Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
Iatrogenic Perforation- A guide to fixing the hole in your patient's toothTaseef Hasan Farook
An overview of the possible types of perforation that may occur during endodontic treatment with their management. This slide presentation covers multiple management possibilities of said perforation proposed by various clinicians from around the world which can aid the readers in their treatment plan for the repair of a tooth perforation
Restoration of endodontically treated teethSanket Pandey
Seminar on restoration of endodontically treated tooth.
Credits to Cohen, Ingle, Respected researchers for their research in this field.
and everyone who previously tried to make a good presentation using the research work.
This presentation is all about restoration of endodontically treated teeth, prefabricated post and core, cast post and core, direct and indirect technique.
Endodontic surgery is a surgical procedure performed to remove or correct the causative agents of radicular and peri-radicular disease & to restore these tissues to functional health.
Iatrogenic Perforation- A guide to fixing the hole in your patient's toothTaseef Hasan Farook
An overview of the possible types of perforation that may occur during endodontic treatment with their management. This slide presentation covers multiple management possibilities of said perforation proposed by various clinicians from around the world which can aid the readers in their treatment plan for the repair of a tooth perforation
Restoration of endodontically treated teethSanket Pandey
Seminar on restoration of endodontically treated tooth.
Credits to Cohen, Ingle, Respected researchers for their research in this field.
and everyone who previously tried to make a good presentation using the research work.
This presentation is all about restoration of endodontically treated teeth, prefabricated post and core, cast post and core, direct and indirect technique.
Endodontic surgery is a surgical procedure performed to remove or correct the causative agents of radicular and peri-radicular disease & to restore these tissues to functional health.
This presentation of mine is a brief overview of surgical management of root canal treatment failure . The non surgical approach is already explained in other presentation.
Flap Design, one from important topics in Oral Surgery Syllabus, student must be know:
Definition Incision and flap.
Principles of flap design.
Enumerate types of flap with advantages, disadvantages, indications...
Complications.
this presentation covers all the aspects and techniques of flap surgery with relevant diagrams and is made from from authentic text books and articles.
Dr. Abhishek Gaur
BDS, MDS
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
A periodontal flap is a section of gingiva and/mucosa that is surgically separated from the underlying tissue to provide visibility and the access to the bone and the root surface. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement.
In this PowerPoint presentation, the periodontal flap is described under the headings: indication, contraindications, classification of flaps, flap design, horizontal and vertical incisions and various flap technique such as modified widman flap, undisplaced flap, palatal flap, apically displaced flap, papilla preservation flap and distal molar surgery for maxillary and mandibular molars. It also contains healing after flap surgery.
Similar to Surgical endodontics (Apicectomy) by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune (20)
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Surgical endodontics (Apicectomy) by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune
1. Dr. Amit T. Suryawanshi
Oral and Maxillofacial Surgeon
Pune, India
Contact details :
Email ID - amitsuryawanshi999@gmail.com
Mobile No - 9405622455
2. Introduction
Definition
History
Indication
Contraindication
Classification of Endo. surgeries
1.Trephination
2.Periradicular curretage
3. Periradicular surgery
(i) Root end resection (Apicectomy)
(ii) Root end preparation & filling
Conclusion
3. Introduction
Surgical intervention is required where endodontic
treatment has failed and tooth is to be retained rather than
extracted.
The percentage of success of endodontic treatment
has been consistently high but failures may arise due to
infection, poor access cavity preparation, inadequate
instrumentation, obturation, missed canals and coronal
leakage.
So if this happens, Surgical endodontics is
needed to save the tooth.
4. Definition-
Surgical endodontics is defined as,” Removal of tissues
other than the contents of root canal to retain a tooth with
pulpal or periapical involvement”
5. History
Surgical endodontics is not a recent innovation.
Trephination and incision and drainage are being done
since ancient times.
In 11th century, first case of endodontic surgery was
performed by Abulcasis.
Root end resection (Apicectomy ) was first
documented in 1871 and apicectomy with retrograde
cavity preparation and filling with amalgum was
documented in 1890.
6. Root amputation was first introduced by Black and
Inlitch in 1886 , then was dealt by Younger (1894)
and Guerini (1909)
In 1930, indications for endodontic surgery were
proposed.
In 1940, Triangular flap was first described by
Fischer.
Neumann and Eikan descibed Trapezoidal flap in
1940.
Semilunar incision was first described by Partsch
hence it is also known as Partsch incision.
7. INDICATIONS
1. Need for surgical drainage
2. Failed endodontic treatment
1. Irretrievable root canal filling material
2. Irretrievable intraradicular post
3. Calcification of the pulp space
4. Procedural errors
1. Instrument fragmentation
2. Non-negotiable ledging
3. Root perforation
9. CONTRAINDICATIONS
Poor systemic health.
Local anatomical considerations
Poor periodontal status.
Short root length.
Acute infection.
Non restorable teeth
10. Success of surgical treatment over non-surgical
treatment.
Medical history
Periodontal evaluation
Patient’s motivation
Informed consent
11.
12. CLASSIFICATION OF ENDODONTIC SURGICAL
PROCEDURES
I. Surgical drainage
1. Incision and drainage
2. Cortical trephination (fistulative surgery)
II. Periradicular surgery
1. Curettage
2. Biopsy
3. Root-end resection
4. Root-end preparation and filling
13. 5. Corrective surgery
i. Perforation repair
a. Mechanical (iatrogenic)
b. Resorptive (internal and external)
ii. Root resection
iii. Hemisection & Bi-cuspidization
III. Replacement surgery
i. Replantation
IV. Implant surgery
1. Endodontic implants
2. Root-form osseointegrated
implants
14. In most cases drainage through the canal is all
that is needed to treat the periradicular abcess
of pulpal origin but there are times, when
invasion of anatomic spaces has extended to a
point that does not allow drainage through the
tooth, and effectively remove the pus then It
becomes mandatory to incise and drain the
abcess.
15. Incisions and flaps
PRINCIPLES OF DESIGN-Principles
and guidelines are applied to the location and
extent of incision.
Why should one follow the principles ???
“The adherence to these principles will ensure that the
flapped soft tissues will fit snugly in their original
position and will properly cover the osseous wound site
and provide an adequate vascular bed for healing”
16. PRINCIPLES:
1. Avoid severing vessels and nerves
2. Make incisions far away from the surgical
area to ensure that the wound margins are
over sound bone and there is room for
adjustments when unexpected extensions
are necessary.
3. Design the flap so that there is adequate
visibility without overexposure of bone.
17. 4. The base of the flap should be the widest
portion to maintain proper circulation.
5. There should be no sharp angles on the flap
6. Vertical or oblique incision should not be
over root eminence. It is best to incise in the
trough.
18. 7. Maintain the integrity of the interdental
papillae.
8. Use sharp instruments to avoid tearing the
mucoperiosteum.
9. Be gentle with the flap.
10. Do not incise close to the gingival sulcus
while using a horizontal or semilunar
incison
19. 11. Incise in the attached gingiva for
semilunar flaps.
20. NOTE:
“More trauma results from short incision rather
than long incision”.
24. Full Mucoperiosteal Flaps.
TRIANGULAR FLAP.
The triangular flap is formed by a intrasulcular
incision and one vertical releasing incision.
25. ADVANTAGES:
Good wound healing as there is minimal disruption
of the vascular supply to the flapped tissue,
Ease of flap reapproximation, with a minimal number
of sutures required.
DISADVANTAGE:
It provides Limited surgical access because of the
single vertical releasing incision.
Difficult to expose the root apices of long teeth (eg,
maxillary cuspids and mandibular incisors.)
26. Additional access can be easily obtained by placement
of a distal releasing incision.
It is recommended for maxillary incisors and
posterior teeth.
“It is the only recommended flap design for
mandibular posterior teeth”.
27. RECTANGULAR FLAP:
The rectangular flap is formed by an intrasulcular and
two vertical releasing incisions.
28. ADVANTAGES:
Increased surgical access to the root apex.
This flap design is especially useful for mandibular
anterior teeth, multiple teeth, and teeth with long
roots, such as maxillary canines.
DISADVANTAGES:
Difficulty in reapproximation of the flap margins and
wound closure.
Postsurgical stabilization is also more difficult as the
flapped tissues are held in position solely by the
sutures. This results in a greater potential for
postsurgical flap dislodgment.
This flap design is not recommended for posterior
teeth.
29. TRAPEZOIDAL FLAP:
Similar to the rectangular flap with the exception that
the two vertical releasing incisions meet intrasulcular
incision at an obtuse angle.
30. Trapezoidal Flap ctnd…..
The angled vertical releasing incisions are designed
to create a broad-based flap with the vestibular
portion being wider than the sulcular portion.
Flap design is made on the assumption that it will
provide a better blood supply to the flapped
tissues.
31. Trapezoidal Flap ctnd…..
Since the blood vessels and collagen fibers in the
mucoperiosteal tissues are oriented in a vertical
direction, the angled vertical releasing incisions will
severe more of these structures.
32. Trapezoidal Flap ctnd…..
This will result in more bleeding, a disruption of
the vascular supply to the unflapped tissues, and
shrinkage of the flapped tissues.
33. Limited Mucoperiosteal Flaps:
Submarginal Curved (Semilunar) Flap:
The submarginal or semilunar flap is formed by a
curved incision in the alveolar mucosa and the
attached gingiva.
34. The incision begins in the alveolar mucosa extending
into the attached gingiva and then curves back into
the alveolar mucosa.
Advantages – No advantages
Disadvantages-
1. Poor surgical access
2. Poor wound healing
“This flap design is not recommended for periradicular
surgery”.
35. Submarginal scalloped rectangular (Luebke-ochsenbein)
flap:
The submarginal scalloped rectangular flap is a
modification of the rectangular flap in which the
horizontal incision is not placed in the gingival sulcus
but in the buccal or labial attached gingiva.
36. ADVANTAGES:
It does not involve the marginal or interdental gingiva
and the crestal bone is not exposed.
DISADVANTAGES:
Vertically oriented blood vessels and collagen fibers
are severed, resulting in more bleeding and a greater
potential for flap shrinkage, delayed healing, and scar
formation.
37. FLAP REFLECTION:
Flap reflection is the process of separating the soft
tissues (mucosa and periosteum) from the surface of
the bone.
The periosteal elevator is used gently to elevate the
periosteum and its superficial tissues from the cortical
plate.
38. After reflection of the attached gingival tissues,
elevation is continued more apically lifting the
alveolar mucosa along with periosteum until
adequate surgical access is obtained.
A thin gauze may be used for reflection to prevent
tearing of the flap.
39. Hard tissue management in endodontic surgery
involves 3 stages:
1.Trephination
2.Periradicular curretage
3. Periradicular surgery
(i) Root end resection (Apicectomy)
(ii) Root end preparation & filling
40. OSTEOTOMY:
Osteotomy is the removal of some portion of the
cortical plate to expose the root end.
Clinician should precisely locate the root end.
A number of factors should be considered to
determine the location of the bony window.
The angle of the crown to the root should be
assessed.
41. When a root prominence or eminence in the
cortical plate is present, the root angulation and
position are more easily determined.
Measurement of the entire tooth length on well-angled
radiograph and transferred to the
surgical site by the use of a sterile millimeter
ruler.
42. When the cortical plate is intact, locate the body of
the root coronal to the apex where the bone covering
the root is thinner.
Once the root has been located and identified, the
bone covering the root is slowly and carefully
removed with light brush strokes, working in an
apical direction until the root apex is identified.
43. Barnes identified four ways by which the root
surface can be distinguished from the
surrounding osseous tissue:
(1) Root structure generally has a yellowish color,
(2) Roots do not bleed when probed,
(3) Root texture is smooth and hard as
compared to the granular and porous
nature of bone, and
(4) The root is surrounded by the periodontal
ligament.
44. Definition- It is the perforation made through the
cortical plate or apical foramen to accomplish the
release of pressure in the periapical area from
the accumulation of exudate within the alveolar
bone.
Indications-
This technique is employed in cases of periapical
abcess in which there is no swelling or drainage
but much pain.
45. Small incision is made over the periapical
region .flap is reflected and bone is
examined.
Radiograph is taken with radiopaque marker
for confirmation. So that there is no chance of
penetration in the wrong area.
46. CORTICAL TREPHENATION:
Perforation of the cortical plate to accomplish the
release of pressure from the accumulation of exudate
within the alveolar bone.
47. The treatment of choice for these patients is
drainage through the root canal system (apical
trephination) whenever possible.
Apical trephination involves penetration of the
apical foramen with a small endodontic file and
enlarging the apical opening to a size No. 20 or
No. 25 file to allow drainage from the
periradicular lesion into the canal space.
The decision about whether to perform apical or
cortical trephination is based primarily on clinical
judgment regarding the urgency of obtaining
drainage.
48. PERIRADICULAR CURETTAGE:
Involves removal of the periradicular inflammatory
tissue and is best accomplished by using various sizes
and shapes of sharp surgical bone curettes and angled
periodontal curettes.
49. Entire tissue mass is removed by inserting the
bone curette, between the soft tissue mass
and the lateral wall of the bony crypt with the
concave surface of the curette facing the
bone.
50. Once the soft tissue lesion has been freed
along with the periphery, the bone curette
should be turned with the concave portion
toward the soft tissue and used in a scraping
manner to free the tissue from the deep walls
of the bony crypt.
51. Periradicular Surgery
ROOT-END RESECTION (APICOECTOMY)
Historically, many authors have advocated
periradicular curettage as the definitive
treatment in endodontic surgery without
root-end resection.
Their rationale was to maintain a cemental
covering on the root surface and to maintain as
much root length as possible for tooth stability.
52. INDICATIONS:
These indications may be classified as,
1) Biological
2) Technical.
Biologic factors:
Persistent symptoms,
Persistent periradicular lesion.
54. There are three important factors for the
surgeon to consider before performing a
root-end resection:
(1) Instrumentation,
(2) Extent of the root end resection,
(3) Angle of the resection.
55. 1.Instrumentation:
Ingle et al. recommended that root-end resection
is best accomplished by the use of tapered
fissure bur or round bur in a low-speed straight
handpiece.
Gutmann and Harrison, have suggested the use
of a high-speed handpiece and a surgical length
plain fissure bur.
56. NOTE:
“Plain fissure burs, at high and low speed,
produce the smoothest resected root
surface”.
57. 2.Extent of the Root-End Resection:
Earlier, it was believed that it is necessary to
resect the root at the level of healthy bone.
58. Average length of root resection is 3mm which
is considered enough to eliminate the source
of infection.
however surgeon must evaluate the patient on
an individual basis.
1. Visual and operative access to the surgical site
2. Anatomy of the root (shape, length,
curvature).
3. Number of canals and their position in the
root
59. 4. Need to place a root-end filling surrounded
by solid dentin.
5. Presence and location of procedural error
6. Presence and extent of periodontal defects.
60. NOTE:
“Conservation of tooth structure during
root-end resection is desirable; however,
conservation should not compromise the
goals of the surgical procedure”.
61. 3.Angle of Root-End Resection.
It should be 30 ° -45 ° from the line
perpendicular to the long axis of
the tooth facing toward the buccal
or facial aspect of the root.
The purpose is to provide enhanced
visibility to the root end and
operative access to accomplish a
root end preparation.
62. NOTE:
Recent literature states that beveling of root end
results in opening of dentinal tubules on the
resected root surface that may communicate with
the root canal space and result in apical leakage,
even when a root end filling has been placed.
63. Root-End Preparation:
The purpose of a root-end preparation
in periradicular surgery is to create a
cavity to receive a root-end filling.
It is performed by the use of small round or
inverted cone burs and straight low-speed
handpiece.
It should be done parallel to the long axis of
the root.
64.
65. Root-End Filling:
The purpose of a root-end filling is to establish a
seal between the root canal space and the periapical
tissues.
Suitable root-end filling material should be,
(1) Able to prevent leakage of bacteria and their
biproducts into the periradicular tissues,
(2) Nontoxic & Noncarcinogenic,
(3) Biocompatible with the host tissues,
(4) Insoluble in tissue fluids,
(5) Dimensionally stable,
(6) Unaffected by moisture during setting,
(7) Easy to use
66. Root-End Filling Materials:
Numerous materials have been suggested
for use as root-end fillings, including:
Amalgam,
Gutta-percha,
Glass ionomers,
Composite resins,
Carboxylate cements,
Zinc phosphate cements,
Zinc oxide–eugenol cements,
Mineral tri-oxide aggregate (MTA).
67. REPOSITIONING AND SUTURING:
Several authors have compared the effects of
continuous and interrupted suture techniques.
Their findings indicate that the interrupted suturing
technique provides better flap adaptation than does
the continuous technique and, therefore, is the
recommended technique, and the most commonly
used, for endodontic surgery.
68.
69. 1. Ask not to drink alcohol or use any form of tobacco.
2.. Ask not to lift up the lip or pull back the cheek to
look at where surgery was done. This may pull the
sutures and cause bleeding.
3. A little bleeding from the surgical site is normal.
This should only last for a few hours. There may be
little swelling of the face. This should only last for a
few days.
70. 4. Place an ice bag (cold) on face where surgery was
done. Leave it on for 20 minutes and take it off for
20 minutes. Do this for 6 to 8 hours.
5. After 8 hours, the ice bag should not be used. The
day after surgery, warm saline gargle. Do this as
often as possible for the next 2 to 3 days. Advice for
warm saline gargle.
7. Rinse the mouth with 1 tablespoon of chlorhexidine
mouthwash two times a day, once in the morning and
once at night for 5 days.
8. Recall for removal of sutures after 7 days,
71. CONCLUSION :
During the last 20 years, endodontics has
encountered dramatic shift in the use of
periradicular surgery.
Previously, periradicular surgery was commonly
considered as the treatment of choice when
nonsurgical treatment had failed but nowadays
periradicular surgery has become very selective
in contemporary dental practice.
72. Text book of endodontics, Ingle 5th edition.
Textbook of oral & maxillofacial surgery By
Daniel M. Laskin. Vol.2
Text book of endodontics, Nisha Garg.
Text book of endodontics By Grossman.
Text book of Surgical endodontics, Guttman
Leukemia or neutropenia,uncontrolled diabetes – where there are more chances of infection and impaired healing
Old patients where cardiopulmonary disorders , kidney and liver problems are common
Patients having Hypertension ,, blleding disorders, myocardial infarction
Patients who have undergone radiation treatment of face
Anatomical considerations such as mandicular second molar area where roots are lingually inclined , apices are close to mandibular canal, too thick buccal
plate. Proximity to nasal floor and maxillary sinus.
Deep pockets , Poor bony support , tooth mobility and furcation involvement
.
Leukemia or neutropenia,uncontrolled diabetes – where there are more chances of infection and impaired healing
Old patients where cardiopulmonary disorders , kidney and liver problems are common
Patients having Hypertension ,, blleding disorders, myocardial infarction
Patients who have undergone radiation treatment of face
Anatomical considerations such as mandicular second molar area where roots are lingually inclined , apices are close to mandibular canal, too thick buccal
plate. Proximity to nasal floor and maxillary sinus.
Deep pockets , Poor bony support , tooth mobility and furcation involvement
.
2. This avoids possibility of collapse of flap into the bony defect with subsequent depression
3. Coz size doesn’t affect the rate of healing.
4.
5. There should be a gentle curve because sharp corners tend to slough because of poor circulation causing excessive scarring.
6. because in the Trough between the adjacent teeth, mucosa and attached gingiva are thicker , so it has better circulation ,it can afford stronger needle entry and exit points and are more extensible during edema.
7. Papilla at the incision line has to be either excluded or included.
8. Incision should be made in one pass. So repositioning is easy and there is less tendency for dehiscence an scar formation
9. Forklike retractors or tweezers should not be used .
10. Because lack of blood supply can cause loss of gingiva there should be 2-3 mm of attached gingiva around each tooth.
11. To gain access and avoide damaging a flap.
dept
The horizontal incision is scalloped and follows the contour of the marginal gingiva above the free gingival groove.
.can be identified using metheylene blue dye
Marker is small sterilised foil of x ray film which is burnished into bone concavity.
According to “Gutmann” and “Harrison”, no studies are available to support this and it is questionable, especially if the source of periradicular infection is still within the root canal system.
Procedural accidents such as fragmentation of instruments , perforation in apical 1/3 rd of root.
1. (example: root end resection of buccal root of maxillary first premolar to gain access to the palatal root).
3. (example: mesiobuccal root of maxillary molars, mesial root of mandibular molars, two canals in central incisors).
4. Example – when there is infected dentin then length of root end resection will be more
5. (example: perforation, ledge, broken instrument, apical extent of root canal filling).
6.- example – level of bone loss.