PRS

PRS

1. Indications

   • periradicular disase
     • anatomy stops nsRCT
       • iatrogenic
         • transportation
         • ledges
         • fractured instrument
       • developmental
         • apical curvature
       • calcified canal
     • previous RCT
       • failed to heal
         • new lesion
       • Re-RCT detrimental
       • extruded material
     • Bx tissue
   • perf pulp chamber floor
   • root fracture
   • pt factors
     • new crown
     • duration RCT

2. Flap

   • papilla base incision
     • Velvart 2004
   • intrasulcular
     • shrinkage during healing
       • loss of papilla height
         • Zimmerman 2001
         • Tarnow 1992
           • contact point to bone
             • 5mm or less
               • papilla present 100% of time

3. Osteotomy

4. Root resection

   • 3mm
     • 90 degrees

5. Root end prep

   • 3mm depth
     • ultrasonic
       • Kim 2006

6. Outcomes

   • Success
     • Saunders 2008
       • Re surgery
         • 74%
       • primary surgery
         • 88%
     • Kim 2011
       • 92%
       • 77% with perio defect
   • Prognosis
     • Factors
       • Positive
         • anterior maxilla
           • small lesion
             • good obturation
               • EMS
                 • MTA
       • Negative
         • No resection
           • No filling
             • large lesion
               • Perio pocket
               • full dehisence
               • repeat surgery
                 • molars
                   • males
                     • pre op pain

7. Imaging

   • PA rad
     • At least 3mm beyond apex
       • angled view
         • morphology
         • perf
         • multi root
     • +/- OPG or occlusal if big
     • GP in sinus
     • Historical to assess healing
   • CBCT

8. Microsurgery

   • success
     • 1.6x higher than TRS
       • Setzer and Kim 2010 /2012 SR
       • 94% EMS
       • 59% TRS

9. root end filling

   • MTA
     • Kim
       • Saunders
       • Torobinejad
       • Tsesis SR 2013
   • Bioceramics