Endodontic surgery

Question 1

Give the 5 types of endodontic surgery.

Answer 1

apical surgery
resorption / perforation repair
root ressection
premolarisation
intentional replantaion

Question 2

What is involved in the planning process of endodontic surgery?

Answer 2

look on notes

Question 3

With radiographic imaging for endodontic surgery what do we look at?

Answer 3

look on notes

Question 4

When is surgical treatment for apical periodontitis an indication?

Answer 4

1. To remove the infection from the root canal.
   
   2. When it is not possible or practical via the normal root canal treatment or retreatment.

Question 5

When is endodontic surgery the only way to remove periapical infections?

Answer 5

When bacteria colonise the external surface of the root.

Typically this happens with some actinomyces bacteria.

Question 6

Where can bacteria be found on the root surface?

Answer 6

look on suf notes

Question 7

Give 7 indications for endodontic surgery.

Answer 7

look on suf notes

Question 8

What are signs the RCT has had a ‘favourable’ outcome?

Answer 8

Absence of pain swelling and other symptoms.
Normal PDL space around the root.

Question 9

What are signs the RCT has had a ‘uncertain’ outcome?

Answer 9

lesion has remained same sixe / dimiished in size

assess

Question 10

What are signs the RCT has had a ‘unfavourable’ outcome?

Answer 10

tooth assoacited with sign and sympotoms of an infection

radiographically visible lesion occurred subsequent to treatments or a pre-exisitng lesion increased in size or the same size

signs of continued roor resorption

Question 11

What is an exception to an unfavourable outcome that is seen radiographically?

Answer 11

Exception lesion may have healed but left a localised irregular mineralised area.

This may be scat tissue formation rather than a sign of persisting apical periodontitis. The tooth should continuetobeassessed.

Question 12

Give some secondary sources of compromised RCT outcomes.

Answer 12

Recurrent carries and Coronal leakage
Carries extending into the root canal or furcation
Root fracture
Root perforation or extending marginalperiodontitis

Question 13

Give 2 potential causes for endodontic failure.

Answer 13

The communication between an infected endodontic space and periradicular tissues

Foreign body reaction e.g. fractured files

Question 14

What is the difference between an apical pocket cyst and an apical true cyst?

Answer 14

The communication between the epithelial lining and the root canal system.

Cyst has communication.

Question 15

How can resectioning the apex cause the need to extract the tooth?

Answer 15

If the root left is too short is weakens the tooth:

Question 16

What can root fracture be caused by in RCT?

Answer 16

It is not an endodontic failure

An improper pressure applied during lateral and vertical condensation.

It can occur during prep of RCT using rotary instruments.

Question 17

How can a root fracture be diagnosed with instruments?

Answer 17

With a probe- locate a deep pus pocket

Question 18

What is MRONJ?

Answer 18

Medication related osteocerosis of the jaw.

Question 19

If an instrument gets stuck during RCT what can be used to retrieve the instruments?

Answer 19

IRS kit

Question 20

Why are C-shaped canals a cause for the need of endodontic reassessment?

Answer 20

Irregular areas in a C-shaped canal can keep remnants of soft tissue, debris, and infected tissue or may be a source of bleeding during a root canal treatment.

They are hard to irrigate and fill, hence problems and incorrect rct is more likely.

Question 21

What 5 things must you check and advise the patient preopratively to endodontic surgery?

Answer 21

medical history
informed consent
corsodyl mw for after surgery
analgesics if patient feels pain
antibiotics

Question 22

What are the 3 flap designs poWhat are the 3 flap designs possible with endodontic surgery?ssible with endodontic surgery?

Answer 22

1. Sulcular full thickness flap - looks similar to 3-sided flap.
2. Mucogingival flap.
3. Papilla perservation flap.

Question 23

How is a sulcular full thickness flap carried out?

Answer 23

Incision into the sulcus, sectioning the intrasulcular papilla

Vertical relieving incisions parallel to fibers and blood vessels in the mucosa- reduces the risk of bleeding & scarring & promote healing

Down to the bone

Extend to get good access & avoid suturing over the defect

Question 24

How is a mucogingival flap carried out and when is it the most suitable flap?

Answer 24

Suitable for crowned teeth to reduce risk of recession

Scalloped incision following gingival margins from the base of gingival sulcus

45 degree bevel to cortical plate to give wide cutting surface and minimise scarring

Vertical relieving incision parallel to each other

Rounded edges at the corner of the flap

Question 25

How is a papilla preservation flap carried out and when is it the most suitable flap?

Answer 25

same but perserve papilla 45 degree bevel to cortical plate to give wide cutting surface and minimise scarring Vertical relieving incision parallel to each other Rounded edges at the corner of the flap

Question 26

After deciding the flap, how do you go about elevating the flap in endodontic surgery?

Answer 26

Periosteum and overlying gingiva elevated with sharp elevator Release the papillae with small flat plastic Walk the elevator along the attached gingiva and then apically Elevator firmly on bone and at a 45 degree angle Peel the gingiva, mucosa and periosteum slowly and firmly Do not want to slip or tear the flap

Question 27

What 3 things may you see upon gaining access to the apex of the tooth?

Answer 27

Intact cortical plate with small or no apical lesion Intact cortical plate with apical lesion Fenestration of cortical plate around the apex

Question 28

What is an ostetomy?

Answer 28

An osteotomy is a surgical procedure that involves the cutting or removal of a portion of bone. It is commonly performed in endodontic surgery to create a surgical access site and allow for the removal of infected tissue or the resection of the apex of a tooth.

Question 29

How large must the osteotomy be after you elevate the flap in endodontic surgery?

Answer 29

4mm to allow ultrasonic tips in. Bevel the edges Ascertain root length and guess where the apex will be Use a sharp probe to explore the area & perforate if possible If thick bone, use small round bur to remove bine where apex is anticipated

Question 30

Once you have removed the bone how must you remove the soft tissue and what must you do if there is bleeding after soft tissue removal?

Answer 30

Try to peel off crypt wall in one piece Removal will reduce bleeding * Soft tissue must be sent for histology If bleeding (Adrenaline gauze pack, Inject LA at the base)

Answer 31

3mm resection, 0 degree bevel, thin long tapered diamond bur