Indications
Materials/instruments
Procedure
Technical considerations
Biological considerations
Anatomical considerations
Medical considerations
Endodontic surgery technique
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To gain access to the root, a horizontal incision is given either including the papilla or cutting through the base of papilla. Submarginal incision is often recommended to minimize the risk of gingival recession in the esthetic zone. Subsequently, a full-thickness flap is raised.
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The highly vascularized granulation tissue in the bone crypt is removed.Hemostasis is achieved using local anesthesia containing epinephrine. Aluminium chloride or ferric sulfate can also be used for controlling bone crypt hemorrhage. If more severe bleeding occurs, electrocauterization may be considered.
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Root resection is performed to eliminate infected ramifications, lateral canals and contaminated dentin.A root resection of 3 mm (mm) apically is sufficient to remove most of the infected ramifications and lateral canals. It is performed in a 90° angle to the long axis of the root. This minimizes any leakage that can occur through cut dentinal tubules. Retrograde root-end cavities are prepared by ultrasonic tips in exposed canal orifices. MTA is used for root-end filling (Fig. 4).×
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The wound surface is thoroughly irrigated with the saline and the wound is closed using surgical sutures for optimal healing. Surgical sutures should hold the edges of a flap in apposition until the wound has healed sufficiently to withstand the normal functional stresses and resist reopening.Resorbable or non-resorbable threads in diameters 5–0 or 6–0 and three-eighths reverse-cutting or tapered needle are used. The sutures are removed after 7–14 days.
Pitfalls and complications
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Pain and swelling after surgical treatment.
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Secondary infection of the surgical site.
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An insult to blood vessels.
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Lack of control of possible coronal leakage and carious lesions under restorations.
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Limited access to the root canal full length.
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Limited possibility to use chemical disinfection.