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Apicoectomy 15,768 views Share Like Download ...
Khizer Syed Follow Published on Dec 5, 2014
apicoectomy well elaborated ... Published in: Health & Medicine 0 Comments 75 Likes Statistics Notes
Full Name Comment goes here. 12 hours ago Delete Reply Block INTRODUCTION This a type of surgery where there is root resection done and the periapical pathological tissues are remo... Are you sure you want to Yes No Your message goes here
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DEFINITION Apicoectomy is the surgical resection of a tooth and its removal together with the pathological periapical t... 3 weeks ago
Mohamed Swilam 1 month ago
Hamza_alkubaisi 1 month ago Show More No Downloads Views Total views 15,768 On SlideShare 0 From Embeds 0 Number of Embeds 22 Actions INDICATIONS Anatomic problems : Calcifications Severe root curvatures Constricted canals Shares 0 Downloads 1,152 Comments 0 Likes 75 Embeds 0 No embeds No notes for slide
Apicoectomy 1. 1. APICOECTOMY By Khizer syed IV/I BDS 2. 2. INDEX INTRODUCTION DEFINITION INDICATIONS CONTRAINDICATIONS INSTRUMENTATION SURGICAL CONSIDERATIONS SURGICAL PROCEDURE COMPLICATIONS 3. 3. INTRODUCTION This a type of surgery where there is root resection done and the periapical pathological tissues are removed. This endodontic surgery is usually done when there is severe infection the pulp or apex. When there is a failure of root canal treatment apicoectomy is indicated. Following endodontic failure, conventional retreatment where possible gives an average success rate of 73%, whereas surgical retreatment with retrofill gives a success rate of 60%. Other studies have shown success rate of about 72%. Nevertheless, the surgical solution is never more successful than redoing the enodontics. 4. 4. DEFINITION Apicoectomy is the surgical resection of a tooth and its removal together with the pathological periapical tissues. Accessory root canals and additional apical foramina are also removed in this way, which may occur in the periapical area and which may be considered responsible for failure of an endodontic therapy. Failed root canal treatment : 5. 5. INDICATIONS Anatomic problems : Calcifications Severe root curvatures Constricted canals 6. 6. Failed root canal treatment : 7. 7. Horizontal root fracture : 8. 8. Procedural errors : Ledging Gross overfills Perforations 9. 9. Large unresolved lesions after root canal treatment : 10. 10. Ceramic crowns : 11. 11. CONTRAINDICATIONS Presence of systemic diseases – leukemia , uncontrolled diabetes , anemia , thyrotoxicosis , etc. Teeth with deep periodontal pockets and grade III mobility. When traumatic occlusion cannot be corrected. Grossly carious tooth 12. 12. Unidentified cause of treatment failure. Anatomical considerations. Maxillary sinus External oblique ridge Mental foramen • Poor crown and root ratio. 13. 13. INSTRUMENTATION #3 bard parker type blade handle and #15 surgical blade Molt periosteal elevator Seldin periosteal elevator Standard dental high speed hand piece Microhead hand piece, or the ultrasonic retrotip device #6 round bur #557 long fissured bur Micro inverted cone bur 33 2 Lucas curettes : #1R-1L and 3R-3L 14. 14. Retro-filling amalgam carrier, diameter 3/64 Small amalgam pluggers: behrman #1/smith/ marquette #1-2, and #11-12 back action 4-0 silk suture on an F-S needle 15. 15. SURGICAL CONSIDERATIONS Operating field : The perioral soft tissues should be clean-washed and painted with povidone-iodine. Skin flora is primarily staphylococcus while the intraoral flora is streptococcus. cleaning with povidone-iodine will minimize contamination of surgical wound 16. 16. Anatomy : Maxillary sinus External oblique ridge Mental foramen Neurovascular bundle with inferior alveolar canal 17. 17. SURGICAL PROCEDURE Flap design : A properly designed and carefully reflected flap will result in good access and uncontrollable healing. The basic principles of flap design should be followed. Three most common incisions given in apicoectomy are :- Submarginal curved (semilunar) Submarginal Full mucoperiosteal 18. 18. Submarginal curved (semilunar) : This is a slightly curved half moon horizontal incision in the alveolar mucosa. 19. 19. Advantages : Avoids injury to the papilla Location allows easy reflection Disadvantages : Access to the periradicular structures is restricted. Excessive hemorrhage. Delayed healing. Scarring. 20. 20. Submarginal incision : The horizontal component is in attached gingiva with one or two accompanying vertical incisions. The incision is scalloped in the horizontal line, with obtuse angles at the corners.
21. 21. It is used most successfully in the maxillary anterior region or occasionally with maxillary premolars Advantages : Esthetics. less likely to result in bone resorption and recession. Better access and visibility. Disadvantages : Hemorrhage Healing by scarring 22. 22. Full mucoperiosteal incision : This is an incision into the gingival sulcus , extending to gingival crest. This procedure includes elevation of interdental papilla, free gingival margin, attached gingiva, and alveolar mucosa. One or two vertical relaxing incisions may be used. 23. 23. Advantages : Maximum access and visibility. Not incising over the lesion or bony defect. Less tendency for hemorrhage. Allowing root planing and bone contouring. Reduced likelihood of healing with scar formation. Disadvantages : Difficult to replace and to suture Gingival recession, exposing crown margins or cervical root surfaces 24. 24. Anesthesia : For most surgical procedures, anesthetic approaches are conventional. In most regions a block is administered . Then local infiltration of an anesthetic with 1:50,000 epinephrine is given to enhance hemostasis. A log acting anesthetic agent is recommended, such as bupivacaine or etidocaine . Bupivacaine0.5% with epinephrine 1:200,000 has been shown to give long lasting anesthesia and later provide a lingering analgesia. 25. 25. Incision and reflection : A firm incision should be made through periosteum to bone. It is important to incise and reflect a full – thickness flap to minimize hemorrhage and to prevent tearing of the tissue. Horizontal root fracture : 26. 26. Reflection is with a sharp periosteal elevator beginning in the vertical incisions, then raising the horizontal component. To reflect the periosteum the elevator must firmly contact bone while the tissue is raised. Reflection is to a level adequate for access to the surgical site, although still allowing a retractor to have contact with bone. 27. 27. Periapical exposure : Frequently, the cortical bone overlying the apex has been resorbed , exposing a soft tissue lesion. If the opening is small, it is enlarged using a large surgical round bur, until approximately half the root and the lesion are visible. With a limited bony opening, radiographs are used in conjunction with root and bone topography to locate the apex. A measurement may be made with a periodontal probe on the radiograph, then transferred to the surgical site to determine the apex location. 28. 28. To avoid air emphysema, the use of handpieces that direct air, water, and abrasive particles into the surgical site should not be used. Vented high speed handpieces or electrical surgical handpieces are preferred during osseous entry, root end resection, or both. regardless of the handpiece used , there should be copious irrigation with a syringe or through the handpiece with sterile saline solution. Enough overlying bone should be removed to expose the area around the apex and atleast half the length of the root. Good access and visibility are important ; the bony window should be adequete. 29. 29. Curettage : Most of the granulomatous, inflamed tissue surrounding the apex should be removed. Gain access and visibility of the apex. Obtain a biopsy for histologic examination. If possible tissue should be enucleated in one piece with a suitably sized sharp curette. Tissue removal should not jeopardize the blood supply to an adjacent tooth. Some areas of the lesion may not be accessible to the curettes such as lingual aspect of the root 30. 30. If hemorrhage from soft or hard tissue is excessive to the extent that visibility is compromised, homeostatic agents or other techniques are useful. The best hemorrhage control is to apply and hold direct pressure over the bleeding site with gauze and to also minimize suction at the site of a bleeder. 31. 31. Root end resection : Root end resection is often , but not always indicated. It is useful to gain access to the canal for examination and placement of a root end preparation and restoration. To remove an undebrided or unobturated portion of root. Before sectioning , a trough is created around the apex with a tapered fissure bur to expose and isolate the root end. Resecting is with the same tapered fissure bur. Depending on the location and whether a root end preparation is to be placed. A bevel of varying degrees is made in a faciolingual direction. 32. 32. Root end preparation and restoration : This is indicated if there likely is an inadequete apical seal. A class I type of preparation should extend at least 3 to 4mm into the root to include the canal. The outline must include other canals and aberrations, such as isthmus. 33. 33. Root end preparation may be done by slow speed, specially designed microhandpieces or by ultrasonic tips. Ultrasonic instruments are easy to use. They also permit less apical root removal in certain situations. They form a cleaner and better shaped preparation. 34. 34. Root end-filling materials : The root end-filling material is placed into the cavity preparation. The material should seal well, be tissue tolerant, easy inserted, minimally affected by moisture and visible radiographically. Amalgam , intermediate restorative material (IRM), and super ethoxy benzoic acid (super EBA), cement have been commonly used. GuttaProcedural errors : Ledging Gross overfills Perforations percha, composite resin, glass ionomer cement and other luting cements are recommended. Mineral trioxide aggregate (MTA) has become a widely used material. 35. 35. Irrigation : The surgical site is flushed with copious amounts of sterile saline to remove soft and hard tissue debris , hemorrhage, blood clots and excess root en-filling material. 36. 36. Radiographic verification : Before suturing , a radiograph is made to verify that the surgical objectives are satisfactory. If corrections are needed, these are made before suturing. 37. 37. Flap replacement and suturing : The flap is returned to its original position and held with moderate digital pressure and moistened gauze. This expresses hemorrhage from under the flap and initial adaptation and more accurate suturing. Silk sutures are generally used. 4-0 suture is used which is absorbable. Both vertical and horizontal sutures are given. After suturing, the flap should again be compressed digitally with moisten gauze for several minutes to express more hemorrhage. The suture knots should note be too tight or it may strangle the tissue and decrease blood supply and cause hypertrophic scars. This encourages less postoperative swelling and more rapid healing. 38. 38. Post operative instructions : Pain – Pain medications should be started immediately postoperative, analgesics or non steroidal antiinflammatory drugs (NSAIDs) are very affective. Antibiotics – This is usually not recommended, because the infection rate following endodontics surgery is less. Swelling – Slight to moderate swelling should be expected, icepacks and NSAIDs may help. Steroids are not recommended. Oral hygiene procedures are indicated. Careful brushing and flossing may begin after 24 hours. Proper nutrition and fluids are important but should not traumatize the area. A chlorhexidine rinse, twice daily, reduces bacterial count at the surgical site. 39. 39. Suture removal and evaluation : Suture ordinarily are removed in 3 to 6 days with short periods being preferred to enhance healing. After 3 days swelling and discomfort should be decreasing. There should be evidence of primary wound closure. Follow ups visits should be at 4 weeks post removal of sutures , then at 6 and 12months 40. 40. COMPLICATIONS Intraoperative : Bleeding – control with local application of adrenaline pack, pressure pack Damage to the neighboring root. Entry into sinus/ inferior alveolar canal. Postoperative : Abscess formation. Fenestration, sinus tract formation. Increased mobility of tooth 41. 41. THANK YOU
Large unresolved lesions after root canal treatment :
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Anatomy : Maxillary sinus External oblique ridge Mental foramen Neurovascular bundle with inferior alveolar canal LinkedIn Corporation © 2018 × Share Clipboard × Email
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Send Email sent successfully.. Facebook Twitter LinkedIn SURGICAL PROCEDURE Flap design : A properly designed and carefully reflected flap will result in good access and uncon... Link Public clipboards featuring this slide
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Submarginal curved (semilunar) : This is a slightly curved half moon horizontal incision in the alveolar mucosa.
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Submarginal incision : The horizontal component is in attached gingiva with one or two accompanying vertical incisions....
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Full mucoperiosteal incision : This is an incision into the gingival sulcus , extending to gingival crest. This procedu...
Advantages : Maximum access and visibility. Not incising over the lesion or bony defect. Less tendency for hemorrhage. ...
Anesthesia : For most surgical procedures, anesthetic approaches are conventional. In most regions a block is administe...
Incision and reflection : A firm incision should be made through periosteum to bone. It is important to incise and refl...
Reflection is with a sharp periosteal elevator beginning in the vertical incisions, then raising the horizontal compone...
Periapical exposure : Frequently, the cortical bone overlying the apex has been resorbed , exposing a soft tissue lesio...
To avoid air emphysema, the use of handpieces that direct air, water, and abrasive particles into the surgical site shou...
Curettage : Most of the granulomatous, inflamed tissue surrounding the apex should be removed. Gain access and visibil...
If hemorrhage from soft or hard tissue is excessive to the extent that visibility is compromised, homeostatic agents or ...
Root end resection : Root end resection is often , but not always indicated. It is useful to gain access to the canal f...
Root end preparation and restoration : This is indicated if there likely is an inadequete apical seal. A class I type o...
Root end preparation may be done by slow speed, specially designed microhandpieces or by ultrasonic tips. Ultrasonic in...
Root end-filling materials : The root end-filling material is placed into the cavity preparation. The material should s...
Irrigation : The surgical site is flushed with copious amounts of sterile saline to remove soft and hard tissue debris ...
Radiographic verification : Before suturing , a radiograph is made to verify that the surgical objectives are satisfact...
Flap replacement and suturing : The flap is returned to its original position and held with moderate digital pressure an...
Post operative instructions : Pain – Pain medications should be started immediately postoperative, analgesics or non st...
Suture removal and evaluation : Suture ordinarily are removed in 3 to 6 days with short periods being preferred to enhan...
COMPLICATIONS Intraoperative : Bleeding – control with local application of adrenaline pack, pressure pack Damage to t...
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Apicoectomy
Apicoectomy
Apicoectomy
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