A CLINICAL ATLAS OF ENDODONTIC SURGERY RALPH BELLIZZI/ROBERT LOUSHINEContents ©ONO MB wDH 10 1 12 13 Presurgical Preparation Armamentarium Flap Design Suturing Incision and Drainage Trephination Decompression Maxillary Anterior Surgery Mandibular Anterior Surgery Mandibular Molar Surgery Maxillary Molar Surgery Maxillary Molar Palatal Root Surgery Postsurgical Complications Suggested Readings Appendix: Selected Manufacturers Listing Index 13 7 29 35 4 49 53 61 oe) 83 103 11 119 129 131 133O_O _—— eee 1 Presurgical Preparation Its at this time, before therapy, that lines of commu: nication are established between clinician and patient. A rapport is developed that allows both patient and inician to mutually share concerns before surgery. The patient is informed why he or she has been ‘eferred, the nature of the problem, and the techniques ‘that will be used to deal with each situation. One of the ‘most important parts of the presurgical conference: is a frank discussion of the prognosis and postsurgical Sequelae that may or may not accompany surgery. Anatomio structures that may be encountered are dis- ‘cussed. Written instructions, both preoperative and postoperative, are used as adjuncts to complement the arrative, which might otherwise inadvertently be for- gotten by the patient during the course of the dis- cussion, Presurgical technique notes Referral data Ensure that all referral data are on hand. Review with the pationt what he or she has been told about the ‘case; elicit his or her expectations and establish the Chief complaint. Compare this information with your referral data. Frequently, very valuable diagnostic data ‘can be gained that was previously overlooked. Record review Review for accuracy and update all vital statistios, to include name, address, date of birth, primary health ‘care contact point, telephone numbers, (both at home ‘and work), as well as social security number, insurance Provider, and next of kin or guardians, Medical history review Before you start any therapy, review the patient's present and past medical history, The existing history ‘must be reviewed, signed, and updated, Conduct a general survey of the major body systergs: cardiovas- ular, respiratory, gastrointestinal, urogenital, endo- crin, and central nervous. Pay particular attention to such areas as: |. Past and present medications Allergies Bleeding tendencies Past and recent hospitalizations Infectious diseases (eg, tuberculosis, hepatitis, herpes, human immunodeficiency virus) Rheumatic fever . Diabetes . Cardiovascular review * Hypertension (take a base line reading and re- Cord it before therapy) + History of recent or past myocardial infarction * By-pass surgery + Valve replacement Cancer Immune suppressive therapy Epilepsy Glaucoma Asthma, gsepe exo 9 10. 4 12 13, ‘Any other health-impaired conditions suspected should bbe ruled out by a physician before therapy. Preoperative radiographs Periapical radiographs (straight-on views and altered angulation, either from the mesial or distal) should be Teviewed before any surgical procedure is attempted, ‘A panoramic radiograph is recommended for posterior surgery {a referral radiograph is sent, it should be kept and made part of the permanent record. However, a new Tadiograph is always taken by the clinician before any form of therapy. Altered angulations reveal additional canals and/or roots, may or may not have been obturated; fractures; position of pins and posts; and to some de- ‘ree the density of any previous obturation. The panoramic radiograph is important, especially in Posterior surgery, because it reveals anatomic land- marks such as the inferior border of the mandible, men- tal foramen, mandibular canal, size and extent of any pathology, and the anterior, posterior, and inferior ex. tension of the maxillary sinuses. ‘An occlusal filmic eves ~