Surgical Endodontics (RCS)

Surgical Endodontics (RCS)

1. Indications

   • Where you cannot access the apex of the tooth with non-surgical RCT due to developmental or iotragenic anomalies
     • Perforated root
     • Broken instruments
     • Fractured apical third of root
   • Periradicular disease in a root filled teeth where non-surgical managementt has failed
     • Only if the RCT was high standard!
   • Periradicular disease in a root filled teeth where it would be detrimental to the retention of the tooth if re-done (crowns)
     • Irremovable posts
   • Where a biopsy of the pariradicular tissue is required
     • Suspicious/non-healing lesions
   • Where it may not be expedient to undertake prolonged nonsurgical root canal retreatment because of patient considerations.

2. Contra-indications

   • Pt factors
     • Severe systemic disease
   • Dental Factors
     • Lack of surgical access
     • Possible involvement of neurovascular structures
     • Where the tooth is subsequently unrestorable
     • Poor general oral status
     • Where there is poor supporting tissue
     • Unusual bony or root configurations

3. Steps

   • 1. Raise a mucoperiosteal flap
     • Place on sound bone
   • 2. Osteotomy
     • Remove some of the cortical bone so you can gain access to the PAP
   • 3. Periradicular curattege
     • The soft tissue in the periradicular region should be removed with curettes to allow adequate visualisation of the root apex.
     • Remove inflammatory tissue but don't damage structures
   • 4. Root end resection
     • As close to 90 degrees as possible
     • At least 3mm with a rose head bur
   • 5. Root-end preparation
     • 3mm deep
     • Use ultrasonic tip
       • Minimises sound tissue loss
     • Use a plugger to compact MTA
   • 6. Close the site