DR ZIA ABBAS

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APICOECTOMY

Surgical amputation of the apex of

tooth root. (Apical 1/3rd)

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APICAL CURETTAGE

Surgical removal of the periapical

pathological material

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 INDICATIONS
1. Elimination Of Apical Delta
The root canal opens into the apical area through multiple
channels in the apex of the tooth called “apical delta”. Main
aim of Apicoectomy is to eliminate this apical delta which in
certain cases is difficult to sterilize by standard root canal
treatment methods.
2. Excessive root filling in the periapical area.
3. Conservative R.C.T. has failed to eliminate periapical
infection.
4. Periapical cyst
5. Large grannuloma which is not eliminated by normal
R.C.T.
6. Fracture of root at apical 1/3rd area.
7. Treatment to be completed in one visit.

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CONTRA INDICATIONS
1. Loose tooth - Less bony support
2. Fracture of root coronal to apical 1/3rd
3. In acute inflammatory condition
4. Close proximity of vital structures i.e.
maxillary sinus, inferior alveolar nerve.
5. Inadequate root filling, too short filling, no
apical seal or voids in the canal itself. (redo
root filling)
6. Medical conditions blood dyscrasias, marble
bone disease, radio therapy, immune
deficient patient, endocarditus risk.

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REQUIREMENTS
1. Pulp testing of neighbouring teeth
2. Good root filling, Good post R.C.T. x-ray.
3. No sinus present in the sulcus or is reduced by
controlling infection.
4. Periodontal pocketing is assessed before hand.
5. Preoperative assessment of close proximity of
neighbouring teeth or vital structures.
6. Assessment of extension of apical lesion to decide
flap design.
7. Antibiotic cover (controlled apical infection)
8. Selection of anesthesia
9. Assessment regarding need for retrograde filling.
10. Operated tooth should be made occlusion free.

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RETROGRADE ROOT FILLING

Sealing of the canal from the apical end

following Apicoectomy. (normally done
by amalgam – zinc free.)

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INDICATIONS
1. Curved root. Coronal reaming and filling not possible .
2. Broken instrument in the canal which cannot be removed.
3. If apical seal not possible by Orthograde filling. (in vide
apical foramen – when root formation is not complete.)
4. Crowned tooth where crown cannot be removed. (risk of
fracture of crown of tooth)
5. Perforation of root, coronal to the apex.
6. If deficiency of apical seal is found at the time of surgery and
there is no time or arrangement to redo the root filling.

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 The two retrograde filling materials
currently
 recommended are Super EBA and
 MTA.
 Super EBA is a modified zinc oxide
 eugenol cement

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Super EBA

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Preparation and Placement of
Super EBA
 The liquid and powder are mixed in
1:4 ratio over a glass slab. Small
increments of powder are
incorporated into the liquid until the
mixture loses its shine and the tip of
EBA does not droop when picked up
with an EBA carrier.

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 A 3-mm-long segment is picked
up by the carrier and placed directly into
the
dried retroprepared cavity under
midrange
magnification.

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 The EBA is condensed into the
cavity.

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 A periodontal curette can be used
to carve away excess Super EBA.

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 The material can be polished with a composite
finishing bur to a smooth finish.

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Mineral Trioxide Aggregate (MTA)

Pellet forming block and placement

instrument.
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 The groove filled with MTA.

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 The MTA pellet is carried
out of the groove using the placement
instrument

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 The MTA pellet on the placement
instrument.

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 MTA transferred into the retropreparation

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 Packing MTA with a ball burnisher

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 A wet cotton pellet is used to
wipe off excess cement

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WOUND CLOSURE
 Wound closure after surgical
procedure has
 Three stages: reapproximation and
compression, stabilization with
sutures, and suture removal.

The flap is nicely

reapproximated
following saline wet gauze
compression of three
minutes.

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 Interrupted suturing of the vertical
incision; note the placement of the suture
knots away from incision line

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POSTSURGICAL CARE
 Postoperative patient instructions should include

1. Intermittent application of ice pack to the surgical site (30 minutes

on, 30 minutes off ) starting immediately after the surgery and
continuing for six to eight hours.

2. Strenuous activity, smoking, and alcohol should be avoided.

3. Normal food is permitted with emphasis on the avoidance of hard,

sticky, and chewy food.

4. Do not pull the lip or facial tissues.

5. Continue the use of analgesics given presurgically (600 mg

ibuprofen every 6 hours as needed). Slight to moderate discomfort
is expected for the first 24–48 hours. Narcotic analgesics are
provided and used only as an adjunct to ibuprofen if needed.

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6. Oozing of blood from the surgical site is normal
for the first 24 hours. It can be managed with
application of a wet gauze pack to the site,
pressed in place with an ice pack.

7. The day following the surgery, chlorhexidine

rinses should be used twice a day, continuing for
three to four days. Warm salt water rinses can be
used every two hours.

8. Brushing of the surgical site is not recommended

until the sutures are removed. Cotton swabs can
be used to clean thesurgical site.

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