Documente Academic
Documente Profesional
Documente Cultură
my
Fragiskos
Indications
The indications for apicoectomy include the following cases:
1. Teeth with active periapical inflammation, despite the
presence of a satisfactory endodontic therapy.
2. Teeth with periapical inflammation and unsatisfactory
endodontic therapy, which cannot be repeated because of:
Completely calcified root canal.
Severely curved root canals.
Presence of posts or cores in root canal.
Breakage of small instrument in root canal or the presence
of irretrievable filling material.
3. Teeth with periapical inflammation, where completion of
endodontic therapy is impossible due to:
Foreign bodies driven into periapical tissues.
Perforation of inferior wall of pulp chamber.
Perforation of root.
Fracture at apical third of tooth.
Dental anomalies (dens in dente).
Contraindications
The contraindications for apicoectomy are as
follows:
Concerning the age of the patient and general
health problems, such as severe cardiovascular
diseases, leukemia, tuberculosis, etc.
Teeth with severe periodontal disease (deep
periodontal pockets, great bone destruction).
Teeth with short root length.
Teeth whose apices have a close relationship
with anatomic structures (such as maxillary
sinus, mandibular canal, mental foramen,
incisive and greater palatine foramen).
Armamentarium
The following instruments are necessary for performing an
apicoectomy:
1) Microhead handpiece (straight and contra-angle) and microbur
2) Special narrow periapical curette tips for preparation of the periapical
cavity
3) Apical retrograde micro-mirror and micro-explorers
4) Local anesthetic syringe and cartridges.
5) Scalpel handle.
6) Scalpel blade (no. 15).
7) Mirror.
8) Periosteal elevator.
9) Cotton pliers.
10)Small hemostat.
11)Suction tips (small, large).
12)Irrigation receptacle.
13)Needle holder.
14)Retractors.
Surgical Technique
The procedure for apicoectomy includes the
following steps:
1. Designing of flap.
2. Localization of apex, exposure of the
periapical area and removal of
pathological tissue.
3. Resection of apex of tooth.
4. Retrograde filling, if deemed
necessary.
5. Wound cleansing and suturing.
Classification of surgical
flaps
There are two major categories of flap
design:
1) Sulcular full thickness flaps (full
mucoperiosteal flaps)
2) Mucogingival flaps (partial
mucoperiosteal flaps)
Rectangular flap:
1) Formed by intrasulcular, horizontal incision and two
vertical releasing incisions
2) Surgical access is increased in this flap
3) This flap design useful for mandibular anterior teeth,
multiple teeth and teeth with long roots e.g. maxillary
canines.
4) This flap design not recommended for posterior teeth
5) Main disadvantages are reapproximation and wound
closure are difficult
6) Postsurgical stabilization is difficult
7) Greater potential for postsurgical flap dislodgment
Trapezoidal flap:
1) Similar to rectangular flap except
two vertical releasing incisions
intersect the horizontal,
intrasulcular incision at obtuse angle
2) Broad based flap with vestibular
portion being wider than the
sulcular portion
Horizontal flap:
1) Also know an envelope flap
2) Created by a horizontal,
intrasulcular incision with NO
vertical releasing incision
3) Limited surgical access
Mucogingival flaps
Semilunar flap:
1) Inadequate visual and operative
access
2) Utilized for incision and drainage
procedure
3) Leaves a noticeable scar
Premedication
The following drugs are used in endodontic
surgeries which are recommended before
and after surgical endodontics:
1) Anti-inflammatory analgesics 400mg
ibuprofen just before the surgery to
minimize postsurgical inflammatory
response
2) Tranquilizers if the patient is anxious
about the surgery, 10mg diazepam
taken 15-30mins before the surgery
Designing of Flap
There are three types of flaps
principally used for apicoectomy:
1) The semilunar
2) Triangular and
3) Trapezoidal
Localization and
Exposure of Apex
1) When the periapical lesion has
perforated the buccal bone,
localization and exposure of the root
tip is easy, after removing the
pathological tissues with a currette
Resection of Apex of
Tooth
The apex is resected (23mmof the
total root length) with a narrow
fissure bur and beveled at a 45
angle to the long axis of the tooth
Retrograde Filling
Gauze impregnated with adrenaline to
minimize bleeding is placed in the
bony defect.
A microhead handpiece with a narrow
round microbur is then used to
prepare a cavity approximately 2 mm
long, with a diameter slightly larger
than that of the root canal
Periapical radiograph
taken after suturing o
flap, showing
retrograde amalgam
filling
Post operative
instructions
Do not do difficult activity or strenous exercise for the
rest of the day
Do not take alcohol or chew tobacco
Good diet and drink lots of liquids for the first few days
Do not lift up the lip or pull back your cheeks. This
may pull the stitches and cause bleeding
A little bleeding is normal
There may be little swelling and bruising of the face
Place an ice bag on face where surgery was done
After 8 hours of the surgery the ice bag should not be
kept but use a hot wet towel on the face. Do this for
the next 2 to 3 days
Rinse the mouth with chlorhexidine mouthwash two
times a day for 5 days
It is important to remove the stitches after 2 days
Complications
The most common perioperative and
postoperative complications that may
occur during and after the surgical
procedure, respectively, are:
Damage to the anatomic structures in
case of penetration of the nasal
cavity, maxillary sinus and mandibular
canal with the bur.