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Surgical Procedure
The following eleven steps, with modifications as appropriate,make up the typical approach: (1) flap design, (2) incision and reflection, (3) access to the apex, (~) curettage,(5) root end resection, (6) root end preparation and filling,  17) radiographic verification, (8) flap replacement and suturing, (9) postoperative instructions, (10) suture removal, and (11) long-term evaluation. This s
BIBLIOGRAPHY
Cohen  lk, Diegelmann RF, Lindblad WJ: Wound healing: bio-  chemical and clinical aspects, Philadelphla, 1992, WB Saunders.
Leaper DJ. !larding KG: Wounds: biology and mallagemetlt, Odbrd, 19~8~th:rord University Press
PATIENT GENERAL HEALTH AND NUTRITION
Proper wound healing depends on a patient’s ability to resist infection, to provide essential nutrients for use as building materials, and to carry out reparative cellularprocesses. Numerous medical conditions lmpalr :a
patient’s ability to resist infection and heal wounds. . These include conditions that establish a. Qtabolic state of metabolism, that impede oxy
EDEMA CONTROL
Edema is an accumulation of fluid in the interstitial space because of transudation from damaged vessels and lymphatic obstruction by fibrin. Two variables help determine the degree of postsurgical edema. First, the greater
the amount of tissue injury, the greater the amount of edema. Second, the more loose connective tissue that is contained in the injured region, the more edema is present. For
DECONTAMINATION AND DEBRIDEMENT
Bacteria invariably contaminate all wounds that are open to the external or oral environment. Because the risk of infection rises with the increased size of an inoculum, one way to lessen the chance of wound infection is to decrease the bacterial count. This is easily accomplished by repeatedly irrigating the wound during surgery and closure. Irrigation dislodges bacteria and o
Dead Space Management
Dead space in a wound is any area that remains devoid of tissue after closure of the wound. Dead space is created by either removing tissue in the depths of a wound or by not reapproxlmating all tissue planes during closure. Dead space in J wound usually fills with blood, which creates a hematoma with a high potential for infection.
Dead space can be eliminated in four ways. The first isÂ
Means of Promoting Wound Hemostasis
Wound hemostasis can be obtained in five ways. The first is by assisting natural hemostatic mechanisms. This is usually accomplished by either using a fabric sponge to place pressure on bleeding vessels or placing a hemostat on a vessel. Both methods cause stasis of blood in vessels which promotes coagulation. A few small vessels generally  require pressure for only 20 to 3
HEMOSTASIS
Prevention of excessive blood loss during surgery is important for preserving a patient’s oxygen-carrying capacity. However, maintaining meticulous hemostasis during surgery is necessary for other important reasons.
One is the decreased visibility that uncontrolled bleeding creates. Even high-volume suctioning cannot keep a surgical field completely dry, particularly in the wellvascularized or
TISSUE HANDING
The difference between an acceptable and an excellent .surgical outcome often rests on how the surgeon handles the tissues. The use of proper ‘incision and flap design techniques plays a role; ‘however, tissue also must be handled
carefully, Excessive pulling or crushing, extremes of temperature, desiccation, or the use of unphysiologic chemicals easily damage tissue. Therefore the s
Prevention of Flap Tearing
Tearing of a flap is a common complication 0f  the next  perienced surgeon who attempts to perform a procedure using a flap that provides insufficient access. Because a properly repaired long incision heals just as quickly as a
short one, it is preferable to create a flap at the onset of surgery that is large enough for the surgeon to avoid either tearing it or interrupting surgery
