Surgical Endodontics and the Alternatives

Clinical Presentation Dr Venezia Sharma
PDH Cambridgeshire

Surgical Endodontics
Surgical endodontics involves the treatment of infections related to the roots of teeth directly ‡ ‡ ‡ ‡ by raising flaps of gingival tissue cleaning out the area of infection (curretage) sealing the root canal from inside the jaw (RRF) the procedure frequently involves removal of the apex of the tooth (apicectomy)

Indications for Surgical Endodontics
Presence of periapical infection with/without symptoms in an adequately root treated tooth where
‡ ‡ non-surgical root canal re-treatment cannot be undertaken or has failed or where re-treatment may be detrimental to the retention of the tooth

Contraindications
‡ Patient factors severe systemic diseases, psychological considerations ‡ Anatomical factors :
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Unusual bony/root configuration Lack of surgical access Possible involvement of neurovascular bundle Where the tooth is unrestorable Poor supporting tissue

‡ The skill, training and experience of the operator also matters

Surgical Procedure
‡ ‡ ‡ ‡ ‡ ‡ ‡ Gingival flap Bone removal Curretage Apical resection Apical preparation Periapical seal Closure of surgical site

Apicectomy of upper anterior

Apicectomy with RRF

1. Alveolar bone 2. Apical radiolucency showing infection around the tooth apex 3. Orthograde root filling within tooth 4. Bony healing area around tooth apex 5. Retrograde root filling (RRF) amalgam or IRM

Possible Complications of Surgery
‡ ‡ ‡ ‡ ‡ ‡ ‡ Bleeding Pain Ecchymosis (bruising) Swelling Tooth mobility Gingival recession Infection

Outcomes
SUCCESSFUL:
± ± ± ± ± ±

Success rates vary from 30-80% No tenderness to percussion Normal mobility of tooth No signs of infection (sinus tract) or swelling No pain or discomfort Radio graphically Good bony infill

UNSUCCESSFUL:
± ± ± ±

Persistent infection or swelling Discomfort on palpation High degree of tooth mobility Radio graphically no / low degree regeneration of bone

Alternatives
‡ Antibiotic therapy ‡ Surgical removal of the tooth ‡ No treatment

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