. Bleeding time. Prothrombin time. Thrombin time. Partial thromboplastin time. Activated thromboplastin

time.

29

THANK YOU