The most common cause of endodontic pathosis is bacteria:
a- True.***
b- False.
----------------------
What is endodontic surgery?
Endodontic surgery involves the removal by surgery of the pathological periapical tissue and the removal of the dental root third, to subsequently perform the sealing of the root canal or ducts.
This surgery is intended to create the optimal conditions for tissue regeneration and the formation of a new tooth support complex.
That is, by periapical or endodontic surgery we get:
- Eliminate the infectious focus, the root cyst, etc. through curettage and / or apical curettage and apicectomy that facilitates it.
- Preserve the causal tooth by treating relevant ducts and apical sealing by means of apicectomy and retrograde filling.
Endodontic surgery has three basic techniques that are: apical curettage, apicectomy and retrograde filling. This type of endodontic surgery requires great thoroughness and the observance of well-regulated stages, which together with the professional's skill will lead to successful technique.
When is endodontic surgery indicated?
The success or failure of this surgery will depend on the anatomical complexity of each tooth, that is, on the root canal system that is present and also, on the skill of the professional who will perform the treatment.
This surgery will be indicated in a general way when it is impossible through the duct system, to reach the infectious dental process to be treated or to the present lesion.
Likewise and therefore, endodontic surgery will be a treatment option when dental re-endodontics is not possible or is insufficient.
For the dentists specialized in dental clinics in Barcelona and Madrid of Propdental there are the following indications for each of the techniques that comprise endodontic surgery (apical curettage, apicectomy and retrograde obturation):
Apical curettage:
- When the filling of a root canal has exceeded the apex, irritating the periapical tissues.
- When an instrument has been forced beyond the apex, within the periapical tissues.
- In those cases in which having carried out a conservative therapy with an endodontic treatment, the periapical lesion is not reduced or even increased, or because periapical symptomatology persists.
- It is not possible to eliminate periapical pain by conservative procedures.
Apicectomy or apical resection:
- When a broken instrument gets stuck in the apical third and gives pathological manifestations.
- An instrument has perforated the root and conservative therapy has failed.
- There is a curvature of the apical third of the root canal that does not allow instrumentation and filling.
Retrograde shutter:
- When there is obliteration of the root canal due to secondary dentin deposits, which prevent instrumentation.
- In the two occlusal or incisal thirds of the duct a broken instrument has become stuck and it is not permeable.
- We cannot remove a defective root filling and there is periapical pathology.
- Tooth with a porcelain crown in which repeating endodontic treatment can cause a fracture of the dental prosthesis.
- There is a very open apex that would be very difficult to seal through the orthopedic route or when an apicoformation treatment has not resulted.
- There is a perforation of the root and the duct has no chance of being treated by the crown.
What are the contraindications of endodontic surgery?
- There are no absolute contraindications when performing endodontic surgery. However, there are a number of circumstances that must be taken into account when planning such surgery.
A complete and correct patient history will allow us to detect risk factors that could affect the performance and outcome of the surgical treatment. Thus, they should take into account:
- Systemic alterations. Such as severe and uncontrolled hypertension, myocardial infarction, sub-acute bacterial endocarditis, uncontrolled hematological problems, osteoradionecrosis, uncontrolled diabetes, ...
- Previous surgical treatments.
- Factors related to the patient. Psychological and / or emotional disorders, limited oral opening, ...
- Local anatomical factors.
- Teeth without the possibility of treatment by re-endodontics, the relationship between the dental crown and the root, if there is an untreated and / or advanced periodontal disease, ...
a- True.***
b- False.
----------------------
What is endodontic surgery?
Endodontic surgery involves the removal by surgery of the pathological periapical tissue and the removal of the dental root third, to subsequently perform the sealing of the root canal or ducts.
This surgery is intended to create the optimal conditions for tissue regeneration and the formation of a new tooth support complex.
That is, by periapical or endodontic surgery we get:
- Eliminate the infectious focus, the root cyst, etc. through curettage and / or apical curettage and apicectomy that facilitates it.
- Preserve the causal tooth by treating relevant ducts and apical sealing by means of apicectomy and retrograde filling.
Endodontic surgery has three basic techniques that are: apical curettage, apicectomy and retrograde filling. This type of endodontic surgery requires great thoroughness and the observance of well-regulated stages, which together with the professional's skill will lead to successful technique.
When is endodontic surgery indicated?
The success or failure of this surgery will depend on the anatomical complexity of each tooth, that is, on the root canal system that is present and also, on the skill of the professional who will perform the treatment.
This surgery will be indicated in a general way when it is impossible through the duct system, to reach the infectious dental process to be treated or to the present lesion.
Likewise and therefore, endodontic surgery will be a treatment option when dental re-endodontics is not possible or is insufficient.
For the dentists specialized in dental clinics in Barcelona and Madrid of Propdental there are the following indications for each of the techniques that comprise endodontic surgery (apical curettage, apicectomy and retrograde obturation):
Apical curettage:
- When the filling of a root canal has exceeded the apex, irritating the periapical tissues.
- When an instrument has been forced beyond the apex, within the periapical tissues.
- In those cases in which having carried out a conservative therapy with an endodontic treatment, the periapical lesion is not reduced or even increased, or because periapical symptomatology persists.
- It is not possible to eliminate periapical pain by conservative procedures.
Apicectomy or apical resection:
- When a broken instrument gets stuck in the apical third and gives pathological manifestations.
- An instrument has perforated the root and conservative therapy has failed.
- There is a curvature of the apical third of the root canal that does not allow instrumentation and filling.
Retrograde shutter:
- When there is obliteration of the root canal due to secondary dentin deposits, which prevent instrumentation.
- In the two occlusal or incisal thirds of the duct a broken instrument has become stuck and it is not permeable.
- We cannot remove a defective root filling and there is periapical pathology.
- Tooth with a porcelain crown in which repeating endodontic treatment can cause a fracture of the dental prosthesis.
- There is a very open apex that would be very difficult to seal through the orthopedic route or when an apicoformation treatment has not resulted.
- There is a perforation of the root and the duct has no chance of being treated by the crown.
What are the contraindications of endodontic surgery?
- There are no absolute contraindications when performing endodontic surgery. However, there are a number of circumstances that must be taken into account when planning such surgery.
A complete and correct patient history will allow us to detect risk factors that could affect the performance and outcome of the surgical treatment. Thus, they should take into account:
- Systemic alterations. Such as severe and uncontrolled hypertension, myocardial infarction, sub-acute bacterial endocarditis, uncontrolled hematological problems, osteoradionecrosis, uncontrolled diabetes, ...
- Previous surgical treatments.
- Factors related to the patient. Psychological and / or emotional disorders, limited oral opening, ...
- Local anatomical factors.
- Teeth without the possibility of treatment by re-endodontics, the relationship between the dental crown and the root, if there is an untreated and / or advanced periodontal disease, ...
What complications exist after endodontic surgery?
To avoid complications in this type of surgery it is essential to master the surgical technique, therefore, we must always put ourselves in the hands of specialists.
With proper treatment planning and establishing the appropriate surgical techniques, these post-operative complications are minimized to the maximum. Some of these complications after endodontic surgery can be:
Pain:
The pain after this type of surgery is usually moderate or mild, and may be more intense the first night after the surgery. To avoid and treat this, we must follow the medication prescribed by the oral surgeon and before an intensification of pain, we must go to the dental office without delay.
Hematoma:
The appearance of a bruise in the treated area is possible as well as an edema. Likewise, the inflammation of the treated area will be normal and the degree of this will not imply the success or failure of the treatment performed.
Ecchymosis:
It is more frequent in patients with whiter skin and older people. It is due to improper handling of soft tissues, especially in the retraction of the flap made excessive pressure, during surgery, on the lips and hard tissues. In about 10-15 days the normality of the area will be restored.
Hemorrhage:
This may be caused by:
- The rupture of a blood vessel during curettage of the lesion to be treated.
- An incomplete muco-periodical retraction.
- Deep incisions through muscle insertions.
- Inadequate replacement.
- Re-adaptation of the flap suture.
- You must press the area of the hemorrhage, that is, the area surgically treated with gauze for about 10-20 minutes.
Successful endodontic surgical treatment:
The definition of failure or endodontic success continues to be very controversial ...
The clinical definition of success is that of a dental piece without symptoms while the definition of radiological success is that of the resolution of periapical radius-lucidity. Likewise, the histological definition of success is the re-establishment of a normal structure in the absence of inflammatory and / or infectious cells.
In summary, we will conclude that the success of endodontic surgical treatment of an affected tooth is when it presents a state of health (bone scar) one year after the intervention.
If you require surgical endodontic treatment, our advice is to put yourself in the hands of specialists.
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