Dr.Samhan Abdullah Alajmi
BDS, MFD (Ireland), CAGS, MSc.Diplomate of the ABE,Fellow in Dental Implants,Specialist Endodontist Boston Dental Group,Kuwait.
The incidence of post treatment disease, although small, translates into a large number of cases where further treatment is needed. When faced with such a situation, the clinician must determine the etiology of the persistent pathosis and devise a rationale and strategy for treatment. Dental clinicians should be able to diagnose persistent or reintroduced endodontic disease and be aware of the options for treatment. If they wish to approach treating these teeth, they should have the appropriate armamentarium and be capable of performing these specialized techniques at the highest level. There are many causes for “failure” of initial endodontic therapy that have been described in the endodontic literature. These include iatrogenic procedural errors such as poor access cavity design, untreated canals (both major and accessory), canals that are poorly cleaned and obturated, complications of instrumentation (ledges, perforations, or separated instruments), and overextensions of root-filling materials. Coronal leakage has also been blamed for posttreatment disease, as has persistent intracanal and extracanal infection and radicular cysts. Also, clinicians must always have a scientifically sound, evidence-based rationale for every treatment decision that is made so that they may best serve the patients who entrust them with their care. Endodontic Microsurgery is a field that is growing fast in the modern Endodontic practice. Periapical surgery and intentional replantation are treatment options that are offered by endodontists to save natural teeth. It involves that removal of the apical part of teeth and sealing the apical part with biocompatible dental material when traditional endodontic procedures fail. With the development of science, the use of microscope and biocompatible materials increased the success of periapical surgery from 59% to 94% (Setzer 2010). Cone-beam CT scans have been used to enhance the planning of periapical surgeries, analyze the periapical lesion and to measure the osteotomy site. Challenges of the procedure such as bleeding control, sinus perforation and fractures assessment will be discussed. Intentional replantation will also be included in this presentation, which is used in cases where periapical surgery is not possible, especially in second molars. The presentation will cover case selection, pre-operative planning, step-by-step protocols from flap design to sutures and prognosis. The aim of this presentation is to teach practitioners on how to include this treatment option when a traditional root canal treatment fails as a further step to save natural teeth. Outline Etiology of periapical disease.Understanding the scope of Microsurgical Endodontics. Case selection in comparison to root canal re-treatment. The use of CBCT for pre-operative planning. Step-by-step procedures of periapical surgery and intentional replantation. Possible challenges that can occur during the surgery. Prognosis of both procedures.