Periradicular Surgery

Question 1

Aims of periradicular surgery?

Answer 1

1 - Apical seal.

2 - Remove existing infection (root end excision and curettage)

Question 2

Indications for periradicular surgery?

Answer 2

1 - Recurrent endodontic failure.
2 - Large periapical lesion that will not heal with endo alone.
3 - Post and core crown that may result in root fracture if removed for orthograde endo.
4 - Repair of perforations.

Question 3

Contraindications for periradicular surgery may be classified as?

Answer 3

1 - Medical history problems
2 - Anatomical problems
3 - Operator skill / experience

Question 4

Flap designs for periradicular surgery?

Answer 4

1 - Semilunar flap. (Less recession, more scarring, bleeding, dysaesthesia and difficult to position)
2 - 2 (or 3) sided flap. (Better access but risk of recession)

Question 5

Stages in periradicular surgery technique

Answer 5

1 - Mucoperiosteal flap raising
2 - Locate lesion with sharp instrument
3 - Bone removal with round burr
4 - 3mm root excision with fissure bur
5 - Enucleation of granulation tissue
6 - 3mm prep with ultrasonic
7 - Filling with RM-ZOE or MTA
8 - Flap replacement and suturing

Question 6

Advantages and Disadvantages of Resin Modified Zinc Oxide Eugenol

Answer 6

Adv - Cheap, easy to use, radiopaque, bacteriostatic

Dis - Moisture sensitive, may resorb, doesnt promote cementogenesis

Question 7

Advantages and Disadvantages of Mineral Trioxide Aggregate

Answer 7

Adv - Moisture resistant, promotes cementogenesis, very good seal

Dis - Expensive, long setting time, difficult to use

Question 8

Causes of failure of periradicular surgery

Answer 8

Inadequate seal, inadequate support for tooth, fracture, poor healing.

Question 9

Stages of review after periradicular surgery.

Answer 9

Review at 1 week (?ROS)
Post op radiographs within 12 weeks
Review in 3 - 6 months
Follow up in 6 months to 4 years.