Apex endodontics skin#
The roots of the lower canine teeth are approached via a skin incision centered over the apical third of the root on the ventral aspect of the mandible. Its length should allow exposure of the apical area with passive retraction of the flap after its elevation with a periosteal elevator.
The incision is continued apically over the far line angle of the next mesial and distal tooth. Palpation of the juga helps localize the root. The semi-lunar incision is centered over the middle of the root to be treated. The roots of the carnassials and upper canine teeth are approached via a buccal mucoperiosteal flap. They are considered strategic teeth because of their greater importance with respect to their size and function.
The teeth most often treated with surgical endodontics in veterinary dentistry are the canine teeth and the carnassials. Surgical endodontics is not a substitute for proper cleaning, shaping, and three-dimensional obturation of the radicular system. If not already done, or if the quality of the root canal treatment is questionable, a normograde endodontic treatment should be done or redone. If suspected from a review of the patient’s medical story, blood-clotting functions should be evaluated (bleeding time, activated coagulation time). A blood clotting deficiency would be a serious problem during surgical endodontic treatment. If needed, the patient’s health status should be stabilized before the procedure. Any systemic disease should be assessed to determine if the patient is a suitable candidate for anesthesia and endodontic treatment.
The patient’s database should include hematological evaluation and blood chemistry. The patient’s medical and dental history should first be reviewed. A tooth, or its root, can’t be saved when it is not restorable, is compromised because of its periodontal status, or has a vertical root fracture. The dental contraindications are the cases where a retreatment has a better prognosis, where the apex of the root cannot be accessed surgically (palatal root of an upper fourth premolar), and where the tooth cannot be saved. The medical contraindications for surgical endodontics are uncontrolled diabetes, end-stage renal disease, and immunodeficiency. The main indications for surgical endodontics are cases with inaccessibility to the root apex through the canal (pulpal stones, canal obliteration), cases where the cause of the lesion is not in the canal (extruded material, foreign bodies) or where, despite elimination of its cause, a periapical lesion self-perpetuates (periapical cysts). In this case, neither modality of treatment would work and the tooth, or its root if a root resection is considered, should be extracted. Vertical root fracture should also be considered a possibility with endodontic treatment failure. Indeed, faulty access or fracture site restorations have often been overlooked as a main cause of endodontic treatment failure. Cases where there are questions about the quality of the instrumentation, obturation, or restoration are definite candidates for retreatment. The choice between the two options, retreatment or surgical endodontics, should be based on the perceived cause of the failure. There have been cases where retreatment has been successful, even after surgical endodontic treatment has failed. However, most studies have shown that the long-term prognosis is better with retreatment than with surgical endodontics. Surgical endodontics is indicated for roots that cannot be treated with a standard normograde endodontic treatment, and those which have been unsuccessfully treated and whose prognosis is better with a surgical treatment than with retreatment. The surgical exposure of the root apex allows the curettage of the periapical lesions, which are submitted for histopathologic evaluation. To remove the cause of the periapical infection, the apical end of the root(s) is surgically removed and the new apical end is cleaned, shaped, and filled three-dimensionally to seal the canal from the periapical tissue. The goal of surgical endodontics is to remove the causal elements of the persisting periapical infection, as well as the associated periapical lesions. Open apex endodontics is a treatment modality that allows treatment of roots that cannot be treated successfully with a standard endodontic treatment. Books & VINcyclopedia of Diseases (Formerly Associate).VINcyclopedia of Diseases (Formerly Associate).
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