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  • Endodontic Microsurgery: Ronald C. Taylor DDS, MSD BCDS Dental School University of Maryland

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    This document discusses the principles of endodontic microsurgery. It begins by outlining case selection criteria and important anatomical considerations like proximity to the mandibular canal or maxillary sinus. It then covers surgical techniques like flap design, osteotomy, root-end resection and beveling, retrograde cavity preparation, and filling. Key points emphasized are the importance of illumination and magnification, removing all root structure, beveling root-ends at 0 degrees, and obtaining a seal of at least 3mm with retrograde fillings to minimize apical leakage. The document provides illustrations of each surgical step and concludes by discussing suturing techniques.

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    This document discusses the principles of endodontic microsurgery. It begins by outlining case selection criteria and important anatomical considerations like proximity to the mandibular canal or maxillary sinus. It then covers surgical techniques like flap design, osteotomy, root-end resection and beveling, retrograde cavity preparation, and filling. Key points emphasized are the importance of illumination and magnification, removing all root structure, beveling root-ends at 0 degrees, and obtaining a seal of at least 3mm with retrograde fillings to minimize apical leakage. The document provides illustrations of each surgical step and concludes by discussing suturing techniques.

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    Attribution Non-Commercial (BY-NC)
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    Download as ppt, pdf, or txt
    56 views47 pages

    Endodontic Microsurgery: Ronald C. Taylor DDS, MSD BCDS Dental School University of Maryland

    Uploaded by

    thevaky
    This document discusses the principles of endodontic microsurgery. It begins by outlining case selection criteria and important anatomical considerations like proximity to the mandibular canal or maxillary sinus. It then covers surgical techniques like flap design, osteotomy, root-end resection and beveling, retrograde cavity preparation, and filling. Key points emphasized are the importance of illumination and magnification, removing all root structure, beveling root-ends at 0 degrees, and obtaining a seal of at least 3mm with retrograde fillings to minimize apical leakage. The document provides illustrations of each surgical step and concludes by discussing suturing techniques.

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    of 47

    ENDODONTIC MICROSURGERY

    Ronald C. Taylor DDS, MSD BCDS Dental School University of Maryland

    PRINCIPLES OF ENDODONTIC MICROSURGERY


    CASE SELECTION ILLUMINATION AND MAGNIFICATION OSTEOTOMY SIZE RESECTED ROOT SURFACE BEVEL ANGLE ISTHMUS IDENTIFICATION AND PREPARATION RETROPREPARATION HEMOSTASIS RETROGRADE FILLING

    CASE SELECTION
    Unsuccessful non-surgical endodontic treatment Retreatment not possible/practical, or unsuccessful Perforation repair Anatomically approachable Medical condition acceptable

    ANATOMICAL CONSIDERATIONS
    MANIDBULAR CANAL MENTAL FORAMEN SINUS FRENULUM

    PROXIMITY TO MANDIBULAR CANAL

    1st

    2nd

    3rd

    SINUS INVOLVEMENT

    SCHNEIDERIAN MEMEBRANE Maxillary 2nd Molars Are Closest to the Sinus 5% of Maxillary Root Apicies Protrude into the Sinus

    Torabinejad OOO 1992

    Sinus Perforations Occur in 28% of Maxillary Posterior Endodontic Surgeries.

    Bernhart DCNA 1997

    Practical Lessons in Endo Surgery, 1998

    SINUS CONSIDERATION

    FLAP DESIGNS

    Ochsenbein-Luebke (Submarginal) Intrasulcular

    Full Thickness Mucoperiosteal Flap Split Thickness Flap

    Flaps Can Be Buccal or Palatal

    Ochsenbein-Luebke

    Intrasulcular flap

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    PALATAL FLAP

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    EXPOSURE OF ROOT ENDS


    ADEQUATE REMOVAL OF BONE ESTIMATE THE ROOT LENGTH TAKE A RADIOGRAPH WITH AN RADIOOPQUE INDICATOR

    Osteotomy

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    RESECTION OF ROOT END (APICOECTOMY)


    LOCATING FORAMEN IDENTIFICATION OF ROOT END COMPLETE RESECTION OF ROOT END IDENTIFICATION OF ROOT CANALS BEVELING ISTHMUS

    Practical Lessons in Endo Surgery, 1998

    ROOT END RESECTION

    Practical Lessons in Endo Surgery, 1998

    THE BEVELED ROOT END

    The incidence of an isthmus is highest in the apical 3-5mm level. Not treating the isthmus can lead to failure.

    Less apical leakage with a 0 bevel. The depth of the retrograde filling should be at least 3mm.

    Kim JOE 1995 Gomes IEJ 2003

    Gilheany, Figdor & Tiaz JOE 1994

    RETROGRADE PREPARATIONS
    Surgical Ultrasonic Tips
    (Wuchenich, Meadows and Torabinejad; JOE 93)

    More effective than round burs Root end preparations were

    Deeper Cleaner More

    Parallel

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    RETROGRADE FILLING

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Practical Lessons in Endo Surgery, 1998

    Dentsply

    Dentsply

    Dentsply

    Pre-Op

    Post-Op

    Recall (1 yr)

    Pre-Op

    Post-Op

    Recall (1 yr)

    HEMISECTION & INTENTIONAL REPLANTATION

    Practical Lessons in Endo Surgery, 1998

    SUTURE TECHNIQUES
    Interrupted Continuous Mattress Continuous Blanket Continuous Sling

    OBJECTIVE = PRIMARY CLOSURE

    SUTURE TYPES

    Resorbable

    Non-resorbable

    Gut Chromic Gut Vicryl

    Silk Nylon

    THANK YOU
    North Oak Professional Bldg 3060 Mitchellville Road Suite 108 Bowie, MD 21032 301.218.7711 Pershing Court Condominiums 804 Pershing Drive Suite 102 Silver Spring, MD 20910 301.562.9455

    RCT Endodontics hitechendo.com

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