Periapical Microsurgery: An Update on Surgical Endodontics (Part 1 of 3)
You will receive 2 credit(s) of continuing education credit upon successful completion of this course. The purchase price of this course is $98.00
Periradicular surgery has evolved into a precise, biologically based adjunct to nonsurgical root canal therapy. This first part of this lecture will cover all significant improvements that have been made in the development of new instruments, materials and techniques. This surgical field is very rarely taught in dental schools and this course provides clinicians a chance to get familiar with this procedure. The goal of this first part, is to familiarize clinicians with this procedure. The following two parts will go over the technical portion of this procedure in order to make clinicians more comfortable in performing straight forward periapical microsurgery cases.
Upon completion of this course, the participant should be able to:
- Know the indication for periradicular microsurgery
- Know the differences between traditional techniques and modern microsurgical techniques
- Know what type of radiography to use and when a CBCT is indicated
- Know alternative surgical treatment options and when they would be indicated (Intentional replantation and autotransplantation)
- Know the new microsurgical instruments
- Describe the different flap designs used in surgical endodontics and their indications
Modern endodontic microsurgical protocols have shown excellent success rates in clinical studies. Recent studies showed a distinct higher success rate when modern microsurgical techniques were compared to the older traditional techniques in performing apical surgeries. Given the positive success of modern techniques in periapical microsurgery, this procedure should be part of the treatment options of failing root canal treated teeth. This lecture has a goal to familiarize clinicians with this procedure.
- Nash KD, Brown LJ, Hicks ML. Private practicing endodontists: production of endodontic services and implications for workforce policy. J Endod. 2002 Oct;28(10):699-705.
- Rubinstein RA, Kim S. Long-term follow-up of cases considered healed one year after apical microsurgery. J Endod. 2002 May;28)5):378-83.
- Maddalone M, Gagliani M. Periapical endodontic surgery: a 3-year follow-up study. Int Endod J. 2003 Mar;36(3):193-8.
- Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique. J Endod. 2006 May;32(5):412-6
- Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature--part1: Comparison of traditional root-end surgery and endodontic microsurgery. J Endod. 2010 Nov;36(11):1757-65
- Song M, Shin SJ, Kim E. Outcomes of endodontic micro-resurgery: a prospective clinical study. J Endod. 2011 Mar;37(3):316-20.
- Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004 Jan;30(1):1-4.
- Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endod J. 1995 Jan;28(1):12-8.
- Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol. 2000 Oct; 16(5):218-21.
- Nair PN. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med. 2004 Nov 1;15(6):348-81.
- Nair PN, Henry S, Cano V, Vera J. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after “one-visit” endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Feb;99(2):231-52.
- Sundquvist G, Reuterving CO. Isolation of Actinomyces israelii from periapical lesion. J Endod. 1980 Jun;(6):602-6.
- Tronstad L, Barnett F, Riso K, Slots J. Extraradicular endodontic infections. Endod Dent Traumatol. 1987 Apr;3(2):86-90.
- Sunde PR, Olsen I, Gobel UB, Theegraten D, Winter S, Debelian GJ, Tronstad L, Moter A. Fluorescence in situ hybridization (FISH) for direct visualization of bacteria in perapical lesions of asymptomatic root-filled teeth. Microbiology. 2003 May;149(Pt 5):1095-102.
- Ricucci D, Martorano M, Bate AL, Pascon EA. Calculus-like deposit on the apical external root surface of teeth with post-treatment apical periodontitis: report of two cases. Int Endod J. 2005 Apr;38(4):262-71.
- Nair PN, Sjogren U, Schumacher E, Sundqvist G. Radicular cyst affecting a root-filled human tooth: a long-term post-treatment follow-up. Int Endod J. 1993 Jul;26(4):225-33
- Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ. Odontogenic myxoma: a clinicopathological study of 33 cases. Int J Oral Maxillofac Surg. 2004 Jun;33(4):333-7.
- Nair PN, Sjogren U, Krey G, Kahnberg KE, Sundqvist G. Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: a long-term light and electron microscopic follow-up study. J Endod. 1990 Dec; 16(12):580-8.
- Nair PN, Sjogren U, Sundqvist G. Cholestrerol crystals as an etiological factor in non-resolving chronic inflammation: an experimental study in guinea pigs. Eur J Oral Sci. 1998 Apr;106(2 Pt 1):644-50.
- Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J. 1998 Nov;31(6):394-409.
- Testori T, Badino M, Castagnola M. Vertical root fractures in endodontically treated teeth: a clinical survey of 36 cases. J Endod. 1993 Feb;19(2):87-91.
- Tamse A, Fuss Z, Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod. 1999 Jul;25(7):506-8.
- Marending M, Peters OA, Zehnder M. Factors affecting the outcome of orthograde root canal therapy in a general dentistry hospital practice. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jan;99(1):119-24.
- Fouad AF, Burleson J. The effect of diabetes mellitus on endodontic treatment outcome: data from an electronic patient record. J Am Dent Assoc. 2003 Jan;134(1):43-51; quiz 117-8.
- Herman R. Endodontics versus single-tooth implants. Int J Periodontics Restorative Dent. 2010 Feb;30(1):5.
- Levin L, Schwartz-Arad D. The effect of cigarette smoking on dental implants and related surgery. Implant Dent. 2005 Dec;14(4):357-61.
- Wang CH, Chueh LH, Chen SC, Feng YC, Hsiao CK, Chiang CP. Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment. J Endod. 2011 Jan;37(1):1-5.
- Wu M-K, Wesselink PR. Timeliness and effectiveness in the surgical management of persistent post-treatment peri- apical pathosis. Endodontic Topics. 2005; 11, 25–31.
- Hargreaves KM, Khan A. Surgical preparation: anesthesia & hemostasis. Endodontic Topics. 2005; 11, 32–55.
- Kovisto T, Ahmad M, Bowles WR. Proximity of the mandibular canal to the tooth apex. J Endod. 2011 Mar;37(3):311-5
- Bornstein MM, Wasmer J, Sendi P, Janner SF, Buser D, von Arx T. Characteristics and dimensions of the Schneiderian membrane and apical bone in maxillary molars referred for apical surgery: a comparative radiographic analysis using limited cone beam computed tomography. J Endod. 2012 Jan;38(1):51-7. doi: 10.1016
- Kim SG, Solomon C. Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives. J Endod. 2011 Mar;37(3):321-5.
- Niemczyk SP. Re-inventing intentional replantation: a modification of the technique. Pract Proced Aesthet Dent. 2001 Aug;13(6):433-9
- Kratchman S. Intentional replantation. Dent Clin North Am. 1997 Jul;41(3):603-17.
- Kling M, Cvek M, Mejare I. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Endod Dent Traumatol. 1986 Jun;2(3):83-9.
- Johnson WT, Goodrich JL, James GA. Replantation of avulsed teeth with immature root development. Oral Surg Oral Med Oral Pathol. 1985 Oct;60(4):420-7.
- Laureys W, Beele H, Cornelissen R, Dermaut L. Revascularization after cryopreservation and autotransplantation of immature and mature apicoectomized teeth. Am J Orthod Dentofacial Orthop. 2001 Apr;119(4):346-52.
- Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol. 1995 Apr;11(2):76-89.
- Sugai T, Yoshizawa M, Kobayashi T, Ono K, Takagi R, Kitamura N, Okiji T, Saito C. Clinical study on prognostic factors for autotransplantation of teeth with complete root formation. Int J Oral Maxillofac Surg. 2010 Dec;39(12):1193-203.
- Reich PP. Autogenous transplantation of maxillary and mandibular molars. J Oral Maxillofac Surg. 2008 Nov;66(11):2314-7.
- Tsesis I, Faivishevsky V, Kfir A, Rosen E. Outcome of surgical endodontic treatment performed by a modern technique: a meta-analysis of literature. J Endod. 2009 Nov;35(11):1505-11.
- Bowers DJ, Glickman GN, Solomon ES, He J. Magnification's effect on endodontic fine motor skills. J Endod. 2010 Jul;36(7):1135-8.
- CALDERWOOD RG, HERA SS, DAVIS JR, WAITE DE. A COMPARISON OF THE HEALING RATE OF BONE AFTER THE PRODUCTION OF DEFECTS BY VARIOUS ROTARY INSTRUMENTS. J Dent Res. 1964 Mar-Apr;43:207-16.
- Mehlhaff DS, Marshall JG, Baumgartner JC. Comparison of ultrasonic and high-speed-bur root-end preparations using bilaterally matched teeth. J Endod. 1997 Jul;23(7):448-52.
- PETER VELVART, CHRISTINE I. PETERS, OVE A. PETERS. Soft tissue management: suturing and wound closure. Endodontic Topics. 2005; 11, 179–195.
- Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992 Dec;63(12):995-6.
- Matter J. Free gingival graft and coronally repositioned flap. A 2-year follow-up report. J Clin Periodontol. 1979 Dec;6(6):437-42.
- von Arx T, Alsaeed M, Salvi GE. Five-year changes in periodontal parameters after apical surgery. J Endod. 2011 Jul;37(7):910-8.
- Harrison JW, Jurosky KA. Wound healing in the tissues of the periodontium following periradicular surgery. I. The incisional wound. J Endod. 1991 Sep;17(9):425-35.
- Harrison JW, Jurosky KA. Wound healing in the tissues of the periodontium following periradicular surgery. 2. The dissectional wound. J Endod. 1991 Nov;17(11):544-52.
- Gutmann JL, Harrison J. SurgicalEndodontics, 1st edn. Boston MA, USA: Blackwell Scienti¢c Publications. 1991; pp. 153-82.
- Moiseiwitsch JR. Avoiding the mental foramen during periapical surgery. J Endod. 1995 Jun;21(6):340-2.
- Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972 Oct;43(10):623-7.
- Velvart P. Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery. Int Endod J. 2002 May;35(5):453-60.
American Dental Association is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.