surgical tics

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    SURGICAL ENDODONTICS

    OBJECTIVE

    To ensure the placement of the

    proper seal between periodontium and

    root canal foramina.

    Surgical procedure permits visual

    and manipulative control of the area and placement of seal.

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    INDICATIONS

    Any condition or obstruction that prevents duct access to the

    apical third f the canal

    Iatrogenic or resorptive perforation that cannot be treated

    with calcium hydroxide

    Periradicular disease associated with foreign body

    Incomplete apexogenesis with blunderbass canals or other

    apices that do not respond to apexification procedure and

    are inadequately sealed with orthograde filling.

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    Abscess formation necessitating incision and drainage Horizontally fractured root tip with periradicular disease

    Periodontal lesion with furcation involvement that do not

    respond to periodontal treatment thus necessitating

    radiosectomy Replantation of avulsed teeth

    Intentional extraction and replantation

    Predictable failure

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    CONTRAINDICATION

    GENERAL

    Medically compromised or brittle patient that is a patient with

    an active systemic disease

    Emotionally disturbed patient ,ie a patient unable

    psychologically to withstand or cope with any surgical

    procedure

    Limitations in the surgical still and experience of the operator

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    LOCAL

    Localized acute inflammation

    Anatomic consideration

    Inaccessible surgical site

    Teeth with poor prognosis

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    CLASSIFICATION

    SURGICAL DRAINAGE

    incision and drainage

    cortical trephination

    PERIRADICULAR SURGERY

    Curettage

    Biopsy

    Root end resection

    Root end preparation and filling

    Corrective surgery

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    1)perforation repair

    2)root resection

    3)hemisection

    REPLACEMENT SURGERY

    extraction\ replantation

    IMPLANT SURGERY

    Endodontic implant

    Root from osseintegrated implant

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    RETROGRADE FILLING

    A retrograde filling is placed in the apically resected root

    when the canal is poorly sealed from the surounding tissue.

    Technique used depends on accessibility of root tip in

    operative site,the presence of hazardous anatomic structures

    surrounding the surgical site

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    MATERIALS USED

    Zinc and zinc free amalgam

    Zinc oxide eugenol

    Cavit

    Polycarboxylate cement

    GIC

    Composite filling

    Silver cones

    Gold foils

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    APICAL SEAL

    The filling of the interface of the canal andperiapical tissue should seal the root canal fromsurrounding tissue

    TECHNIQUE

    The cavity in the beveled surface of the root isprepared for a retrograde filling with small, round

    burs followed by inverted cone burs The ideal preparation has the smallest exposed

    surface of the apex while encompassing allforamina and extends about 2mm inside the root

    canal. 1) debride the operative site, dry the root tip with

    sterile cotton pellets to prevents any seepage intothe wound during packing and condensation

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    2) place varnish over the prepared cavity. pack the amalgaminto the cavity the cavity using a retrofilling amalgam carrier

    3)wipe and adapt the margins of the amalgam to dentin with a

    moist cotton pellet

    4) remove all pellets surrounding the root apex cautiously toprevent amalgam particles trapped in the cotton from falling

    into the surrounding tissue.

    5) irrigate the wound with sterile saline or anesthetic solution

    and aspirate the solution to debride the wound site

    6)examine the root tip ,filling and surrounding tissue , bothvisually and radiographically to that the canals have been

    properly sealed

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    RADIOSECTOMY/ROOT RESECTION

    It denotes the removal of one or more roots of the molar

    INDICATION

    When endodontic treatment of one root is technically

    impossible or when such treatment has failed.

    When untreatable furcation involvement is present andremoval of the root with facilitate oral hygiene in that area.

    When extensive bone loss has occurred around one root of an

    upper molar

    When a fractured root of upper molar is present. CONTRAINDICATION

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    Gum Tissue Opened

    Tissue Removed

    Root End Resected

    Root End Filled Bone Healed

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    When loss of bone involves more than one root and the

    remaining root would have inadequate support

    When roots are fused

    TECHNIQUES

    1) administration of local anesthesia

    2)probe the area to determine the extend and outline of

    alveolar bone destruction around the root to be removedelevate the mucoperiosteal flap

    4)with the contra angle hand piece and cross cut bur

    severe the root where it joins the crown and remove the

    root.

    5) with a stone or diamond point smooth the resected

    stumps and contour the tooth.

    6) clean the area and replace the flap and suture

    7)remove the packing and suture after 1 week

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    HEMISECTION

    Is a procedure in which one root and its corresponding

    portion is cut and removed. INDICATIONS

    When the periodontal involvement of the root is severe.

    When loss of bone is extensive in the furcation area when

    caries involves much of the roots CONTRAINDICATIONS

    Similar to radisectomy

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    TECHNIQUE

    It involves the same technique as that is used for root resection

    In this procedure ,half of the crown is removed along with one

    of the roots of mandibular molar

    The retained mesial and distal halves serves as abutment for

    prosthesis or restoration

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    BICUSPIDISATION

    Bisection

    Molar is cut into separate mesial and distal portion without

    the removal of an part of the crown or root

    It is performed when the mandibular molars exhibit proper

    anatomic form and stability

    Molars with divergent roots and bone loss restricted to furcal

    areas are ideal for bicuspidisation

    The portion of the teeth will require crown

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    APICOECTOMY Removal of root tip

    INDICATIONS When the anatomy of the canal system has not been conductive to non

    surgical treatment

    When iatrogenic perforation or ledges prevent apical sealing

    When the root tip is resorbed or fractured

    PROCEDURE

    Radiograph is taken to determine the level at which root should be

    amputated

    Design the mucoperiosteal flap

    Now the flap is raised.

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    control hemorrhage within the defect by crushingbleeding points in the bone by pressure or by cottonpellets dipped in epinephrine

    Suture the mucoperiosteal flap and maintain firmpressure the area for 10 minutes

    Obtain an immediate post operative radiograph to check

    the level of root amputation and future comparison 21

    Make an opening into periapical

    Bony defect is removed using surgical bur or chiselExtend the opening into the labial plate to obtain good

    accessto thelimits of the defect

    Then with a fissured cylindrical bur amputate the root at the

    appropriate level

    Apical foramen is sealed either by retrograde filling or sealing

    the guttapercha into the canal

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