APICOECTOMY Surgical Endo Therapy

97 Rating(s).


Posted on By ashok gowda In Endodontics

Hi its a case of Periapical surgery followed by direct resin veneer . Once we remove the pathology healing follows. Ashok

Symptomatic 10 & 11
Periapical defect



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20 Comments


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Huge defect


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Sectioning the tip in an angle


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Patent canal


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M.T.A


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Retrograde Condensation


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Immediate Radiograph


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3 moths post OP
Direct Resin Bonding


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Lumen size is reducing = Osteogenesis is taking place


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Ashok

Beautiful surgery and documentation.

What prognosis did you give the patient before the procedure ? Also was the patient symptomatic ?

Rocco


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Thanks Rocco, patient came to me with symptom. She had pain in lateral incisor and she gave a history of trauma to that tooth few years back . Now this case is almost 5 months old, and she is asymptomatic . Canine was non vital so I did Root treatment even for that. Regarding prognosis I told her Iam trying to save this tooth, now she is happy and she is not concerned with that any more . Regards. Ashok


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beautiful case,
just a few questions...
would you consider today a differant flap design (to reduce scaring ..)
and why didnt you complete the root canal filling coronal to the mta in lateral?
but again very impressive stuff
tnx
aryeh


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Thanks Aryeh, good questions .
1. I know few conservative flap designs to avoid scar in anterior segment, but they are not complete scar free. After seeing the defect size i thought to raise the full flap. Do you recommend any design in particular in such kind of cases? Let me know, i will work on that .

2. Once we do the retro filling with MTA, and the canal is dry, and the coronal seal is good, we can wait for couple of months with out any canal filling , IF we have already planned to observe the case . This case belongs to that category. I will do the filling after 3 more months. Regards. Dr.Ashok


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Hi again, what i meant by flap design was maybe considering a semi lunar long flap on oral mucosa apical to keratinized gingiva (similar to what dr. Campos showed on his lecture on open sinus lift and his wet gauze technique)
Thus keeping the scar in papila especialy out of sight in aesthetic zone. But again this is great work .jusy my thoughts.
Aryeh


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Hi Aryeh, you are right, that's a good technique to hide the scar if the patient has a low smile line and IF the defect is SMALL . Please have a look at the picture, its a big lesion, the amount of Bone defect is starting from just 2 to 3 mm below the cervical line of the tooth. Enucleating the entire cyst lining will be very tough as per your flap design, I may miss the lining below the root in that region during curratage because of less access OR i might have damaged the lining and wouldn't have removed it in one piece. Hence I selected to raise the flap. Regards. Ashok


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Beautiful case and documentation Ashok. Nice conservative results. Thanks for sharing!


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Thanks for your kind words Damir, regards, Ashok


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