Endodontic Surgery (Apicoectomy)

Endodontic procedure (Apicoectomy)In this modern times patient increasingly wish to stay fresh their natural dentition and often reluctant to get there teeth extracted . Endodontic cognitive process (apicoectomy) is the interference performed on the composition apices of an infected tooth, and its re role and removal of pathological tissues around the apices followed by placement of a weft (retro selection) to impression the root end. Endodontic surgery offers patient a second come about or the final chance to save there tooth. Success of blood end surgery had a poor prognosis and advantage cast in the past but due to recent advances Endontics due to the surgical operating microscope and in the buff tecniques the charge per unit is much higher than before winnerIts indications are as follows1 RCT treated tooth that has severe peri top(prenominal) hullabaloo disrespect of a satisfactory RCT2 Tooth with persistant periapical inflammation and inadequate RCT and has the f ollowing problems a Severely curved root put upals where access is an issue to ease up the heightb Completely calcified root canalsC Presence of post and cores in rootd Breakage of small instrument or filling material where it is not retrievable and an infection is still present in the apical region.Teeth with periapical inflammation where completion of endodontic therapy due to1 Foreign body present in the periapical tissues2 Perforation of the inferior groyne of the pulp chamber3 Perforation of the root4 Fracture of the apical third of the root5 Dental anomalies (Dense in Dente )6 chafe for periradicular curettageA non heal endodontic lesion is recognized by long-lived pain and/or swelling, possibly with radiographic changes indicating increasing periapical drop loss. Non mend endodontically treated teeth that do not appear to be healing are not automatic indications for stock and replacement with an implant. Persistent nonhealing cases can be saved by endodontic microsur gery with a predictably palmy prognosisNonsurgical endodontic treatment has a high respect of clinical success despite the anatomic and pathologic challenges of the procedure. Success in case of tooth without periapical extension of pathosis is more than 90%. On the other hand, studies attest that infected root canals with an extension of pathosis into the periapical space overhear a cut down healing capacity . previously the conventional endosurgery has very low success rate . it was recorded as low as 37.4 % but outright with recent advancement in endodontic surgery the success rate has improved significantly. According to a speculate conducted by shimon Friedman and Chaim Mor ( success of endodontic therapy -healing and functionality) in patients were endodontic surgery is performed the chances of healing after retreatment is between 74 to 86 %and their chance of being functional overtime is 91 to 97 % .Another study ( modern endodontic surgery concept and practice by sy ngcuk Kim and Samuel Kratchman)said that the traditonal apical surgerybased on clinical symptoms and radiographic findings ranges from 44% to 90%.it has even off higher success rate with the endodontic microsurgery. . According to another study (outcome of surgical endodontic treatment performed by a modern proficiency A meta anlysis conducted by Igor Tsesis , Surgical endodontic treatment have a success rate of 91 .4 % when followed up in a yr time .According toa study named Outcome of endodontic micro re- surgery by Minju song and team . When an endodontic surgery fails we need to describe the problem and find the reason for failure. To solve the problem further treatment analogous retreatment with surgery and, extraction are the viable options. Some studies in the past have documented poor success rate if we have to redo a failed surgery again. But this study said that with the new microscope and microsurgical devices the success rate can be as high as 92.9 %. Most of the re ason for failure is poor technique,poor seal at the apical region and not employ biocompatible materials like MTA and super PBA in the past. In another recent study it was found that, at least in America, endodontic surgery was the least expensive intervention for failed RCT when compared to endodontic re-treatment and crown, extraction and fixed partial denture, or extraction and implant (Kim Solomon, 2011).When primary endodontic treatment fails retreatment should be done and when retreated and if there is severe inflammation in the periapical tissues then endo surgery can be an option using advance techniqies and good operationg skill can add to the success of endo surgery.1 MicroscopeThe microscope will provide good visual image, identification and treatment of infected canals, isthmuses and disagreement anatomy not reachable with traditional instrumentation techniques. Microscope can reach to more different locations and narrow spaces, by providing a clear theater of opera tions of vision. Good visualization also prevents damage to anatomical structures. Microscopic techniques significantly decrease complications and expand the case applicability for performing this procedure on teeth adjacent to these structures. With increased magnification and illumination, differentiating the root surface from the touch bone is also enhanced .A main cause of nonsurgical endodontic failure results from the inability to clean and sterilize the apical canal space, which is a complex anatomical entity.2 supersonic tipsThat allow accurate cookery along the long bloc of the root canal with clear visualization of the preparation . This technique will allow us to do root-end fillings in the proper position to seal the root canal to sufficient filling depth and thickness to effectively seal the canal, dentinal tubules and accessory canals. Ideal ultrasonic tip length is 3mm long. A minimum of 3mm preparation depth is unavoidable to prevent leakage.3 Surgical advancesA smaller osteotomy will nullify bone removal (approximately 3-4mm) in diameter reducedbone and permits quick uneventful postoperative healing postoperative healing. By removing less bone in the coronal direction, buccal bone can be continue and subsequent periodontal sequelae that may lead to the loss of the tooth are prevented.Root-tip resection of 3mm is ask to eliminate lateral canals and apical ramification- A study shows that the resection of 3mm of apex eliminates 98 percent of apical ramifications and 93 percent of lateral canals.Root section bevel angle is reduced to 0 -10 degreesClear examination of the resected root surfaces for fracture and anoatomical variationsRoot-end fillings with MTA (Mineral Trioxide Aggregate- It has excellent biocompatibility, osteo- and cemento-inductive capabilities, effective antibacterial and sealing properties, and faster radiographic healing in comparison to SuperEBA and IRM. MTA will not cause wanton tissue discoloration that can otherwi se result from root-end filling materials like amalgamMagnification Eyes or Loupes (1-4x) Microscope (4-24x)Illumination Dental heat Bright focused lightArmamentarium Macro-instruments Micro-instrumentsOsteotomy Size Large (7-10mm diameter) Small (3-3mm diameter)slang Angle Acute (45-60 degree) Shallow (0-10 degree)Root-end Preparation Non-axial Axial to long axis of toothDepth of Root-end prep 1mm non-axial 3mm axialInspection resected root surface none AlwaysRoot-end filling material Amalgam MTASuccess rate over 1 year Less than 50% Over 90% stockyThere are many factors to consider when choosing to perform microsurgeryon a tooth versus performing other treatment options such asnonsurgical retreatment or tooth extraction. Fortunately for the patient,the ability to perform endodontic microsurgery is an effective and highly prospered procedure that produces minimal discomfort, alleviates periradicularpathosis, maintains restorations and provides for function andaesthetics as shown i n omen 6.33,34