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The apicoectomy with retrograde amalgam is an excellent and accepted surgical technique for salvaging teeth. Anatomic considerations in molar teeth are not a contraindication to this technique.
A gutta-percha root-filling point placed during apicoectomy may be condensed by the application of pressure to its coronal end or tension to its apical end. Scanning electron microscopy clearly demonstrates the effect that these techniques have on the adaptation of the root filling to the canal. The pressure method would appear to produce the more satisfactory result.
This article describes the development of a surgical technique employing a carbon dioxide laser for endodontic periapical procedures. The advantages of laser application for sterilization and removal of the infected root apex, as well as enhanced hemostasis, are cited. A case in which the "laser apicoectomy" technique was performed successfully for treatment of secondary apical abscess is presented.
The application of Nd:YAG laser to tooth surface can change its surface permeability. The purpose of this study was to investigate the effects of Nd:YAG laser on the permeability of dentin following apicoectomy and retrofill. Sixty single-rooted teeth were randomly assigned to six groups of 10 teeth each. The six groups were arranged in three pairs, experimental and control groups. The canals of teeth in pairs 1 and 2 were cleaned, shaped, obturated, and their apical 2 mm were resected. A class I preparation was prepared and filled with amalgam in each tooth in pair 1. The apical 2 mm of each tooth in pair 3 was removed, and a class I preparation was prepared and filled with amalgam. The apical surface of resected roots in half of the samples in each pair was lased twice by using Nd:YAG laser. The duration of lasing and the number of pulses were recorded for each tooth. After application of nail polish to the unoperated surface of each tooth, the teeth were placed in 0.5% methylene blue dye for 48 h. The amount of dye penetration in sagittal sections of each tooth was measured. The amount of dye penetration was significantly lower in lased roots than in nonlased ones (p < 0.05). Based on our results, it appears that application of Nd:YAG laser reduces the permeability of resected roots.
The radiographs from 715 patient charts were analyzed to study the effect of 11 factors on the success and failure of apicoectomies. Of these, 424 had recall radiographs of 6 months or more and were evaluated for changes in radiolucencies. The data were analyzed by cross-tabulation and chi-square analysis for significant relationships. Complete healing was found in 65% of the recall cases, while incomplete and unsatisfactory healing occurred in 29.4% and 5.6% of the cases, respectively. Complete healing was found to increase with patient age. Those over 60 yr of age had the highest percentage of complete healing. No statistical difference in healing was found between maxillary and mandibular teeth. Also, postsurgical healing associated with those teeth which were inadequately obturated with gutta-percha, silver points, or paste-filling materials did not differ significantly. No significant difference in healing was found between the teeth that were retreated nonsurgically before surgery and those that were not. Healing was independent of the placement of a retrofilling as well as the type of retrofilling period. Significantly better healing was seen with teeth that were permanently restored following surgery.
PURPOSE: This study evaluated the outcome of periradicular surgery using a new set of retrotips for root-end cavity preparation. PATIENTS AND METHODS: Forty-three patients who had 50 consecutively treated teeth with periradicular pathology were enrolled in this prospective study. After apicoectomy, root-end cavity preparation was performed, using diamond-surfaced retrotips driven by a sonic handpiece; EBA-cement was used as the root-end filling material. Healing assessment was based on clinical and radiographic criteria. RESULTS: At the 1-year follow-up, 82% of the reexamined surgical cases presented with successful healing. Fourteen percent of the treated teeth were deemed as improved (partial healing), and 4% were classified as failures. CONCLUSION: The new retrotips were found to be ideal for root-end cavity preparation. They simplify the surgical approach to root ends where the working space is limited by restricted access. Root-ends prepared with this new sonoabrasive technique yielded excellent results at the 1-year follow-up examination.
The impacted incisor was moved into its proper position with surgical exposure and orthodontic traction. Although apicoectomy was performed during the orthodontic treatment, the incisor showed good stability after the long retention period.
Several studies have reported devitalization of teeth following surgical procedures in the area of the root apices. The purpose of this investigation was to observe the 1-4-week wound healing pattern in monkey dental tissues following intentional vital apicoectomy (IVA). Two adult Macaca mulatta were used in this study. All of the teeth were surgically transected within the apical one-third with a bur. The soft tissues were then closed. At death, a maxillary and a mandibular quadrant for 1, 2, 3 and 4 weeks following surgery were obtained after vascular perfusion. Each quadrant was demineralized in EDTA, processed, serially sectioned at 7 microns and alternately stained with hematoxylin and eosin, Preece's modified trichome, and McKay's bacterial stains. Examination of sequential IVA cuts showed an initial disruption of the pulpal neurovascular supply resulting in pulpal necrosis. The pulpal tissues underwent a process of replacement with PDL-like connective tissues and deposition of cementum on all cut dentin surfaces of the tooth roots as well as in some of the pulp chambers. No abscesses, external resorption or ankylosis were found.
Dogs' teeth with infected root canals, were submitted to apicoectomy and the root canals were filled flush or 2 mm short. In a third group the canals were left unfilled and only the access openings were closed. One hundred and eighty days after the treatment, the animals were killed and the specimens prepared for histological analysis. Repair was not observed in the teeth with unfilled root canals. The healing observed in the teeth with root canals filled flush was less complete than the healing observed when the root canals were filled 2 mm short.
Apicoectomy is a frequently performed operation. In order to produce consistently good results the operation and its varieties are described, with stress being placed on correct assessment of each case prior to surgery.
We developed a new technique instead of usual retrograde apicoectomy for cases in which apical lesions appear after prosthetic treatment. The technique is as follows. After treatment of the apical area by raising a flap, part of the labial bone is removed and the labial surface of the root is exposed. Then the labial part of the root is removed and the root canal is opened. After that, the residual carious dentin is removed completely. At the final stage, the open root canal is filled with tooth adhesive and low viscosity composite resin (Clearfil-SC). This technique is indicated for cases in which the crown restoration is not removed for some reasons and treatment from apical side is not possible. This technique is clearly the last choice, but many teeth will remain.
Recently, the Er: YAG laser has attracted attention because of its possibility of cutting hard tissue with extremely small thermal injuries. In this paper, eight cases (thirteen teeth) of apicoectomy using Er: YAG laser are reported. All procedures were performed without using air turbin or electric drill. The advantages of Er: YAG laser application include: absence of uncomfortable vibration: less chance for contamination of the surgical site: and reduced risk of trauma of adjacent tissue compared with ordinary methods.
Osseointegrated implants provide predictable restorative support for crowns, restorations, prosthesis abutments, and removable dentures. Their widespread use in recent years has produced different types of complications. Retrograde peri-implantitis, a lesion occurring at the periapical area of an osseointegrated implant, has recently been described. This paper presents a series of reports describing the occurrence and management of retrograde peri-implantitis involving implants replacing teeth with histories of failed endodontic and apicoectomy procedures.
In this paper, we present the apicoectomy with reverse filling procedure in posterior teeth, as an alternative surgical method, in those cases where conservative endodontic treatment is unable or fails to bring successful results (prosthetic restorations, broken instruments, calcified and tortuous root canals, dens in dente, unfinished root apex). We choose to restrict our presentation in posterior teeth where the surgical procedure is more difficult due to anatomical conditions (maxillary sinus, mandibular canal, number of root canals, inaccessible posterior oral cavity, etc). We analyse the indications of such an operation and the elements we examine to evaluate the cases. We are showing the different stages of the operation as well as the usage of original instruments for the retrograde amalgam procedure. There is a further discussion on problems from the usage of the filling material, the dental amalgam, and, the problems throughout the procedure (level and degree of the apical bevel, cavity preparation, etc).
When an apicoectomy is performed, using retrograde sealing with amalgam, the healing of the periapical area is not always perfect. In a number of cases the cause of this imperfect healing may be due to the improper sealing ability and the moderate tissue compatibility of amalgam. A literature study has been carried out, based on the assumption that glass ionomer cement will provide a better sealing and will cause less tissue reaction. It appeared that, at least in theory, glass ionomer cement is to be preferred to amalgam when it comes to apical sealing properties and tissue reaction. In terms of usability, resorption, hardness and costs no significant differences were found. The conclusion is drawn that glass ionomer cement is an equal or perhaps even better alternative for retrograde amalgam.
A self retaining apicoectomy retractor suitable for use under local or general anaesthesia in the upper and lower premolar, canine or incisor regions is described. Constructed from an Ash no. 1 rubber dam clamp the device can be cheaply and easily constructed from materials available in most orthodontic or dental laboratories.
The apicoectomy in molars is a well accepted, though not so popular, method for the treatment of molars with chronic inflammatory periapical disease. This paper is about the indications as well as the surgical technique of the operation. The procedure is connected with very good clinical results and no serious complications, therefore is suggested for wider clinical application.
The optimal way to address endodontic failures is to retreat the root canal system first and only then to consider apical surgery. Unfortunately, in practice, it is often not done in this way. Patients are subjected to apical surgery, without any attempts at retreatment. A series of cases is presented illustrating failures of apicoectomy and successful endodontic retreatment.