PubMed · 11432106
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H Chalfin, M Kellert. 2000. Microscopic surgery.. https://pubmed.ncbi.nlm.nih.gov/11432106/
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Questionnaires were circulated to all Fellows of the British Society of Oral and Maxillofacial Surgeons in 1999, 75% of whom replied (n = 194). There was a wide range of responses for both the timing of review appointments and the taking of radiographs. Most patients were first followed up 1 week after operation (46%), but 38% were reviewed in the second week. Five surgeons did not review patients at all and two did not review until 6 or 9 months, respectively. Nearly two-thirds routinely offered a second follow-up appointment but only 14% offered more than two, the maximum being seven. Most arranged postoperative radio-graphs but the timing ranged from immediately postoperatively to 1 year after the procedure. Less than one-third requested a second postoperative radiograph between 1 month and 1 year. The largest disparity was in the time of discharge to the general dental practitioner, which ranged from immediately to 5 years, the most popular time of discharge being at 3 months. The wide variations may reflect unnecessary recall of patients and misuse of valuable clinical time.
The purpose of this study was to evaluate a stainless steel (CT-5) and zirconium nitride coated (KiS) microsurgical ultrasonic instrument with regard to possible root-end fracture production during retropreparation. Forty extracted human central incisors were prepared in a crown-down fashion. Canals were obturated with gutta-percha by lateral condensation. Root-ends were resected. Teeth were placed in methylene blue for 48 h and evaluated by three independent evaluators under microscope. Teeth with existing fractures were eliminated from the study. The remaining teeth were randomly divided into two equal groups. Group A was prepared with the CT-5 tip and Group B with the KiS tip. Preparation time was recorded for all roots. The teeth were again immersed in methylene blue for 48 h and reevaluated. No root-end fractures were produced by either the KiS or CT-5 microsurgical ultrasonic instruments.
Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.