Contraindications (or Cautions)
if othe options are available, periapical surgery may no! referred choice (Box] 7-3).Cllidcnti(ictf CUIIW IIf trcut nunt fuirWt Relying on surgery to try to correct all root canal treatment failures could be .labeled indiscriminate. An important consideration is to first, identify the cause of filllure.vthcn S(,COllcC design an appropriate corrective treatment plan. Usually. retreatrnent is indicated and will :’i\”(‘ t he best chance 01 success. Surgery to correct a treat men! failure’ for which the cause can-rot be dentified is often llm”L”n·~••Iul. Surgical managenient at all peri~pical jldtho\l”‘> .. large .pcri-
apical lesions, or both is often not necessary, because they will resolve after appropriate root canal treatment. This includes sions that may be. cystic; these also usually heal after root canal treatment. When conventional root canal treatment is possible. In most situations orthograde conventional root canal treatment is preferred (Fig. 17-11′ on page 391).4 Surgery is not indicated just because debridement and obturation are in the same visit, although there has been a long-held, incorrect notion that single-visit hould be accompanied by surgery, particularly if a periradicular lesion is present. Simultaneous root canal treatment and apicalurgery.
Few situations occur in which simultaneous root canal therapy and apical surgery is indicated. Usually, an approach that includes both of these as a single procedure has no advantages. It is preferable, and. likely will result in better success, to perform only the conventional treatment without the adjunctive apical surgery. Another consideration is posttreatment symptoms. The level and incidence of pain after apical surgery is higher as compared with root canal treatment.” Anatomic considerations. Most oral structures do not interfere with a surgical approach but must be considered, An example is the maxillary sinus, whic may become exposed. Creating a sinus opening is neither unusual nor dangerous. However, caution is necessary to not introduce foreign objects into the opening and to remind the patient not to exert pressure by f~cibly blowing the nose until the surgical wound has healed (in 1 to 2.weeks). Bony structures generally do not contraindicate surery, with the exception of the external oblique ridge rer the mandibular second and third molars. In most this structure prevents adequate access to the ro ble. Other approaches, such as intentional replantation(Fig. 17-12 on page 392), may be indicated. The zygomatic buttress may inhibit access to maxillary molar apices. A prominent chin creates a shallow vestibule with limited access to mandibular anteriors. The mental foramen is of concern but is easily avoided by identifying its position radiographically and during flap reflection. Poor crOW1Iand root ratio. Teeth with very short roots have compromised bony support and are’ poor candidates for surgery; root end resection in such cases may compromise stability. However, shorter roots may support a relatively long crown if the urrounding cervical periodontium is healthy (see Fig. ’17-5) . .\fcdiwi (‘Iptell/ic) complications, The general health and condition of the patient are always. essential considerations. No specific contraindications for endodontic surgery exist that would not be similar to those for other types of oral surgical procedures.