Endodntic surgery 2 Yaser Baroud.

Slides:



Advertisements
Similar presentations
Medical Technologies Jr. Program
Advertisements

The Anatomy, Physiology and Morphology of Teeth
Structure of the Teeth and Supporting Tissues
Complications of Extraction of Impacted Teeth
Differences in surgery regarding age
Tissues surrounding teeth
Dr. Rakesh kumar yadav Associate professor. The hard tissue surrounding the dental pulp can take a variety of configurations and shapes thorough knowledge.
TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
Furcation: The Problem and Its Management
Scalpel Handles No. 3 Most common No. 3
are often weakened coronally by excessive removal of tooth structure is often narrower than the bur used to make the initial access. (cervical.
Pre-Prosthetic Surgery
Root Coverage Procedures in the Treatment of Gingival Recession Hend AL-Harbi, BDS, Nadir Babay, DDS,MS, DESM Introduction: Gingival recession can be defined.
Presented by: Mellissa Boyd, RDH, BSDH
Extraction and Immediate Placement of Implant. Introduction The dental implants revolutionized the practice of dentistry and have become a successful,
PREPARATIONS FOR PARTIAL VENEER CROWNS
Management of Impacted Teeth Part II
Orthodontic extrusion
ACCESS CAVITIES Dr Saidah Tootla.
EPIDEMIOLOGY OF PERIODONTAL DISEASE
4. Split Tooth A complete fracture initiated from the crown and extending subgingivally, usually directed mesiodistally through both of the marginal ridges.
Root Coverage Procedures in the Treatment of Gingival Recession
Artificial opening occurs in the pulp wall creating communication between the pulp and the exterior. Background Root Perforation.
Overall Classification: UNCLASSIFIED//REL TO NATO/ISAF.
Furcation: The Problem and Its Management
Management of furcation-involved teeth. Intraoperative revision of furcation involvement include – Furcation depth – Width of furcation entrance – Height.
Periodontal Instruments and Periodontal Surgical Instruments.
Furcation Recession Mobility
I. Internal Pulp Cavity Morphology Related to Endodontic and Restorative Therapy
“Gingiva” Dr.Muhammad Wasif Haq.
Endodontic Access Cavity Preparation
Extraction and Immediate Placement of Implant Sameer A. Mokeem King Saud University.
MAXILLARY AND MANDIBULAR CANINES
Ren-Yeong Huang DDS PhD
Dental Nomenclature II
Exodontics Extraction of the tooth  Prognosis of tooth is grave  Client prefers low cost method  Multiple anesthesias are contraindicated in patient.
Principles of endodontic surgery
MANAGEMENT OF FURCATION INVOLVEMENT BY VARIOUS APPROACHES
報告者:傅超俊 報告日期: 2012/05/15. Introduction  a high incidence of discrepancies in gingival margin levels between an implant crown and the contralateral natural.
Two Types of Extractions Closed Involves simple luxation or elevation without the removal of alveolar bone,
Figure 2. Case 1 clinical photographs
Indications for surgical extraction Surgical procedures
Rest and Rest Seats Dr.shanai M..
The Surgical Phase of Therapy
Rational, Indications and Techniques
Principles of complicated Exodontia I
Access Cavity Dr. Ahmed Jawad Alashaw.
Periodontal Plastic and Esthetic Surgery
Tran alveolar or open ext.
refers to a light area on the film
Introduction to Oral & Dental Anatomy and Morphology 12
Flaps use in oral surgery
Pontic design معالجة اسنان\ خامس د.احمذ م(3) 14\ 11\ 2016
Removable partial denture Rests & Rest Seat
Interpretation of Periodontal Disease
Management of Osseous Defects
Resective Osseous Surgery
Supplemental injection techniques
PERIODONTAL PLASTIC AND ESTHETIC SURGERY
Exodontia Extraction forceps
Pulp and root morphology of primary teeth
Treatment of Furcation-Involved Teeth
Periodontal Flap Surgery
Interpretation of Periodontal Disease
Flap Design for Minor Oral Surgery
Rests & Rest Seats.
THE PERIODONTAL FLAP.
THE FLAP TECHNIQUE FOR POCKET THERAPY
Presentation transcript:

Endodntic surgery 2 Yaser Baroud

Flap Design Surgical access is a compromise between the need for visibility of the surgical site and the potential damage to adjacent structures The most common incisions are Submarginal curved (semi-lunar), Submarginal Full mucoperiosteal (sulcular). The submarginal and full mucoperiosteal incisions have either a three-corner (triangular) design or a four-corner (rectangular) design.

Semilunar incision Slightly curved half-moon horizontal incision in the alveolar mucosa. Should be avoided. Disadvantages: Limited access Alveolar mucosa heals more slowly than attached mucosa (dehiscence). Incision may be carried at the inflamed area .

Submarginal incision The horizontal component of the submarginal incision is in attached gingiva with one or two vertical incisions. The incision is scalloped in the horizontal line, with obtuse angles at the corners. Used mostly in the anterior area and premolars. 4 mm of attatched gingiva and good periodontal health are prerequisites.

Submarginal incision Advantages : Disadvantages: Esthetic because it leaves the gingiva intact around the crown. Provides better access and visability than semilunar flap. Disadvantages: Heals by scarring and hemorrhage Sometimes ,, the access is limited ?!!!

Full mucoperiosteal incision The procedure includes elevation of interdental papilla, free gingival margin, attached gingiva, and alveolar mucosa. One or two vertical releasing incisions may be used, creating a triangular or rectangular design. This design is preferred over the previous designs.

Full mucoperiosteal incision Advantages: Maximum access and visibility Not incising over bony defect Lower risk for hemorrhage Less scar Disadvantages: Difficult to replace and suture Gingival recession

Anesthesia Maxilla: ***Sedation Mandible: IAN block Infiltration for hemostasis Maxilla: Infiltration ***Sedation

Inscision and elevation of the flap Full thickness flap (down to the bone). Start elevating the vertical incision first, then the horizontal. Avoid flap stretching.

Periapical exposure Sometimes the bone is resorped and the root exposed. In cases of intact buccal plate, a measurement may be made with a periodontal probe on the radiograph and then transferred to the surgical site to determine the apex location. Bone is better removed by electrical surgical handpeice.

Copious irrigation Bone should be removed to expose the area around the apex and at least half the length of the root (expose ,,,, then cut). Lower incisor roots are carefully exposed because proximity with adjacent teeth could lead to treatment of the wrong apex. Be careful of the root curvatures.

Curettage Most of the granulomatous, inflamed tissue surrounding the apex should be removed to: Gain access Histopathology (if indicated) Minimize hemorrhage Tissue should be enucleated with a suitably sized sharp curette.

Tissue removal should not jeopardize the blood supply to an adjacent tooth. ((Portions of inflamed tissue or epithelium may be left, without compromising healing; total removal is not necessary.)) Hemorrhage control can be achieved by holding direct pressure over a bleeding site with gauze soaked in local anesthetic solution with epinephrine and by minimizing suction at the site of a bleeder.

Root end resection Root end resection is indicated because it removes the region that most likely had the poorest obturation and more accessory canals. Before sectioning, a trough is created around the apex with a tapered fissure bur to expose and isolate the root end. A bevel of varying degrees is made in a faciolingual direction.

The amount of root removed depends on the reason for performing the resection. In general, approximately 2 to 3 mm of the root is resected—more, if necessary, for apical access or if an instrument is lodged in the apical region; less if too much removal would further compromise stability of an already short root.

Retrograde filling Filling seals the canal system, preventing further leakage. The depth of the preparation must be at least 1 mm deeper than the bevel to seal the apex adequately. Ultrasonic tips are used.

Ultrasonic tips The ease of use and special angulations require less of a bony opening and less beveling of the apical region and permit a deeper, denser fill.

Root end filling material Filling should seal well and should be tissue tolerant, easily inserted, minimally affected by moisture, and visible radiographically. The root end–filling material must be stable and nonresorbable indefinitely. Amalagam (zinc free) IRM Super ethoxy benzoic acid EBA

No single, all-purpose, superior root end–filling material exists. **Mineral trioxide aggregate (MTA) has shown favorable biologic and physical properties and ease of handling. MTA is conductive to bone formation MTA is hydrophilic Working time for 10 minutes. No single, all-purpose, superior root end–filling material exists.

Irrigation Copious irrigation With MTA, irrigation is done before the filling to avoid washing out the filler. Radiographic evaluation Flap replacement and suturing Instructions Suture removal

Corrective surgery Corrective surgery is the management of defects that have occurred by a biologic response (i.e., resorption) or iatrogenic (i.e., procedural) error. Many defects are accessible; others are difficult to reach The procedure involves exposing, preparing, and then sealing the defect.

Indications for corrective surgery 1-Procedural errors: Openings through the lateral root surface created by the operator, typically during access, canal instrumentation, or after space preparation. ((Perforations)) If the defect is on the interproximal aspect, in the furcation, or close to adjacent teeth or to the lingual aspect, adequate repair may not be possible

Corrective surgery 2- Resorptive perforation: Causes : May originate internally or externally Result in a communication between the pulp and the periodontium. Causes : Trauma Internal bleaching procedures Orthodontic tooth movement Restorative procedures

Contraindications of Corrective surgery Anatomic considerations Nerves, vessels, bone (external oblique ridge) Location

Other types of endodontic surgery Root amputation: Removal of one or moor roots of multirooted tooth.

Hemisection: Surgical division of a multirooted tooth. In mandibular molars the tooth is divided buccolingually through the bifurcation . In maxillary molars the cut is made mesiodistally, also through the furcation.

Bicuspidization: Surgical division of a mandibular molar. The crown and root of both halves are retained. Indicated when there is furacational pathosis or envolvement.