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Apicectomies |
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Indications for Surgery: ¨ Impossible to prepare and fill apical 1/3rd of tooth, e.g. pulpal calcification, curved apex, open apex ¨ Broken instrument in canal ¨ Post crown on tooth with apical pathology (only if post crown has sealed the coronal root and crown margin) ¨ Root perforation ¨ Fractured and infected apical 1/3rd ¨ Persistent infection due to apical cyst
Assessment: Intraoral radiograph, best possible root filling in situ, free from acute infection, crown sealed with good quality restoration.
Access and Flap design 1. Should permit an unobstructed view and easy access or instrumentation 2. Should allow adequate blood supply and the margins to lie over bone not over a void Commonly used flaps Semilunar Flap Leubke—Ochsenbein flap Full muco-periosteal flap Root Apex resection ¨ Gain access to periapical region with bone removal ¨ Remove peri-apical diseased soft tissue by curettage ? Sample to histology ¨ Remove the apical delta of the root (about 3mm) resection angle ideally should be 90 degrees
The Retrograde Root Filling ¨ Clean and prepare the apical 3mm ¨ Hermetically seal the apex no ideal material has yet been introduced. Amalgam is commonly used other materials include super EBA, MMA and MTA ¨ Debridement and Irrigation
Flap Closure
Warnings: ¨ Post-op swelling ¨ Remember the mental nerve for lower premolar apicectomies ¨ Think hard about alternative to apicectomies of the lower molars ¨ Apicectomy of upper first molars is fine, providing the palatal root can be treated by orthograde approach, is hemisected or you are happy to deal with a breach of the antrum ¨ Remember the buccal and palatal roots in upper first premolars
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AN OVERVIEW |
