Periapical or periradicular surgery

Oral surgery lecture 9
Periapical or periradicular surgery:
This surgery includes many topics such as surgical drainage, root hemisection, apical curettage and apicectomy.
Apicectomy: by definition it is a surgical resection of apical third of the root of the tooth so that to obtain perfect apical sealing accompanied by surgical removal of apical pathosis.
Indications:
1- Canal calcification.
2- Aberrant canal.
3- External and internal root resorption.
4- Sever root curvature.
5- Failed root canal treatment.
6- Horizontal root fracture.
7- Errors during canal preparation such as:
a- Canal perforation.
b- Fracture instrument.
c- Ledging.
d- Over-extension or under extension filling.
Contraindications:
1- Unhealthy periodentally tooth.
2- Sever carious teeth.
3- Unknown cause of failure root canal treatment.
4- Uncontrolled systemic diseases and leukemia.
5- Anatomical structures such as mental foramen, external oblique ridge and maxillary sinus.
6- Poor crown to root ratio.
Apicectomy procedure:
1- Incision and flap reflection.
2- Bone exposure and locating the root apex:
a- Visual and tactile sensation.
b- By using radiograph and reamers then transferred to surgical field.
c- Very uncommon using methylene blue dye.
3- Osteotomy and exposure of the apical 1/3rd .
4- Curettage of the apical lesion.
5- Root resection at 45? or perpendicular to the long axis of the tooth .
6- Orthograde/retrograde filling.
7- Retrograde filling: class I cavity preparation at the root apex either by burs or ultrasonic tips.
8- Root end filling with mineral trioxide aggregate (MTA) or Biodentine.
9- Irrigation with normal saline.
10- Flap apposition and suturing.

Post-operative instruction :
1-Surgical site should not be disturbed.
2- Pressure should be maintained by using cold pack until bed time.
3- Oral hygiene should be indicated except the surgical site.
4-Brushing after 24 hrs.
5- Maintain proper nutrition and fluid.
7- Pain killer to manage postoperative pain.
8- Antibiotic may be prescribed.
9- Suture removal after 5-7 days.
10-Follow up clinically and radiographically.

Complications:
• Intraoperative bleeding.
• Postoperative:
o Abscess formation.
o Fenestration, sinus tract formation, teeth mobility.