Periapical surgeries

The main objective of Endodontics is to remove micro-organisms from the root canal and safeguard the tooth and the adjacent tissues from contracting infections of any kind. To ensure that the canal is effectively cleaned and obturated, microscope is increasingly used nowadays.

There are lot of fine details with respect to the dental anatomy that visualization without magnification tends to miss out . For instance the presence of extra canals, subtle root cracks, narrow canal entrance, colour changes on account of ageing or calcification may go undetected in the absence of a microscope.

The naked eye can distinguish lines or objects that are at least 0.2 mm apart. However if they are closer than that then the objects tend to appear as one. Hence enhanced visualization is the key aspect of microscope assisted treatment.

Heightened magnification also improves the precision of treatment. It brings down the depth and diameter of the field of view. The dentist gets a much better insight of the surgical field.

Improved ergonomics on account of improved posture is yet another advantage. Without having to shift one's position or adjust the posture of the patient , the dental practitioner manages to accomplish the task by looking straight without altering body posture.

Let us look at those key procedures where microscopic endodontics plays a significant role in achieving optimal results.

Periapical Surgery:

Periapical surgery is a standard surgical procedure that's used as a last resort when conventional Root Canal treatment fails. It is used to heal periapical lesions and enable tissue regeneration of the periapical region. It is  often considered to be an extension of the root canal treatment and not a separate procedure.

Periapical region refers  to the area that surrounds the apex of the root of the tooth. Surgery in the periapical region is meant to remove cysts or granulomas from the apical (tip of the root) region .

Despite an RCT/Repeat RCT if there is persistent pain, inflammation and the presence of draining sinus  then it's an indication that periapical surgery is required.

In the event of root perforations or an extrusion of the obturation ( a protrusion of the material used for root filling ) then periapical surgery is indicated. A marked curvature, calcification or fracture of instruments in the canal can also necessitate the same treatment.

The procedure involves raising the gingival flap and drilling a hole into the bone to reach the lesion. Once the lesion is removed, the root end tip is sectioned and sealed properly with MTA or any other Bio- regenerative cement . The flap is closed and sutured. The objective is to secure a tight seal at the root end.  This would prevent micro-organisms from entering the root canal and causing infections.

Use of a surgical microscope helps in magnifying and illuminating the surgical area. It also facilitates gentle incisions , flap elevation and osteotomy (bone removal) limited to a small area.  A microscope enables the use of small sonic/ultra sonic micro tips that assist in precision surgery. Microscope aided surgery hence is highly recommended in order to detect additional canals, fractures on the root, reduce trauma and  assist faster healing.

A periapical lesion if left unattended would result in recurring infections and bone damage thus endangering the teeth adjacent to the affected one as well. Periapical surgery thus facilitates removal of the lesion while retaining the functionality of the tooth.

Authored By : Dr. S. Hemamalathi and Dr. K. S Senthil Kumar

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