21 July 2012

Apicoectomy | Oral surgery


Apicoectomy is an endodontic surgical resection of the root tip of a tooth and its removal together with the pathological periapical tissue and root end cavity is prepared and filled with a biocompatible material. It is also called as endodontic microsurgery.
The art of procedure, use of microsurgical techniques such as a dental operating microscope, micro instruments, ultrasonic preparation tip and calcium-silicate based filling materials.

 # INDICATION
  1. Failure of conventional root canal therapy.
  2. Failure of Re-root canal therapy because of  
    •  completely calcified root canal
    •  severely carved root canals
    •  presence of posts or cores in root canal
    •  breakage of small instrument in root canal or presence of irretrievable filling material.
  1. Complete root canal therapy is impossible due to
    •  Foreign bodies driven into periapical tissue.
    •  Perforation of inferior wall of pulp chamber.
    •  Perforation of root fracture at apical third of tooth
    •  Dental anomalies (dens in dente)
# CONTRAINDICATION
  1. Teeth with severe resorption of periodontal tissue (deep periodontal pockets, great bone destruction)
  2. Teeth with short root length
  3. Teeth whose apices have a close relationship with anatomic structures (such as maxillary sinus, mandibular canal, mental foramen, incisive and greater palatine foramen and if causing injury to these during the surgical procedure is considered probable.
# PROCEDURE
  1. Designing flap
  2. Localization of apex, exposure of the periapical area and removal of pathological tissue
  3. Resection of apex of tooth
  4. Retrograde filling
  5. Wound cleaning and suturing
# COMPLICATION
  1. Bleeding from greater palatine artery during apicoectomy of palatal root.
  2. Damage to the anatomic structures in case of penetration of the nasal cavity, maxillary sinus and mandibular canal with the bur.
  3. Improper healing
  4. Dislodged filling material due to superficial placement as a result of insufficient preparation of apical cavity. 
  5. Incomplete root resection due to insufficient access or visualization and misjudged Length of root.
  6. As a result, the apical portion of the root remains in position and retrograde filling is placed improperly with all the resulting consequences.
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