Summary of "Surgical Endodontics"
Summary of "Surgical Endodontics" Video
This video provides an overview of key surgical endodontic procedures based on the sixth edition of the Guide to Clinical Endodontics by the American Association of Endodontists (AAE). It covers indications, methodology, and clinical considerations for various surgical interventions used to manage persistent or complex endodontic pathologies.
Main Ideas and Concepts
- Introduction to Surgical Endodontics
- Focus on surgical procedures used when non-surgical root canal therapy is insufficient or not possible.
- Emphasis on AAE guidelines and biopsy recommendations for persistent or atypical lesions.
- AAE Biopsy Recommendations
- Biopsy should be taken if:
- Enough tissue can be safely removed for histopathological examination.
- The pathology is persistent or inconsistent with typical endodontic disease.
- Patient’s medical history indicates systemic disease or cancer.
- Biopsy = removal of soft or hard tissue for microscopic examination.
- Biopsy should be taken if:
Detailed Procedures Covered
- Incision and Drainage
- Indicated for localized soft tissue swelling and pain due to abscess.
- Purpose: release exudate, decompress swelling, collect bacterial samples.
- Procedure:
- Surgical incision through soft tissue.
- Possible placement of a temporary drain.
- Antibiotics prescribed if diffuse swelling (cellulitis), systemic symptoms, or immunocompromised patient.
- Visualized as incision releasing pus from a soft tissue swelling adjacent to a necrotic tooth.
- Trephination (Teffonation)
- Similar to incision and drainage but involves perforation through alveolar bone.
- Indicated when exudate is confined within bone.
- Procedure:
- Surgical perforation of cortical bone using a bur.
- Drain placement and antibiotics as needed.
- Provides a pathway to drain intraosseous exudate.
- Apicoectomy (Root End Resection)
- Indicated for persistent or worsening periapical pathology after root canal treatment or inaccessible apical pathology.
- Procedure:
- Elevation of mucoperiosteal flap.
- Bone removal for access.
- Removal (resection) of apical root tip and associated diseased tissue.
- Often combined with:
- Peri-radicular Curettage: removal of diseased tissue and foreign material at root apex.
- Root End Filling: preparation and filling of root end with biocompatible material after Apicoectomy.
- Root Resection (Root Amputation)
- Indicated for multi-rooted teeth where one root is diseased and others are sound.
- Used for vertical root fractures, severe infrabony defects, perforations, or persistent apical pathology.
- Procedure:
- Ideally after completion of root canal treatment and restoration.
- Removal of affected root while preserving the rest of the tooth.
- Techniques:
- Vertical Cut Technique: section through furcation to remove affected root and crown portion.
- Horizontal Resection: amputation of root only, preserving crown and prostheses.
- Intentional Replantation
- Considered when non-surgical and surgical treatments are not possible or have poor prognosis.
- Criteria:
- Tooth can be extracted without high fracture risk.
- Acceptable periodontal status.
- Persistent peri-radicular pathology.
- Procedure:
- Extraction of the tooth.
- Root end repair or filling outside the socket.
- Replantation of the tooth with or without stabilization.
- Surgical Removal of a Fractured Apical Segment
- Indicated when apical root fracture leads to pulpal necrosis.
- Coronal portion must be restorable and functional.
- Procedure:
- Mucoperiosteal flap elevation.
- Bone removal for visualization.
- Removal of fractured apical root segment and surrounding diseased tissue.
- Possible root end resection/filling and guided tissue regeneration or bone grafting.
Summary of Methodology / Steps for Surgical Procedures
- Incision and Drainage
- Identify localized swelling.
- Incise soft tissue.
- Drain exudate.
- Place drain if needed.
- Prescribe antibiotics if systemic involvement.
- Trephination
- Identify intraosseous exudate.
- Perforate cortical bone using bur.
- Drain exudate.
- Place drain and/or antibiotics as indicated.
- Apicoectomy with Curettage and Root End Filling
- Raise mucoperiosteal flap.
- Remove bone for access.
- Remove diseased tissue (curettage).
- Resect root apex.
- Prepare and fill root end with biocompatible material.
- Root Resection (Amputation)
Category
Educational
