1. Endodontic surgery
Dr.V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY SURGEON
REG: NO 4118 –TAMILNADU- INDIA( ASIA)

2. INTRODUCTION
 Endodontic surgery is defined as a
surgical aid to treat endodontic problems.

3. Classification
1. Incision & drainage
2. Peri-apical surgery
- Curettage
- Retrograde filling
- Apicoectomy
3. Postoperative evaluation –alternative
methods.
- Re-implantation
- Endodontic implants

4. 1. Incision & Drainage
 It is carried out to drain the pus & toxins
from the peri-apical region under antibiotic
cover so that the patient is relieved of
discomfort, pain & swelling.
 The surgical avoids the spontaneous
drainage and the resultant cutaneous
fistula.
 Success depends on the timing of the
procedure.
 Better under block anesthesia.

5. Peri-apical surgery
 It includes amputation, curettage & retrograde
filling.
 In practice all these 3 procedures are carried out
as part of Apicoectomy.
 Indications:
 1. Predisposing factors for the failure of
conservative root canal therapy.
-Unfavourable curved root apex
-Root resorption
-Accessory root canals
-Apical third root fracture
-Cyst formation

6. Cont….
2. Failure following root canal therapy
- inadequate or overfilled root canal
-fragmentation of the instruments inside the root
canal
-persistent postoperative discomfort
-lateral perforation at the apical third of the root
-persistent periapical radiolucency

7. Cont…..
3. Inaccessibility to ‘ conservative root canal
therapy’
- Porcelain jacket crown or post crown
-Anatomical defects like dens in dente
-Calcified root canal
-Non-vital teeth used as abutments for bridges
-Broken RCT instruments in the root canal.

8. Contraindications
1. Anatomical considerations
- Surgical inaccessibility eg, molars
- Sharp root
- Inadequate or poor bony support due to
advanced periodontal disease
- Proximity of the root apex to anatomical
structures like mental foramen, inferior alveolar
canal, nasal or antral floor.

9. Cont…
2. Systemic disorders
- First trimester of pregnancy
- Uncontrolled diabetes, heart disease,
hypertension, kidney , liver and
hemorrhagic disorders.
- Focal sepsis consideration
- Emotional and uncooperative patients.

10. Surgical technique
1. Anesthesia – LA –Block anesthesia.
2. Design of the flap :
a. Semi lunar flap
b. Triangular flap
c. Trapezoidal flap
d. Rectangular flap
e. Modified labial flap
f. Vertical incision
3. Reflection of mucoperiosteal flap

13. CONT…..
4. Apical surgery
- Bone window
- Identify root apex – root resection (bur)
- Curettage – granulomatous sac
5. Retrograde filling
- Seal the apical foramen adequately after cleaning,
preparation, disinfection of the root canal.
- Zinc free amalgam – material of choice
6. Suturing

16. ROOT PREPARATION

17. ROOT PREPARATION

18. ROOT FILLING

19. Postoperative follow-up
1. Suture removed on 7th post op day
2. Review at regular intervals
3. Recall to evaluate the prognosis of the
tooth after Apicoectomy

20. Prognosis depends on
 Presence of preoperative symptoms
 Size of the preoperative periapical lesion
 Quality of the root canal filling
 Its timing relative to he surgery
 Presence of a retrograde filling
 Type of the retrograde filling
 Technique and skill of the surgeon
 Tooth involved

21. Reasons for failure
1. Incomplete apical seal
2. Damage to the root like lateral perforation
3. Post surgical migration of the epithelial attachments
towards the root apex, damage to the periodontal,
alveolar 7 gingival tissues
4. Wound breakdown

22. Reimplantation
 It refers to the intentional removal of a
tooth and its reinsertion into its socket
after endodontic therapy and root section
in vitro.

23. Indications:
- This is limited to posterior teeth where
apicoectomy is not feasible or inaccessible
- It internal or external resorption has perforated
the root apex
- Where the root canal in posterior tooth is
sharply curved, it cannot be treated by
conventional methods.

24. Procedure
1. LA – Atraumatic tooth removal, curettage of
the socket
2. Tooth is endodontically treated, root filled; root
resections and retrograde filling are done by
another operator. Care to prevent drying of the
tooth.
3. Treated tooth is replaced into the socket. Tooth
is immobilized with any appropriate method of
wiring.

25. CONT….
4. Postoperatively, adequate relief must be
provided for any possible traumatic
occlusion of the tooth.
5. Splint is left insitu for a period of 8 weeks.

26. Endodontic implants
 It is a rigid structure which extends through the
root canal into the periapical osseous tissue, to
lengthen the existing root anchorage and to
provide stability of the tooth.
 In contrast to other implants, endodontic
implants are not exposed to the oral
environment.
 They act as stabilizers when the loss of
periodontal support is more than 40%.

27. ENDODONTIC IMPLANT

28. Indications:
1. To reinforce the management of
transverse root-fracture
2.To stabilize the overdenture abutment
3. To stabilize during the autoimplantation
4. In teeth with severe periodontal
disturbances and extensive bone loss,
endodontic implant is used as an aid to
pulp-periodontal therapy.

29. Thank you