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Even though a lot of materials have been already used as retrofillings, glass ionomer cement is still rarely used. As it seems to be biocompatible, its usefulness as retrograd filling material after apicectomies is clinically described.
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Synthograft (beta-tricalcium phosphate) is a bioresorptive ceramic material which stimulates osteogenesis after implantation into bone defects and disappears from the site of implantation. In this study, Synthograft was used as a filling in bone defects following apicotomy of teeth with extensive periapical and lateral bone defects along the tooth root involving more than 1/3 of the root, and when an extended periodontal fissure was present in addition. The study included 13 patients with one or more teeth involved. The tricalcium phosphate powder was mixed with patient's own blood and inserted into bone cavities. The patients were followed up during 12 months after surgery by clinical and radiographic control examinations. In all the 13 cases, clinical results were very good, i.e. healing of the wound proceeded without any signs of inflammation, whereas later in the course of follow-up no signs of reaction to the foreign material were observed. Preoperatively loose teeth had gradually become firm and after 12 months were within the limits of physiological motility. Roentgenograms revealed the bone cavities to have filled with newly formed bone, and the periodontal ligament, otherwise lost, was also restored. Results of this study showed the Synthograft implant to be well tolerated by recipients, thus it can be recommended as a filling in extensive bone periapical and lateral defects after tooth apicotomy.
Many materials have been used as retrograde fillings. Zinc oxide and eugenol, cavit, composite, gold foils, and other materials have been used in an attempt to seal the apical extent of the root canal. However, the most common material is amalgam.
The use of more biocompatible materials in comparison with silver, gutta-percha and amalgam was introduced a decade ago. First titanium was used, later followed by alumina. Both clinical as well as radiological results favor their use. Yet it appears that the system is mainly confined to the maxillary front teeth and mandibular canines.
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At the Department of Oral and Maxillo-facial Surgery of Heidelberg University, apicectomies in posterior teeth have long been performed in addition to implantation. We always aimed at maintaining a vital periodontium, before alloplastic materials for implantation were considered. In follow-up examinations of 247 resected roots of posterior teeth, we recorded a success rate of 90%.
Data on 2 series of apicectomies performed in 1966-69 and 1978-82 respectively are compared. The comparison was based on clinical assessments and radiographic findings in patients given a repeated check-up a later date. Similar results were obtained in the two series, confirming the importance of scrupulous pre-operative endodontic treatment combined with the use of non-absorbable canal material. It is felt that this, combined with a scrupulously precise periapical surgical technique will ensure total success in all cases.
A new procedure for apical closure after apical root resection with a metal filling is presented which is easy to handle with appropriately standardized equipment and ensures exact apical closure. By conical preparation of the whole root, a standardized metal peg which resists distortion can be used for anchoring the crown prosthesis without further preparation. Temporarily a standardized guttapercha peg can be used for closure. Even if renewed work on the root becomes necessary later, the apical metal closure remains firm because of its wedging.
The radiologically controled apicectomy shows frequently unsuccessful results. In histological examinations of the root apex area after apicectomy chronic inflammation is regularly seen even in negative radiologic findings. Examination of the most frequently used root filling material (zincoxyphosphate with guttapercha point) by scanning electron microscopy shows a porous surface and between the canal wall and the root filling material there appears regularly a deep groove as no contact is achieved. The rough surface structure, the chemical composition and the loose contact of the components in this area are considered irritative factors and reasons of failure in treatment.
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The author deals with certain incision techniques for the purpose of apicectomy that that are but rarely used due to their relatively limited range of indications. Furthermore, he describes and recommends two new incision techniques. The first is a variant of the V-incision at the labial frenum; the second is a Y-incision to be employed when there is a flat oral vestibule or an interfering frenulum of the cheek.
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Apicectomy is a supplement to conservative therapy in those cases in which the latter fails to achieve bacteria-proof obturation. Indications for it are presented. The technique of the procedure, which has widely been standardized in the last years, is appreciated in detail. Hints at the evaluation of the results of treatment are given.
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