Endodontic Surgery

Bilog
Falloran
Ferrer
Delos Reyes
Palor
Quinones`
 What is Endodontic Surgery?
• A surgical procedure performed to correct or
remove the causative agents of radicular and
periradicular disease and to restore these tissues
to functional health
 Indications:
• Need for surgical drainage
• Failed endodontic treatment
-irretrievable root canal filling material
-irretrievable intraradicular post
• Calcification of pulp space
• Procedural errors
-instrument fragmentation
-non-negotiable ledging
-root perforation
• Symptomatic overfilling
• Corrective surgery
• Root caries
• Root resection
• Hemi section
 Contraindications
• Poor systemic health
• Local anatomical considerations
• Poor periodontal status
• Short root length
• Acute infection
• Non restorable tooth
 Pre-surgical consideration

•Medical history
•Periodontal evaluation
•Patient’s motivation
•Informed consent
Classification of Endodontic Surgery
SURGICAL DRAINAGE
 INCISION AND DRAINAGE

• Indicated when purulent and or hemorrhagic exudate forms within

soft tissue or the alveolar bone as a result of a symptomatic
periradicular abscess
TREPHINATION
 APICAL TREPHINATION
• Apical trephination- involves penetration of the apical foramen with a
small endodontic file and enlarging the apical opening to a size No.20
or 25 file to allow drainage from periradicular lesion into the canal
space
 CORTICAL TREPHINATION
• is a procedure involving the perforation of the cortical plate to
accomplish the release of pressure from the accumulation of exudate
within the alveolar bone
PERIRADICULAR SURGERY
 CURETTAGE
• is a part of the treatment procedure of periradicular surgery.
• Its main purpose is to remove pathological periradicular tissues for
visibility and accessibility to facilitate the treatment of the apical root
canal system, or sometimes for the removal of harmful foreign
materials present in the periradicular area
 Biopsy
• Although the majority of oral lesions are benign, if there is any
possibility that the growth could be cancerous or pre-cancerous, it's
likely that a biopsy will be performed

• Typically, the procedure requires only local anesthesia, and it doesn't

take long. If incisions are made, they are often closed with self-
dissolving sutures (stitches) that don't need to be removed.
Apicoectomy
• Is a surgical resection of a tooth and its removal together with the
pathological periapical tissues. Accessory root canals and additional
apical foramina are also removed in this way, which may occur in the
periapical area and which may be considered responsible for failure of
an endodontic therapy

• A root end surgery, also known as apicoectomy, root resection,

retrograde root canal treatment or root-end filling, is an endodontic
surgical procedure whereby a tooth's root tip is removed and a root
end cavity is prepared and filled with a biocompatible material.
Indications

• severe root curvatures

• Failed root canal treatment
• Horizontal root fracture
• gross overfills
Contraindications
• Presence of systemic diseases
• Teeth with deep periodontal
pockets and grade III mobility
• When traumatic occlusion
cannot be corrected
• Grossly carious tooth
Root Resection
• Is the process by which one or more of the roots of a tooth are
removed at the level of the furcation while leaving the crown and
remaining roots in function
Indications
• To remove undebrided or unobturated or both portion of a root
• For dilacerated roots
• Ledged or blocked canals
HEMISECTION
• A surgical procedure whereby the roots of a tooth (affected by
periodontal, endodontic and structural) are separated and treated as
individual teeth. Used when maintaining the tooth intact is impossible
because of gum disease.
Indications
1. The tooth is affected by caries, vertical root fracture, periodontal
disease or iatrogenic root perforation where only one root of a
multi rooted tooth is affected.
2. The surviving root is accessible and treatable endodontically.
3. The surviving root is structurally capable of supporting a dowel and
core restoration.
4. The surviving root is aligned so as to provide proper draw for the
resulting fixed prosthetic restoration.
**The root morphology allows for surgical access and proper
periodontal maintenance of the final restoration.
REPLACEMENT SURGERY
REPLANTATION
• Grossman, in 1982, defined intentional replantation as “the act of
deliberately removing a tooth and following examination, diagnosis,
endodontic manipulation and repair-returning the tooth to it’s
original socket”.

CLASSIFICATION:
1. Intentional replantation
2. Unintentional replantation
Indications
• Nonsurgical endodontic treatment not possible due to limited mouth
opening.
• Calcifications, posts or separated instruments present in canals making
nonsurgical endodontics therapy difficult.
• Persistent infection even after root canal treatment.
• Inaccessibility for surgical approach for periodicular surgery due to
anatomic factors.
• Perforations in inaccessible areas where for surgery excessive bone loss
required.
• For thorough examination of root defects like crack or perforation.
• Accidental avulsion (i.e. unintentional replantation)
Contraindications
• Curved ad flared canals
• Nonrestorable tooth
• Moderate to severe periodontal disease
• Missing interseptal bone
• Presence of vertical root fractures
Technique
• The tooth should be extracted with minimal trauma to the tooth and socket.
• Ideally, elevators are not used and the root surface is not engaged with the forceps.
• Incise periodontal fibers using No.15 scalpel blade.
• Gently elevate the tooth using forcep in rocking motion until grade I mobility is achieved.
The forcep should be placed away from the cementum so as to avoid damage to
periodontal ligament.
• The root surface must be kept moist by wrapping the root with gauge soaked in a
physiologic solution such as Hanks balanced salt solution.
• Thoroughly examine the roots for defects or fractures.
• Repair the root defects if indicated. Any repair or procedure should be done as quickly as
possible in the bath of normal saline or HBSS solution so as to prevent desiccation.
• Irrigate the extraction socket using normal saline.
• Gently place the tooth back in the socket.
• After placing tooth back, place a rolled gauze piece on occlusal
surface of the tooth and ask patient to bite on it. This will help in
seating the tooth into socket. Ask patient to maintain biting pressure
for ateast 5 to 10 mins.
• Stabilize the tooth using periopak, suture or splints. Recall the patient
after 7 to 14 days so s to remove the stabilization and to evaluate the
mobility.
• Follow up should be done after 2, 6, 9 and 12 months of surgery.
• The prognosis for successful healing after replantation is most closely
related to preventing trauma to the PDL and cementum during
extraction and minimizing extraoral time.
Causes of failure of reimplantation
• Extended extraoral time resulting in damage to periodontal cells.
• Contamination during procedure resulting to infection and resorption.
• Undetected fracture of tooth.
• Mishandling of tooth during reimplantation procedure.
IMPLANT SURGERY
 ENDODONTIC IMPLANTS
• are artificial metallic extension, which can safely
extend out through the apex of the tooth into sound
bone.
• Endodontic implants increases the root to the crown
ratio and stabilizes a tooth with weakened support. It
serves the patient well and avoid replacement for
many years.
• Materials: Titanium, Chromium cobalt alloys
 Indications
• Periodontal bone loss, particularly the involvement of a single tooth,
where extraction and replacement is difficult
• a horizontal fracture of a tooth that required the removal of the apical
segment and the remaining coronal portion is too weak to remain
due to an unfavorable crown-root ratio
• pathological resorption of the root apex due to chronic abscess
• pulpless tooth with unusually short root
 CONTRAINDICATIONS
• Presence of calcification in roots
• Proximity of anatomic structures
• Patient suffering from systemic disease
• Presence of curved canals
 Reasons for failure
• Extrusion of cementing media
• Inadequate seal at junction of implant and the apex
• Wrong technique of placement
THANK YOU! 