l5 tic Surgery

Ronald C. Taylor DDS, MSDBCDS Dental School University of Maryland

CASE SELECTION ILLUMINATION AND MAGNIFICATION OSTEOTOMY SIZE RESECTED ROOT SURFACE BEVEL ANGLE ISTHMUS IDENTIFICATION AND PREPARATION RETROPREPARATION HEMOSTASIS RETROGRADE FILLING

Unsuccessful non-surgical endodontic treatment

Retreatment not possible/practical, or unsuccessful

Perforation repair Anatomically approachable Medical condition acceptable

MANIDBULAR CANAL MENTAL FORAMEN SINUS FRENULUM

1st 2nd 3rd

SCHNEIDERIAN MEMEBRANE Maxillary 2nd Molars Are

Closest to the Sinus 5% of Maxillary Root Apicies

Protrude into the Sinus Torabinejad OOO 1992

Sinus Perforations Occur in 28% of Maxillary Posterior Endodontic Surgeries. Bernhart DCNA 1997

Practical Lessons in Endo Surgery, 1998

Ochsenbein-Luebke (Submarginal)

Intrasulcular

Full Thickness Mucoperiosteal Flap

Split Thickness Flap

Flaps Can Be Buccal or Palatal

Ochsenbein-Luebke Intrasulcular flap

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

ADEQUATE REMOVAL OF BONE ESTIMATE THE ROOT LENGTH TAKE A RADIOGRAPH WITH AN

RADIOOPQUE INDICATOR

Osteotomy

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

LOCATING FORAMEN IDENTIFICATION OF ROOT END COMPLETE RESECTION OF ROOT END IDENTIFICATION OF ROOT CANALS BEVELING ISTHMUS

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

The incidence of an isthmus is highest in the apical 3-5mm level.

Not treating the isthmus can lead to failure. Kim JOE 1995 Gomes IEJ 2003

Less apical leakage with a 0 bevel.

The depth of the retrograde filling should be at least 3mm. Gilheany, Figdor &

Tiaz JOE 1994

Surgical Ultrasonic Tips (Wuchenich, Meadows and Torabinejad; JOE ‘93)

More effective than round burs Root end preparations were

Deeper Cleaner More Parallel

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Practical Lessons in Endo Surgery, 1998

Dentsply

Dentsply

Dentsply

Pre-OpPost-Op Recall (1 yr)

Pre-Op Post-Op Recall (1 yr)

Practical Lessons in Endo Surgery, 1998

Interrupted Continuous Mattress Continuous Blanket Continuous Sling

OBJECTIVE = PRIMARY CLOSURE

Resorbable Gut Chromic Gut Vicryl

Non-resorbable Silk Nylon

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