- Slides: 30
Dr. Hani Al Sheikh Radhi Endodontic surgery
Terms to remember �Orthograde endodontics (conventional) �Retrograde Endodontics (Endodontics surgery)
Points to remember �Always think orthograde is the Rx of chocie. �Why we can not do conventional endodontic treatment. (Identify the cause). �Then think about RE-ENDO. �FINALLY THE RETROGRADE (APICECTOMY)
The main point is : �“Surgical approach is only indicated when it is agreed that orthograde retreatment is either not possible or will not solve the problem”.
Retrograde Root Filling History �early as the 1880’s attempts were made to remove the problematic section only of the tooth. �The terms Retrograde filling, retroseal, or retrofill, were introduced about 1925. �In about 1930 it was understood that regeneration of the lost tissue (bone) can be achieved if the root canal system is sealed. (conventionally or retrograde).
History �Retrograde filling in 1925 was explained as: “ the preparation of a root-end cavity and insertion of a root-end filling in the prepared cavity while leaving the main portion of the root canal space untreated and unfilled”
The main goals �Our goal and target is to remove bacteria and pathogens from the root canal system to prevent spread of infection to the periapical area. �Orthograde versus Retrograde can explain why we do not prefer the apicectomy when we compare the bacterial load and recurrence of infection.
Root Canal System complexity �Explain why total clearance is not possible. �Undetectable canals �Very small canals �All infected.
Endodontic Surgery �Indications to perform endodontic surgery
Endodontic Surgery �Usually the conventional can solve the problem. �We switch to retrograde if: Drainage is required (why we do drainage? Sometimes access through the crown no more than 24 hrs. ) Biopsy of we suspect the lesion nature.
Endodontic Surgery Indications �Biopsy / drainage �No pulp space for Rx �Bizarre root configuration �Presence of post & core in the canal. �Breakage of Instrument in the canal. �Foreign bodies driven into the periapical area. �Perforation of the root. �Dental anomalies.
Armamentarium of Endodontic Surgery � 2 Generations of endodontic surgery instruments and materials. � To improve the success and prognosis.
General Armamentariums � � � � Microhead handpiece (straight and contra-angle) and micro-bur. Special narrow periapical curette tips for preparation of the periapical cavity. Apical retrograde micro-mirror and micro-explorers. Local anesthetic syringe and cartridges. Scalpel handle. Scalpel blade (no. 15). Mirror. Periosteal elevator. Cotton pliers. Small hemostat. Suction tips (small, large). Irrigation. Needle holder. Retractors. Sutures.
Armamentarium 1 ST GENERATION 2 ND GENERATION � Microhead handpiece � Ultrasonic preparation heads
Armamentarium 1 ST GENERATION 2 ND GENERATION � Conventional Mirror � Different mirrors & sizes
Armamentarium 1 ST GENERATION 2 GENERATION � Micro-surgical blades
Armamentarium �Special amalgam carrier
Armamentarium �Special mirror and explorers (probes)
Surgical Approach �Flap design
Surgical appraoch � 3 types of flaps Semilunar 3 sided flap Luebke-Oschenbein
Surgical approach � Semilunar flap Not recommended Blood supply Observation Healing problem
Surgical approach �Luebke-Oschenbein Not recommended Blood supply.
Surgical approach � 3 sided flap