9162019

1

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Auto-transplantation

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Pathogenesis

Of Pulp and

Periapical

Lesions

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Survival Rates for Root Canal

TreatmentLazarski MP Walker WA Flores CM et al

Epidemiological evaluation of the outcomes of nonsurgical root canal treatment in a large cohort of insured dental patients J Endod27791 2001

Salehrabi R Rotstein I Endodontic treatment outcomes in a large patient population in the USA an epidemiological study J Endod 200430846-50

Doyle SLHodges J Pesun IJ Law AS Bowles WRRetrospective Cross Sectional Comparison of Initial Nonsurgical Endodontic Treatment and Single-Tooth Implants J Endod 200632822-827

ndash

1 2

3 4

5 6

9162019

2

Systematic Reviews

bull Creugers et al 1991 Sys Rev FPD Survival

bull Scurria et al 1998 Sys Rev FPD Survival

bull Creugers et al 2000 Sys Rev Imp Survival

bull Goodacre et al 2003 Sys Rev FPD Comp

bull Goodacre et al 2003 Sys Rev Imp Comp

bull Salinas amp Eckert 2007 Sys Rev Imp - FPD

bull Iqbal amp Kim 2007 Sys Rev Imp ndash Endo

bull Torabinejad et al 2007 Sys Rev Imp Endo FPD

bull Ng et al 2008 Sys Rev Endo

The Outcomes of Endodontic

Treatment Single Implant Fixed

Partial Denture and No Tooth

Replacement

A Systematic Review

M Torabinejad P AndersonJ Bader LJ BrownLH Chen CJ

Goodacre MT Kattadiyil D Kutsenko J Lozada R Patel F Petersen I

Putterman S N White

Journal of Prosthetic Dentistry

200798(4)285-311

CLINICAL OUTCOMES

Weighted Success amp Survival

Implant Prostho Endo

Success 2-4 98 (96-100) 78 (76-81) 89 (88-91)

Success 4-6 98 (97-99) 76 (74-79) 94 (92-96)

Success 6+ 95 (93-96) 80 (79-82) 84 (81-87)

Survival 2-4 96 (94-97) 94 94

Survival 4-6 97 (95-98) 93 94 (91-96)

Survival 6+ 97 (96-98) 82 97 (97-97)

Failure (Strict)

Failure (lenient)

(13-19) (3-8)

Pooled and weighted failure rates of root canal

treatment after six years

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Etiology of Non-healing Initial

Endodontic Treatment

bull Persistent or Reintroduced Intra-canal

Infection

bull Procedural Accidents

bull Extra- canal Infection

bull Foreign Body Reaction

bull True Cysts

bull Scar Tissue After Initial HealingNair et al Int Endod J 200630249-81

7 8

9 10

11 12

9162019

3

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

EX

NT ProsImplant

Do Nothing

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Indications for Retreatment

Inadequate Previous Root Canal Treatment(with pathosis symptoms in need of restoration bleaching)

Non Surgical Accessibility

Restorable teeth

Sound periodontal conditions

Teeth with favorable crown to root ratio

Motivated Patient

Contra Indications for Retreatment

bull Adequate Previous Root Canal Treatment

bull Inaccessibility

bull Non Restorable tooth

bull Poor periodontal condition

bull Vertical Fracture

bull Inadequate crown to root ratio

bull Unmotivated Patient

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

13 14

15 16

17 18

9162019

4

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

bull Suturing

19 20

21 22

23 24

9162019

5

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

bull Superior Depth of Anesthesia

bull Less Antigenic

Why Amides

bull It has rapid onset

bull Produces profound anesthesia

bull Provides prolonged action

bull It has low toxicity amp

antigenicity

bull Has high diffusion rate

bull Comes with different

concentrations of epinephrine

Why Lidocainebull The site should be slowly

infiltrated (1 mlmin)

bull Inject sub-mucosally

bull Avoid muscle injections

How to Inject

25 26

27 28

29 30

9162019

6

bull Pooling of Solution

bull Delayed Diffusion

bull Minimal Contact with Neural Elements

bull Inadequate Hemostasis

OtherwisePurpose of Local Anesthesia

bullProvide Anesthesia

bullCreate Hemostasis

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Ferric Sulfate

Calcium Sulfate

Bone Wax

Collagen-based Materials

Surgicel

Gelfoam

Aluminum Chloride

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Racellet 3 B

W

Posiive Control

Ngative ControlPU foam With Epi

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

31 32

33 34

35 36

9162019

3

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

EX

NT ProsImplant

Do Nothing

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Indications for Retreatment

Inadequate Previous Root Canal Treatment(with pathosis symptoms in need of restoration bleaching)

Non Surgical Accessibility

Restorable teeth

Sound periodontal conditions

Teeth with favorable crown to root ratio

Motivated Patient

Contra Indications for Retreatment

bull Adequate Previous Root Canal Treatment

bull Inaccessibility

bull Non Restorable tooth

bull Poor periodontal condition

bull Vertical Fracture

bull Inadequate crown to root ratio

bull Unmotivated Patient

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

13 14

15 16

17 18

9162019

4

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

bull Suturing

19 20

21 22

23 24

9162019

5

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

bull Superior Depth of Anesthesia

bull Less Antigenic

Why Amides

bull It has rapid onset

bull Produces profound anesthesia

bull Provides prolonged action

bull It has low toxicity amp

antigenicity

bull Has high diffusion rate

bull Comes with different

concentrations of epinephrine

Why Lidocainebull The site should be slowly

infiltrated (1 mlmin)

bull Inject sub-mucosally

bull Avoid muscle injections

How to Inject

25 26

27 28

29 30

9162019

6

bull Pooling of Solution

bull Delayed Diffusion

bull Minimal Contact with Neural Elements

bull Inadequate Hemostasis

OtherwisePurpose of Local Anesthesia

bullProvide Anesthesia

bullCreate Hemostasis

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Ferric Sulfate

Calcium Sulfate

Bone Wax

Collagen-based Materials

Surgicel

Gelfoam

Aluminum Chloride

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Racellet 3 B

W

Posiive Control

Ngative ControlPU foam With Epi

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

31 32

33 34

35 36

9162019

4

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

bull Suturing

19 20

21 22

23 24

9162019

5

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

bull Superior Depth of Anesthesia

bull Less Antigenic

Why Amides

bull It has rapid onset

bull Produces profound anesthesia

bull Provides prolonged action

bull It has low toxicity amp

antigenicity

bull Has high diffusion rate

bull Comes with different

concentrations of epinephrine

Why Lidocainebull The site should be slowly

infiltrated (1 mlmin)

bull Inject sub-mucosally

bull Avoid muscle injections

How to Inject

25 26

27 28

29 30

9162019

6

bull Pooling of Solution

bull Delayed Diffusion

bull Minimal Contact with Neural Elements

bull Inadequate Hemostasis

OtherwisePurpose of Local Anesthesia

bullProvide Anesthesia

bullCreate Hemostasis

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Ferric Sulfate

Calcium Sulfate

Bone Wax

Collagen-based Materials

Surgicel

Gelfoam

Aluminum Chloride

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Racellet 3 B

W

Posiive Control

Ngative ControlPU foam With Epi

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

31 32

33 34

35 36

9162019

5

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

Esters Amides

Procaine Lidocaine

Tetracaine Mepivacaine

Propoxycaine Prilocaine

Chloroprocaine Etidocaine

Local Anesthetics

bull Superior Depth of Anesthesia

bull Less Antigenic

Why Amides

bull It has rapid onset

bull Produces profound anesthesia

bull Provides prolonged action

bull It has low toxicity amp

antigenicity

bull Has high diffusion rate

bull Comes with different

concentrations of epinephrine

Why Lidocainebull The site should be slowly

infiltrated (1 mlmin)

bull Inject sub-mucosally

bull Avoid muscle injections

How to Inject

25 26

27 28

29 30

9162019

6

bull Pooling of Solution

bull Delayed Diffusion

bull Minimal Contact with Neural Elements

bull Inadequate Hemostasis

OtherwisePurpose of Local Anesthesia

bullProvide Anesthesia

bullCreate Hemostasis

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Ferric Sulfate

Calcium Sulfate

Bone Wax

Collagen-based Materials

Surgicel

Gelfoam

Aluminum Chloride

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Racellet 3 B

W

Posiive Control

Ngative ControlPU foam With Epi

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

31 32

33 34

35 36

9162019

6

bull Pooling of Solution

bull Delayed Diffusion

bull Minimal Contact with Neural Elements

bull Inadequate Hemostasis

OtherwisePurpose of Local Anesthesia

bullProvide Anesthesia

bullCreate Hemostasis

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Ferric Sulfate

Calcium Sulfate

Bone Wax

Collagen-based Materials

Surgicel

Gelfoam

Aluminum Chloride

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

The Hemostatic Agents Used in

Endodontic Surgery

Epinephrine Cotton Pellet

Racellet 3 B

W

Posiive Control

Ngative ControlPU foam With Epi

Clinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

31 32

33 34

35 36

9162019

7

Types of FlapsbullIntrasulcular

(full thickness)

bullsubmarginal

Types of FlapsbullIntrasulcular

(full thickness)

Types of FlapsbullIntrasulcular

(full thickness)

1 Triangular

2 Rectangular

3 Trapezoidal

bull A Full Mucoperiosteal

ndash 1 Triangular

bull A Full Mucoperiosteal

ndash 1 Triangular

ndash 2 RectangularTypes of FlapsbullIntrasulcular

(full thickness)

bullSubmarginal

37 38

39 40

41 42

9162019

8

bull A Full Mucoperiosteal

ndash 1 Triangular

ndash 2 Rectangular

ndash 3 Trapezoidal

bull B Sub-marginal

ndash 1 Luebke-Oschsenbein

bull A Full Mucoperiosteal

ndash 1 Triangular

ndash 2 Rectangular

ndash 3 Trapezoidal

bull B Sub-marginal

ndash 1 Luebke-Oschsenbein

ndash 2 Papillae Based Flap

bull Use High-Speed Handpiece

bull Use Sharp Round Burs

bull Use Light Pressure

bull Use ldquoBrush Strokerdquo Motion

bull Avoid Deep Penetration

bull Use Periodic Irrigation

bull Use Good Aspiration

Biologic Removal of Osseous Tissue

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Targeting The Apex

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Targeting The Apex

43 44

45 46

47 48

9162019

9

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Intraoral scan

Targeting The ApexGuide design

bull Blue Sky Bio implant guide design software

bull Import and merge both CBCT amp intraoral

scans

bull Virtual implant design

bull Create the guide

bull Export the STL file

bull 3D Print

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

Targeting The Apex

EXPORT THE STL FILE TO A 3D PRINTER

Create the guide

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

Targeting The Apex

CHECK ON THE ACTUAL MODEL FOR THE FIT

Printed Guide

49 50

51 52

53 54

9162019

10

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

bull Perform the ostectomy

Targeting The ApexClinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

RADIOLUCENT LESIONS WHICH MIMICKED

PERIRADICULAR PATHOSIS

(Top 10 Commonly Reported Lesions)

1 ACTINOMYCOSIS 22

2 FIBRO-OSSEOUS LESIONS (FIBROUS DYSPLASIA 11

PAGETrsquoS DISEASE PERIAPICAL CEMENTAL

DYSPLASIA OSSIFYING FIBROMA)

3 ODONTOGENIC KERATOCYSTS 9

4 CARCINOMA (METASTATIC AND LOCAL) 8

5 LYMPHOMA (INCLUDING BURKITTrsquoS amp HISTOCYTIC 7

6 TRAUMATIC BONE CYSTS 4

7 NASOPALATINE DUCT CYSTS 3

8 RESIDUAL CYST 3

9 AMELOBLASTOMA 2

10 CENTRAL GIANT CELL GRANULOMA 2

11 OTHER 24

Clinical Procedures During

Endodontic SurgeryLocal Anesthesia

Flap Elevation

Ostectomy

Biopsy

Root-end Resection amp Preparation

Root End Filling

Suturing

bull Removal of Anatomic Variations

bull Removal of Operator Errors

bull Evaluation of the Apical Seal

bull Creation of an Apical Seal

bull Reduction of Fenestrated RootApices

Rationale for Root End Resection

bull

Factors Affecting Resection

bull Access to the Surgical Site

bull Anatomy of Root

bull Need for Root-End Filling

bull Location of Procedural Error

bull Location of Pathologic Defect

bull Presence amp Location of Accessory Canals

55 56

57 58

59 60

9162019

11

Ultrasonic

Preparation of Root-

End Cavities

Comparison Between Two

Root-End Preparation

Techniques in Human

Cadavers

Wuchenich Meadows amp Torabinejad

J of Endodon 1994

Effects of Ultrasonic Root-

End Cavity Preparation on

the Root Apex

Clinical Procedures During

Endodontic Surgerybull Local Anesthesia

bull Flap Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

Root End Filling Materials

bull I History

bull II Rationale

bull III Substances

61 62

63 64

65 66

9162019

12

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

BiocompatibleBioactive

Long-term dimensional stability

Unaffected by moisture

Bactericidal or bacteriostatic

Easy to manipulate

Radioopaque

Inexpensive

Traditional Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass Ionomers

New Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass IonomersMineral Trioxide

AggregateOther Calcium Silicate-

Based Cements

Other Calcium Silicate Based Cements

bull Bioaggregate

bull Biodentine

bull CEM

bull Micromega MTA

bull iRoot BP Plus

bull EndoCem MTA

bull RetroMTA

bull OrthoMTA

bull Channel MTA

bull MTA Angelus

bull Bio MTA Plus

bull Endo Sequence Repair Material

bull MTA-Caps

bull MTA-Bronco

bull DiaRoot

bull DiaDent

bull Endo-CPM

bull Generex A

bull Capasio

bull CEM

bull MTA Fillapex

bull CER

bull Nano-Modified MTA (NMTA)

bull TheraCal LC

bull MTA-Bio

bull CALCIUM OXIDE 65

bull SILICON DIOXIDE 21

bull FERRIC OXIDE 5

bull ALUMINUM OXIDE 4

bull CALCIUM SULPHATE 25

bull MAGNESIUM OXIDE 2

bull SODIUM OXIDE 25

bull POTASSIUM OXIDE 25

bull Bismuth Oxide 20

What is MTA

67 68

69 70

71 72

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

8

bull A Full Mucoperiosteal

ndash 1 Triangular

ndash 2 Rectangular

ndash 3 Trapezoidal

bull B Sub-marginal

ndash 1 Luebke-Oschsenbein

bull A Full Mucoperiosteal

ndash 1 Triangular

ndash 2 Rectangular

ndash 3 Trapezoidal

bull B Sub-marginal

ndash 1 Luebke-Oschsenbein

ndash 2 Papillae Based Flap

bull Use High-Speed Handpiece

bull Use Sharp Round Burs

bull Use Light Pressure

bull Use ldquoBrush Strokerdquo Motion

bull Avoid Deep Penetration

bull Use Periodic Irrigation

bull Use Good Aspiration

Biologic Removal of Osseous Tissue

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Targeting The Apex

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Targeting The Apex

43 44

45 46

47 48

9162019

9

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Intraoral scan

Targeting The ApexGuide design

bull Blue Sky Bio implant guide design software

bull Import and merge both CBCT amp intraoral

scans

bull Virtual implant design

bull Create the guide

bull Export the STL file

bull 3D Print

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

Targeting The Apex

EXPORT THE STL FILE TO A 3D PRINTER

Create the guide

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

Targeting The Apex

CHECK ON THE ACTUAL MODEL FOR THE FIT

Printed Guide

49 50

51 52

53 54

9162019

10

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

bull Perform the ostectomy

Targeting The ApexClinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

RADIOLUCENT LESIONS WHICH MIMICKED

PERIRADICULAR PATHOSIS

(Top 10 Commonly Reported Lesions)

1 ACTINOMYCOSIS 22

2 FIBRO-OSSEOUS LESIONS (FIBROUS DYSPLASIA 11

PAGETrsquoS DISEASE PERIAPICAL CEMENTAL

DYSPLASIA OSSIFYING FIBROMA)

3 ODONTOGENIC KERATOCYSTS 9

4 CARCINOMA (METASTATIC AND LOCAL) 8

5 LYMPHOMA (INCLUDING BURKITTrsquoS amp HISTOCYTIC 7

6 TRAUMATIC BONE CYSTS 4

7 NASOPALATINE DUCT CYSTS 3

8 RESIDUAL CYST 3

9 AMELOBLASTOMA 2

10 CENTRAL GIANT CELL GRANULOMA 2

11 OTHER 24

Clinical Procedures During

Endodontic SurgeryLocal Anesthesia

Flap Elevation

Ostectomy

Biopsy

Root-end Resection amp Preparation

Root End Filling

Suturing

bull Removal of Anatomic Variations

bull Removal of Operator Errors

bull Evaluation of the Apical Seal

bull Creation of an Apical Seal

bull Reduction of Fenestrated RootApices

Rationale for Root End Resection

bull

Factors Affecting Resection

bull Access to the Surgical Site

bull Anatomy of Root

bull Need for Root-End Filling

bull Location of Procedural Error

bull Location of Pathologic Defect

bull Presence amp Location of Accessory Canals

55 56

57 58

59 60

9162019

11

Ultrasonic

Preparation of Root-

End Cavities

Comparison Between Two

Root-End Preparation

Techniques in Human

Cadavers

Wuchenich Meadows amp Torabinejad

J of Endodon 1994

Effects of Ultrasonic Root-

End Cavity Preparation on

the Root Apex

Clinical Procedures During

Endodontic Surgerybull Local Anesthesia

bull Flap Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

Root End Filling Materials

bull I History

bull II Rationale

bull III Substances

61 62

63 64

65 66

9162019

12

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

BiocompatibleBioactive

Long-term dimensional stability

Unaffected by moisture

Bactericidal or bacteriostatic

Easy to manipulate

Radioopaque

Inexpensive

Traditional Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass Ionomers

New Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass IonomersMineral Trioxide

AggregateOther Calcium Silicate-

Based Cements

Other Calcium Silicate Based Cements

bull Bioaggregate

bull Biodentine

bull CEM

bull Micromega MTA

bull iRoot BP Plus

bull EndoCem MTA

bull RetroMTA

bull OrthoMTA

bull Channel MTA

bull MTA Angelus

bull Bio MTA Plus

bull Endo Sequence Repair Material

bull MTA-Caps

bull MTA-Bronco

bull DiaRoot

bull DiaDent

bull Endo-CPM

bull Generex A

bull Capasio

bull CEM

bull MTA Fillapex

bull CER

bull Nano-Modified MTA (NMTA)

bull TheraCal LC

bull MTA-Bio

bull CALCIUM OXIDE 65

bull SILICON DIOXIDE 21

bull FERRIC OXIDE 5

bull ALUMINUM OXIDE 4

bull CALCIUM SULPHATE 25

bull MAGNESIUM OXIDE 2

bull SODIUM OXIDE 25

bull POTASSIUM OXIDE 25

bull Bismuth Oxide 20

What is MTA

67 68

69 70

71 72

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

9

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

Intraoral scan

Targeting The ApexGuide design

bull Blue Sky Bio implant guide design software

bull Import and merge both CBCT amp intraoral

scans

bull Virtual implant design

bull Create the guide

bull Export the STL file

bull 3D Print

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

Targeting The Apex

EXPORT THE STL FILE TO A 3D PRINTER

Create the guide

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

Targeting The Apex

CHECK ON THE ACTUAL MODEL FOR THE FIT

Printed Guide

49 50

51 52

53 54

9162019

10

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

bull Perform the ostectomy

Targeting The ApexClinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

RADIOLUCENT LESIONS WHICH MIMICKED

PERIRADICULAR PATHOSIS

(Top 10 Commonly Reported Lesions)

1 ACTINOMYCOSIS 22

2 FIBRO-OSSEOUS LESIONS (FIBROUS DYSPLASIA 11

PAGETrsquoS DISEASE PERIAPICAL CEMENTAL

DYSPLASIA OSSIFYING FIBROMA)

3 ODONTOGENIC KERATOCYSTS 9

4 CARCINOMA (METASTATIC AND LOCAL) 8

5 LYMPHOMA (INCLUDING BURKITTrsquoS amp HISTOCYTIC 7

6 TRAUMATIC BONE CYSTS 4

7 NASOPALATINE DUCT CYSTS 3

8 RESIDUAL CYST 3

9 AMELOBLASTOMA 2

10 CENTRAL GIANT CELL GRANULOMA 2

11 OTHER 24

Clinical Procedures During

Endodontic SurgeryLocal Anesthesia

Flap Elevation

Ostectomy

Biopsy

Root-end Resection amp Preparation

Root End Filling

Suturing

bull Removal of Anatomic Variations

bull Removal of Operator Errors

bull Evaluation of the Apical Seal

bull Creation of an Apical Seal

bull Reduction of Fenestrated RootApices

Rationale for Root End Resection

bull

Factors Affecting Resection

bull Access to the Surgical Site

bull Anatomy of Root

bull Need for Root-End Filling

bull Location of Procedural Error

bull Location of Pathologic Defect

bull Presence amp Location of Accessory Canals

55 56

57 58

59 60

9162019

11

Ultrasonic

Preparation of Root-

End Cavities

Comparison Between Two

Root-End Preparation

Techniques in Human

Cadavers

Wuchenich Meadows amp Torabinejad

J of Endodon 1994

Effects of Ultrasonic Root-

End Cavity Preparation on

the Root Apex

Clinical Procedures During

Endodontic Surgerybull Local Anesthesia

bull Flap Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

Root End Filling Materials

bull I History

bull II Rationale

bull III Substances

61 62

63 64

65 66

9162019

12

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

BiocompatibleBioactive

Long-term dimensional stability

Unaffected by moisture

Bactericidal or bacteriostatic

Easy to manipulate

Radioopaque

Inexpensive

Traditional Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass Ionomers

New Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass IonomersMineral Trioxide

AggregateOther Calcium Silicate-

Based Cements

Other Calcium Silicate Based Cements

bull Bioaggregate

bull Biodentine

bull CEM

bull Micromega MTA

bull iRoot BP Plus

bull EndoCem MTA

bull RetroMTA

bull OrthoMTA

bull Channel MTA

bull MTA Angelus

bull Bio MTA Plus

bull Endo Sequence Repair Material

bull MTA-Caps

bull MTA-Bronco

bull DiaRoot

bull DiaDent

bull Endo-CPM

bull Generex A

bull Capasio

bull CEM

bull MTA Fillapex

bull CER

bull Nano-Modified MTA (NMTA)

bull TheraCal LC

bull MTA-Bio

bull CALCIUM OXIDE 65

bull SILICON DIOXIDE 21

bull FERRIC OXIDE 5

bull ALUMINUM OXIDE 4

bull CALCIUM SULPHATE 25

bull MAGNESIUM OXIDE 2

bull SODIUM OXIDE 25

bull POTASSIUM OXIDE 25

bull Bismuth Oxide 20

What is MTA

67 68

69 70

71 72

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

10

bull CBCT scan (reviewing the complexity of the case vital anatomical structures nearby)

bull Intraoral scan

bull Create the guide and export the STL file to a 3D printer

bull 3D Print

bull Perform the ostectomy

Targeting The ApexClinical Procedures During

Periradicular Surgery

bull Local Anesthesia

bull Flap Design and Elevation

bull Ostectomy

bull Biopsy

bull Root-end Preparation

bull Root End Filling

bull Suturing

RADIOLUCENT LESIONS WHICH MIMICKED

PERIRADICULAR PATHOSIS

(Top 10 Commonly Reported Lesions)

1 ACTINOMYCOSIS 22

2 FIBRO-OSSEOUS LESIONS (FIBROUS DYSPLASIA 11

PAGETrsquoS DISEASE PERIAPICAL CEMENTAL

DYSPLASIA OSSIFYING FIBROMA)

3 ODONTOGENIC KERATOCYSTS 9

4 CARCINOMA (METASTATIC AND LOCAL) 8

5 LYMPHOMA (INCLUDING BURKITTrsquoS amp HISTOCYTIC 7

6 TRAUMATIC BONE CYSTS 4

7 NASOPALATINE DUCT CYSTS 3

8 RESIDUAL CYST 3

9 AMELOBLASTOMA 2

10 CENTRAL GIANT CELL GRANULOMA 2

11 OTHER 24

Clinical Procedures During

Endodontic SurgeryLocal Anesthesia

Flap Elevation

Ostectomy

Biopsy

Root-end Resection amp Preparation

Root End Filling

Suturing

bull Removal of Anatomic Variations

bull Removal of Operator Errors

bull Evaluation of the Apical Seal

bull Creation of an Apical Seal

bull Reduction of Fenestrated RootApices

Rationale for Root End Resection

bull

Factors Affecting Resection

bull Access to the Surgical Site

bull Anatomy of Root

bull Need for Root-End Filling

bull Location of Procedural Error

bull Location of Pathologic Defect

bull Presence amp Location of Accessory Canals

55 56

57 58

59 60

9162019

11

Ultrasonic

Preparation of Root-

End Cavities

Comparison Between Two

Root-End Preparation

Techniques in Human

Cadavers

Wuchenich Meadows amp Torabinejad

J of Endodon 1994

Effects of Ultrasonic Root-

End Cavity Preparation on

the Root Apex

Clinical Procedures During

Endodontic Surgerybull Local Anesthesia

bull Flap Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

Root End Filling Materials

bull I History

bull II Rationale

bull III Substances

61 62

63 64

65 66

9162019

12

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

BiocompatibleBioactive

Long-term dimensional stability

Unaffected by moisture

Bactericidal or bacteriostatic

Easy to manipulate

Radioopaque

Inexpensive

Traditional Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass Ionomers

New Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass IonomersMineral Trioxide

AggregateOther Calcium Silicate-

Based Cements

Other Calcium Silicate Based Cements

bull Bioaggregate

bull Biodentine

bull CEM

bull Micromega MTA

bull iRoot BP Plus

bull EndoCem MTA

bull RetroMTA

bull OrthoMTA

bull Channel MTA

bull MTA Angelus

bull Bio MTA Plus

bull Endo Sequence Repair Material

bull MTA-Caps

bull MTA-Bronco

bull DiaRoot

bull DiaDent

bull Endo-CPM

bull Generex A

bull Capasio

bull CEM

bull MTA Fillapex

bull CER

bull Nano-Modified MTA (NMTA)

bull TheraCal LC

bull MTA-Bio

bull CALCIUM OXIDE 65

bull SILICON DIOXIDE 21

bull FERRIC OXIDE 5

bull ALUMINUM OXIDE 4

bull CALCIUM SULPHATE 25

bull MAGNESIUM OXIDE 2

bull SODIUM OXIDE 25

bull POTASSIUM OXIDE 25

bull Bismuth Oxide 20

What is MTA

67 68

69 70

71 72

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

11

Ultrasonic

Preparation of Root-

End Cavities

Comparison Between Two

Root-End Preparation

Techniques in Human

Cadavers

Wuchenich Meadows amp Torabinejad

J of Endodon 1994

Effects of Ultrasonic Root-

End Cavity Preparation on

the Root Apex

Clinical Procedures During

Endodontic Surgerybull Local Anesthesia

bull Flap Elevation

bull Ostectomy

bull Biopsy

bull Root-end Resection

bull Root End Filling

Root End Filling Materials

bull I History

bull II Rationale

bull III Substances

61 62

63 64

65 66

9162019

12

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

BiocompatibleBioactive

Long-term dimensional stability

Unaffected by moisture

Bactericidal or bacteriostatic

Easy to manipulate

Radioopaque

Inexpensive

Traditional Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass Ionomers

New Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass IonomersMineral Trioxide

AggregateOther Calcium Silicate-

Based Cements

Other Calcium Silicate Based Cements

bull Bioaggregate

bull Biodentine

bull CEM

bull Micromega MTA

bull iRoot BP Plus

bull EndoCem MTA

bull RetroMTA

bull OrthoMTA

bull Channel MTA

bull MTA Angelus

bull Bio MTA Plus

bull Endo Sequence Repair Material

bull MTA-Caps

bull MTA-Bronco

bull DiaRoot

bull DiaDent

bull Endo-CPM

bull Generex A

bull Capasio

bull CEM

bull MTA Fillapex

bull CER

bull Nano-Modified MTA (NMTA)

bull TheraCal LC

bull MTA-Bio

bull CALCIUM OXIDE 65

bull SILICON DIOXIDE 21

bull FERRIC OXIDE 5

bull ALUMINUM OXIDE 4

bull CALCIUM SULPHATE 25

bull MAGNESIUM OXIDE 2

bull SODIUM OXIDE 25

bull POTASSIUM OXIDE 25

bull Bismuth Oxide 20

What is MTA

67 68

69 70

71 72

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

12

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

Ideal Characteristics of Root End Filling Materials

Seal pathways to root canal system

BiocompatibleBioactive

Long-term dimensional stability

Unaffected by moisture

Bactericidal or bacteriostatic

Easy to manipulate

Radioopaque

Inexpensive

Traditional Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass Ionomers

New Materials

Amalgam IRM Super EBACompositesGold FoilCavitZinc Phosphate

Cement

Indium FoilCalcium HydroxideTri-calcium

PhosphateHydroxyapatiteGlass IonomersMineral Trioxide

AggregateOther Calcium Silicate-

Based Cements

Other Calcium Silicate Based Cements

bull Bioaggregate

bull Biodentine

bull CEM

bull Micromega MTA

bull iRoot BP Plus

bull EndoCem MTA

bull RetroMTA

bull OrthoMTA

bull Channel MTA

bull MTA Angelus

bull Bio MTA Plus

bull Endo Sequence Repair Material

bull MTA-Caps

bull MTA-Bronco

bull DiaRoot

bull DiaDent

bull Endo-CPM

bull Generex A

bull Capasio

bull CEM

bull MTA Fillapex

bull CER

bull Nano-Modified MTA (NMTA)

bull TheraCal LC

bull MTA-Bio

bull CALCIUM OXIDE 65

bull SILICON DIOXIDE 21

bull FERRIC OXIDE 5

bull ALUMINUM OXIDE 4

bull CALCIUM SULPHATE 25

bull MAGNESIUM OXIDE 2

bull SODIUM OXIDE 25

bull POTASSIUM OXIDE 25

bull Bismuth Oxide 20

What is MTA

67 68

69 70

71 72

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

13

Why Not Portland Cement

1 The quality composition and bio-

compatibility can not be controlled

2 Some forms of PC contain 6 times as

much arsenic compared to GMTA

Monteiro Bramante C et al OOOOE 2008

Why Not Portland Cement

3 It has a higher solutilty and may degrade after

clinical application jeopardizing the seal

Danesh G et al Int Endod J 200639213-9

4 Compressive strength is significantly lower

Islam I et al J Endod 200632193-7

5 It has excessive expansion which may crack the

root

Islam Iet al J Endod 200632193-7

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Bioaggregate

bull Biodentine

bull BioRoot RCS

bull CEM

bull Capsio

bull Cerkamed MTA plus

bull Channels MTA

bull DiaRoot Bioaggregate

bull Delian MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull Endosequence

bull Fast-Set MTA

bull Generex-A

bull Grey MTA plus

bull Harvard MTA

bull iRoot BP Plus

bull iM3 MTA

bull iRoot

bull MEDCEM MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

bull EMTA

bull EndoBinder EMTA

bull Endocem MTA

bull Endoflas Cem

bull EndoCemZr

bull Endo CPM

bull Endo CPM

bull Endo-Eze MTA

bull Endoseal MTA

Commercially Available Calcium Silicate CementsCommercially Available Calcium Silicate Cements

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull ProRoot MTA

bull Quick-Set

bull ReMTA

bull RetroMTA

bull Spieko MTA Cement

bull Tech BioSeal MTA

bull TheraCal LC

bull Trioxident

bull Vivid Root MTA

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull Medicept MTA

bull MM-MTA

bull MTA+

bull MTA Angelus

bull MTA-Bio

bull MTA Caps

bull MTA Cem

bull MTA-CPM

bull MTA Filapex

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

bull MTA Flow

bull MTA FORTE

bull MTA-Plus

bull Neo MTA Plus

bull NEX MTA

bull Nexobio MTA

bull Odontocem

bull OrthoMTA

bull PD MTA White

I References

MTA Past Present Future

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part I Chemical Physical and Antibacterial Properties

Parirokh M and Torabinejad M J Endo 2010 3616ndash27

73 74

75 76

77 78

9162019

14

Mineral Trioxide Aggregate A Comprehensive Literature Review

Part II Leakage and Biocompatibility Investigations

Torabinejad M and Parirokh M J Endo 2010 36190ndash202

Mineral Trioxide Aggregate A Comprehensive Literature Review -

Part III Clinical Applications Drawbacks and Mechanism of Action

Parirokh M and Torabinejad M J Endo 2010 36400ndash413

Mineral Trioxide Aggregate and Other Calcium Silicate and Calcium Alumino- silicate Cements A

Comprehensive Literature Update Part I Chemical Composition and Vital

Pulp Therapy

Parirokh M and Torabinejad M In Preparation

Mineral Trioxide Aggregate and Other Calcium Silicate and Calcium

Aluminosilicate Cements A Comprehensive Literature Update -Part II Clinical Applications and

Complications

Torabinejad M and Parirokh M In Preparation

Handout

Dentinogenesis after pulp

capping a Scanning

Electron Microscopy study

Masoud Parirokhsup1 Saeed Asgarysup2 Mohammad Jafar

Eghbalsup2and Sally Stowe3

Identification of Hard Tissue

After Experimental Pulp

Capping Using Dentin

Sialoprotein (DSP)

As a MarkerW E Andelin S ShabahangK Wright M Torabinejad

J Endo 200329646-50

79 80

81 82

83 84

9162019

15

DSP Staining

0

10

20

30

40

50

60

70

80

90

MTA CH BMP

Heavy

Light

None

Per

cen

t

Investigation Of Mineral Trioxide

Aggregate For Root End Filling In

Dogs

M Torabinejad Et al J Endodon 199519603-8

HISTOLOGIC ASSESSMENT

OF MTA AS ROOT END

FILLING IN MONKEYS

M TORABINEJAD ET AL J ENDODON 199723225-8

Mechanisms of Actions

bull Provides a Tight Seal

Mechanisms of Actions

bull Sarkar NK et al J Endod 20053197-100

bull Bozeman TB et al J Endod 200632425-8

bull Reyes-Carmona JF Felippe MS Felippe WT J Endod

200935731-6

Forms HA (or carbonated apatite) on the

MTA surface and provides a biologic seal

Mechanisms of Actions

bullProvides a Tight Seal

bullIs Biocompatible

85 86

87 88

89 90

9162019

16

Mechanisms of Actions

Encourages differentiation and migration of hard-tissue producing cells

Kuratate M et al J Endod 200834970-4

Teacuteclegraves O et al J Biomed Mater Res B Appl Biomater200885180-7

BiocompatibleBioactive

Cementum is deposited directly on the surface of MTA

-- Torabinejad 1995

-- Asgary 2010

MTA stimulates cytokines conducive to hard tissue

healing

-- Ham 2005

-- Andelin 2003

MTA induces stem cell growth of the apical papilla

-- Schneider 2014

Mechanisms of Actions

bullProvides a Tight Seal

bullIs Biocompatible

bullReleases Cytokines

Mechanisms of Actions

bullProvides a Tight Seal

bullIs Biocompatible

bullReleases Cytokines

bullHas High Ph

Clinical Procedures During

Endodontic SurgeryLocal Anesthesia

Flap Elevation

Ostectomy

Biopsy

Root-end Resection

Root End Filling

Suturing

bull Absorbable

(Gut Chromic Gut Collagen Polyglactin (Vicryl) Polydioxanone)

bull Non-Absorbable(Silk Nylon Linen Cotton Polyester Steel)

91 92

93 94

95 96

9162019

17

Biologic Considerations During Wound Closure

1-Avoidance of excessive tension on suturestissues

2-Knots to be positioned away from the wound edges

3-Use the least amount of sutures possible

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Indications for Surgery

bull Calcified Canals

bull Irretrievable Filling Materials

bull Symptomatic Cases

bull Procedural Accidents

bull Presence of Non Removable Post

bull Unusual Canal Anatomy

bull Exploratory Surgery

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Auto-transplantation

Contra Indications for Surgery

bull Medical Conditions

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

97 98

99 100

101 102

9162019

18

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

bull Anatomic Factors

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

103 104

105 106

107 108

9162019

19

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

109 110

111 112

113

9162019

16

Mechanisms of Actions

Encourages differentiation and migration of hard-tissue producing cells

Kuratate M et al J Endod 200834970-4

Teacuteclegraves O et al J Biomed Mater Res B Appl Biomater200885180-7

BiocompatibleBioactive

Cementum is deposited directly on the surface of MTA

-- Torabinejad 1995

-- Asgary 2010

MTA stimulates cytokines conducive to hard tissue

healing

-- Ham 2005

-- Andelin 2003

MTA induces stem cell growth of the apical papilla

-- Schneider 2014

Mechanisms of Actions

bullProvides a Tight Seal

bullIs Biocompatible

bullReleases Cytokines

Mechanisms of Actions

bullProvides a Tight Seal

bullIs Biocompatible

bullReleases Cytokines

bullHas High Ph

Clinical Procedures During

Endodontic SurgeryLocal Anesthesia

Flap Elevation

Ostectomy

Biopsy

Root-end Resection

Root End Filling

Suturing

bull Absorbable

(Gut Chromic Gut Collagen Polyglactin (Vicryl) Polydioxanone)

bull Non-Absorbable(Silk Nylon Linen Cotton Polyester Steel)

91 92

93 94

95 96

9162019

17

Biologic Considerations During Wound Closure

1-Avoidance of excessive tension on suturestissues

2-Knots to be positioned away from the wound edges

3-Use the least amount of sutures possible

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Indications for Surgery

bull Calcified Canals

bull Irretrievable Filling Materials

bull Symptomatic Cases

bull Procedural Accidents

bull Presence of Non Removable Post

bull Unusual Canal Anatomy

bull Exploratory Surgery

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Auto-transplantation

Contra Indications for Surgery

bull Medical Conditions

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

97 98

99 100

101 102

9162019

18

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

bull Anatomic Factors

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

103 104

105 106

107 108

9162019

19

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

109 110

111 112

113

9162019

17

Biologic Considerations During Wound Closure

1-Avoidance of excessive tension on suturestissues

2-Knots to be positioned away from the wound edges

3-Use the least amount of sutures possible

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Indications for Surgery

bull Calcified Canals

bull Irretrievable Filling Materials

bull Symptomatic Cases

bull Procedural Accidents

bull Presence of Non Removable Post

bull Unusual Canal Anatomy

bull Exploratory Surgery

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

PA Surgery

Indications and Contraindications

Adjunctive Surgery

Auto-transplantation

Contra Indications for Surgery

bull Medical Conditions

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

97 98

99 100

101 102

9162019

18

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

bull Anatomic Factors

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

103 104

105 106

107 108

9162019

19

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

109 110

111 112

113

9162019

18

Contra Indications for Surgery

bull Medical Conditions

bull Indiscriminate Surgery

bull Anatomic Factors

Topics To Be Covered

bull Pathogenesis Of Pulp and Periapical Lesions

bull Success Rate of Root Canal Treatment

bull Etiology of Non-healing Initial Endodontic Treatment

bull Treatment Options Following Non-healing RCT

No Treatment

Non Surgical Re-treatment

Surgical Re-treatment

Incision amp Drainage

Periapical Surgery

Indications and Contraindications

Adjunctive Surgery

Classification of Endodontic

Surgery

A Incision and Drainage

B Periradicular Surgery

C Adjunctive Surgery

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

103 104

105 106

107 108

9162019

19

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

109 110

111 112

113

9162019

19

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

Adjunctive Surgery1 Root Amputation

2 Hemisection

3 Bicuspidization

4 Replantation

5 Transplantation

6 Crown Lengthening

109 110

111 112

113