Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Download
Standard view
Full view
of .
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Atrevievy of Rootaresectivetherapy

Atrevievy of Rootaresectivetherapy

Ratings: (0)|Views: 12|Likes:
Published by Rajsandeep Singh
root resection surgical technique
root resection surgical technique

More info:

Categories:Types, Reviews
Published by: Rajsandeep Singh on Sep 26, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less

11/06/2013

pdf

text

original

 
ATREVIEVY OF
ROOTARESECTIVETHERAPY,AS
A
TREATMENT OPTION FOR MAXILLARYMOLARS
TIMOTHY HEMPTON,
D.D.S.;
CATALDO LEONE,
DM.D.,
D.SC.
Restorative treatment
planning
is often confounded when periodontalattachment
loss,
caries
or
tooth
fracture
involves the furcationarea of the tri-rooted
maxil
larymolars.
Although such
involvement
invariably diminishes
the
long-term prognosis
of theaffected
teeth,
extraction is notalways an option. Root
resective
therapy, which removes the involved
root
plus its associatedcrown portion
(trisection),
is oneof several treatment modalitiesthat can be used in such cases.This article reviews
the
indicationsand contraindications
for
root resective therapy, describesthe
technique of surgical trisec
tionand presents
a case
inwhich combined
resective,
endodonticand
prosthetic
managementresulted in a successful
outcome.
)
ne of the most compelling
challenges
we
face
in
dentistry today
is treatment planning
in
the posterior maxilla.Multirooted teethsuch
as
maxillary
molars have
root contours
that
greatly
limit
ac
cessibilityto
cleaning during nonsurgical and surgical
therapy.1'2
The maxillary
molar
usually has
three roots. These
roots
may be
di
vergentor fused, or they can be divergent coronally and fusedapi
cally
(Figure
1).
The locations of
separation
of the
roots
fromtheroot trunk-the furcation
areas-typically
occur on
themesial,
distal
and buccal
aspects
of maxillary
molars.Periodontal disease that extends
into
the furcation
areascan
pose
significant difficulty during
treatment,
as can
extensive caries
or root
fractures
that involve the furcation
areas.
Treating any of
 
these
problems
is
particularly
difficult with
regard
to
the interproximalfurcation areas (mesial and distal), as the diseaseprocess and
subsequent
treatment
could affect the
periodontal
attachment apparatusof the
adjacent
teeth. Root resective
therapy
can
be usedwhen attachment
loss,
caries or
a
fracture involves
a
furcation
area
of
a
maxillary
molar.This article reviews root resective therapy and theconcomitant
endodontic and prosthetic
management
as a treatment
option
for
maxillary
molars. The
indications
and
techniques
of this
treatmentare
presented
as
well
as
literature that reports
success
and failureof this
treatment.
REVIEW
OF
RELEVANT LITERATURE
A
significant
number of papers have been publishedregarding the
potential
for
success
with
root resective
therapy.34
Endodontic therapyis
typically performed either
before
or
after
root
resection.Endodontic
complications
(root fractures) have been citedas
a reason
for eventual failure of teeth treated with
root resective
therapy.57
A
root
from
a
maxillary
molar and theassociated portionof the
crown
supported by
that
root can
be
removed,
rather thanamputating just the
root as it emanates
apically
from
the
crown.Greenstein called this
treatment
of
maxillary
molars
a
trisection ofthe
tooth.8 Keough
reviewed the
technique
of removing
aroot
and
its
accompanying crown portion while concurrentlymodifying theemergence
profile
of the tooth
as it emanates
from theosseous
crest. He
advocated recontouring adjacent
osseous
structures to reestablish
 
positive
osseous
architecture.9
JADA,
Vol. 128,
April
1997 449
Downloaded from
 jada.ada.org
on September 25, 2010
~~C[INICAL PHACTIIE
LAL iLf13 L~
Figure
1.
Maxillary
molars
can
have
divergent
roots
(A),
fused roots
(B)
or
roots that
diverge coronally
and fuse at the apex
(C).
Modifying
tooth
structure
in
this fashion eliminates under
cuts
and has been
described
asa
"barreling
in"
of
the
root
form.'0 Crown
preparation
of
the altered tooth and
prosthetic
contours to
allow
increased
access
by
the
patient
has been
demonstrated
by
Kastenbaum."1Carnevale and
others"2
reported
a success
rate
of 95
percent
for
root
resective
therapy
using
the
surgical
and
prosthetic
proce
duressimilar
to
those advocated
by Keough9
and
Kastenbaum".
Proper
selection of
teeth,
con
servative
endodontic
access
andthe
design
of
the
prosthetic
treatment may
have lead
to
the
low failure
rate.
Determining
whether the
morphology
of the tooth is
amenable
to root
resective
ther
apyis critical. An
important
fac
tor
is the
length
of the
root
trunk. This
length
can
be de
fined
as
the distance between
the cementoenamel
junction
and
the
opening
of the furcation.
Atooth with
a
long
root
trunk is
less
likely
to
have furcation in
volvement,
as
the
junctional
ep
ithelium
must traverse
a
longer

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->