retreat/surgery Flashcards
indications for retreatmetn
symptomatic patient
non healing endo outcomes (PA radiolucency larger)
recontamination
poor original endo tx
what is the prognosis for a retreated tooth
dont know, depends on what is causing the problem and whether you can fix it
causes of non healing/continued symtpoms
inadequate coronal seal (leaky restoration)
non treated/inadequate treatment (under instrumented etc)
fractures
trauma/resorption
immunologic factors
misdiagnosis
big problem with retreats?
you dont know what someone has done before you
is retreating easier than initial treatment
no its more difficult, takes longer, needs more clinical skill
what can cause obstructions during retreat
posts and cores calcifications ledges separated instruments missing canals
how to remove gutta percha
heat, solvents, endo instruments
how to remove carrier based obturation materials
instruments, solvent, very hard to remove!!
how to remove silver cones
endo instruments esp hand files
how to remove pastes
burs, ultrasonics, hand instruments
when is endo surgery indicated?
-probably will fail without sx approach
retreatment not possible or did not work
biopsy indicated
contraindications to endo surgery
anatomic factors (palate, IAN canal etc)
medical or systemic complications
retreatment could address problem
cause of previous tx failure not ID’d
apicoectomy technique
periosteal flap, osteotomy w/ round bur
0-10 deg bevel
resect entire root end
leave as much possible while still achieving goal
evaluate root surface for cracks and shit
root end preparation in apicoectomy
approx 3 mm in depth
make sure you are centered in the canal
prepare all canals and isthmuses
check for cracks/fractures
what is “to dye for” methylene blue used for
helping visualize PDL and fractures
