Principles of Endodontic Surgery


Anatomic Problems
Restorative Considerations
Horizontal Root Fracture
Irretrievable Material in Canal
Procedural Error
large Unresolved l,esions After Root Canal
Treatment •
Contraindlcations (or Cautions)
Unidentifie.d Cause of Treatment Failure
When Conventional Root Canal Treatment is
Simultaneous Root Canal Treatment and Apical
Surgery .
Anatomic Considerations
Poor Crown and Root Ratio
Medical (Systemic) Complications
Surgical Procedure
Flap Design
Semilunar Incision
Submarginal Incision
Full Mucoperiosteal Incision
Incision and Reflection
Perlaplcat Exposure
Root End Resection
Root End Preparation and Restoration
Root End-Filling Materials

Irrigation .
Radiographic Verification
Flap Replacement and Suturing
Postoperative Instructions
Suture Removal and Evaluation
Procedural Errors
Resorptive Perforatiow;
Anatomic Considerations
Location of Perforation
Surgical Approach I .
Repair Material
Prognosis Su’r.gICal Procedure
Light and Magnification Devices
Surgical Microscope
Fiber Optics
Guided Tissue Regeneration
Bone Augmentation
Training and Experience
Determinlnq the Cause of Root Canal Treatment
Surgical Difficulties

Endodontic surgery the management or provenion of j1crir;ldic.ular pathosis by J sl~igi~al In ‘enl’r JI. this Includes abscess drainage, periaplcal ur ~t’r.· COrTC, tive surgery, intentional replantation, and rtl( n:I1I()\ ell dlo.\ 17-1). lIT en” hil~ tradttlonally been an important part of end t anti.. treatment. However, until recently there was lit; l’ research on indications and contraindications, techruques, success and failure (i.e., long-term prognosis), wound healing, and materials and devices to augment procedures. Because of this lack of information, many
surgeries were performed for the wrong reasons, such as the routine correcting of failed root canal treatment, removing of large lesions believed to be cysts, or the performing of single-visit root canal treatment: Indeed, on occasion, a surgical approach is clearly indicated, but [ew situations exist in which sl/rgery is required. Other modalities, such as root canal treatment or retreatrnent, may be preferred. However, when surgery is required, it must adhere to basic endodontic principles, that is, the assessing and  obtaining of adequate debridement and obturation of the. canal or canals.’

Root canal treatment is generally a successful procedure if the. problem is accurately diagnosed and careful technique Is used. A common misconception is that if conventional root canal treatment fails, surgery is indcated forcorrection. Usually this is not true’; most failures are better managed by retreatment.? At other times surgery is necessary to correct a failure or, for other reasons, may be the only alternative to extraction. The purpose of this chapter is to present the Indications and contraindications for endodontic surgery, the diagnosis and treatment planning, and the basics of endodontic surgical techniques. Most of the procedures presented should ‘be performed by specialists, or on occasion, by experienced generalists. However, the general dentist must be skilled in diagnosis and treatment planning and able to recognize which procedures are indicated
in particular situations. When a patient is to be referred to a specialist for treatment, the general dentist must have knowledge sufficient to describe the surgical procedure. In addition, the generalist should assist in the follow-up care and long-term assessment of treatment outcomes.

The procedures discussed in this chapter are drainage of an abscess, apical (l.e., perpendicular) surgery, and corrective SURGERY.

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