Surgical Endodontics Question And Answers

Surgical Endodontics Important Notes

• Cardinal principles of flap design
  • The base of the flap should be wider than the free end to ensure adequate circulation into the flap
  • The sutured flap margins should rest on sound bone
  • Incision should be made with a firm, continuous stroke, perpendicular to cortical bone
  • Short, intermittent incisions result in tissue tags and ragged margins
• Trephination is a type of artificial fistulation in which the cortical bone is perforated to release the build-up pressure and exudate around root apex to release pain
• Semilunar incision
  • Semilunar incision Advantages
    • High healing potential
    • Minimal bone damage
  • Semilunar incision Disadvantages:
    • Inaccessibility
    • Excessive haemorrhage
    • Delayed healing
    • Scarring
• Replacement resorption
  • It is characterized by gradual root resorption including periodontal ligament, cementum and dentin of root with replacement by bone and finally the tooth becomes ankylosed
  • It is considered as success of replanted tooth
• Best storage media for avulsed tooth
  • Tooth socket
  • Patient’s saliva
  • Milk
  • Water
• Transport media for avulsed tooth
  • HBSS [Hank balanced salt solution]
  • Coconut water
  • Saliva
  • Vestibule of mouth
  • Milk
  • Saline
  • Water
    • Viaspan
    • CPP – ACP [Casein Phosphopeptide – Amorphous Calcium Phosphate]
• Contraindications of periradicular surgery
  • Proximity to anatomic structures
  • Serious systemic health problems
  • Emotionally distressed patient
  • Inaccessible surgical sites
  • Teeth with poor prognosis
• Types of post
  • Tapered or parallel
    • Tapered posts
      • They are least retentive of all posts
      • Produces high incidence of root fracture
      • Concentrates stress at the post-core junction
    • Parallel posts
      • More retentive
      • Less incidence of root fracture
      • Concentrates stress apically on the post
  • Threaded or non-threaded
    • Threaded posts
      • Produces the greatest potential for root fracture
      • Recommended for post-endodontic restorations
    • Non-threaded posts
      • Produces the least stress
      • Have the least tendency for root fracture
  • Metallic or non-metallic
• Stitch abscess may develop due to
  • Local laceration of tissue
  • Accumulation of debris at the site of suturing
  • Tying of knot in the line of incision

Surgical Endodontics Short Essay

Question 1. Indications for periapical surgery. Add a note on flap designs
Answer.

Indications Of Periapical Surgery:

Surgical drainage:

• Failed non-surgical treatment
• Calcified metamorphosis of pulp space
• Horizontal fracture at the root tip
• Iatrogenic errors
• Anatomic variation
• Biopsy
• Corrective surgery
• Replacement surgery
• Implant surgery
• Exploratory surgery

Read And Learn More: Endodontics Question and Answers

Flap Designs

• Semilunar flap:
  • It is a curved horizontal incision with the convex portion of the incision towards the gingival crest
  • The incision begins at the mesiobuccal fold and follows a half moon path
  • Semilunar flap Indications:
    • When incisors are involved
  • Semilunar flap Advantages:
    • Simple
    • Easy to reflect
    • Easy to maintain oral hygiene
    • Gingival attachment is not disturbed
  • Semilunar flap Disadvantages:
    • Restricted access with limited visibility
    • Limited use
• Luebke Oschenbein flap:
  • Named after Luebke and Oschenbein
  • It is a modified semilunar flap in which a scalloped horizontal incision is made in the attached gingiva with vertical incisions
  • Luebke Oschenbein flap Advantages:
    • Greater access and visibility
    • The flap is easily displaced and sutured
    • Marginal gingiva is not disturbed
  • Luebke Oschenbein flap Disadvantages:
    • Scarring is possible
• Triangular flap:
  • Indicates for surgery involving short rooted teeth
  • An incision along the gingival border forms the base of the triangle
  • A single vertical incision is carried far into the alveolar mucosa
  • Vertical incision is made between the root eminences of teeth
  • Triangular flap Advantages:
    • The possibility of incision crossing the lesion is eliminated
  • Triangular flap Disadvantages:
    • Retraction is difficult
• Trapezoidal flap:
  • Two oblique incisions are made and the entire flap is retracted toward the vestibule
  • Horizontal incisions are made to separate the flap
  • Trapezoidal flap Advantages:
    • Good accessibility
    • Convenient method
  • Trapezoidal flap Disadvantages:
    • Gingival tissue attachment is lost

Question 2. Apicectomy.
Answer.

Apicectomy

It is the ablation of the apical portion of the root end attached to soft tissues.

Apicectomy Indications:

• Anatomical anomalies
• Persistent infections
• Need for biopsy
• Medical reasons
• Lack of time
• Over fillings

Apicectomy Contraindications:

• Systemic diseases
• Deep pockets
• Acute infection
• Short root length

Apicectomy Preparation:

• Class 1 preparation – 3 mm into root dentin
• Walls are made parallel to pulp space
• Remove all isthmus tissue
• 0-10 bevel is given
• Reset upto 3 mm of the apical portion
• Seal the apical portion
• Closure of flap
• Suturing

Apicectomy Complications:

• Bleeding
• Damage to neighboring root
• Entry into nerve
• Abscess
• Fenestration
• Increased mobility of tooth

Question 3. Root end Filling Materials/Retrograde filling materials.
Answer.

Root End Filling Materials Properties:

• Root End Filling Materials Should be well-tolerated
• Root End Filling Materials Should adhere to tooth surface
• Root End Filling Materials Should be stable
• Root End Filling Materials Should be resistant
• Root End Filling Materials Should be bactericidal
• Root End Filling Materials Should be noncorrosion
• Root End Filling Materials Should not stain
• Root End Filling Materials Should be radiopaque

Root End Filling  Materials:

• Amalgam:
  • Radiopaque
  • Well tolerated
  • Slow setting
  • Dimensionally unstable
• ZOE:
  • Weak
  • Long setting time
  • Irritation due to Eugenol
• IRM:
  • Higher success rate
• Super EBA:
  • Low solubility
  • Radiopaque
• MTA:
  • Least toxic
  • Hydrophilic
  • Radiopaque
• Composite Resin:
  • Technique sensitive
• Gold foil:
• Glass Ionomer:
• Cavit:
  • Available in single-paste forms

Question 4. Post and Core.
Answer.

Root End Filling  Post: It is a rigid restorative material placed in the root of a non-vital tooth.

Root End Filling  Core: It is a supragingival portion that replaces the missing tooth structures

Root End Filling  Functions Of Post

• Retains core
• Distributes stresses

Root End Filling  Requirements Post:

• Provide maximum protection
• Provide maximum retention
• Easy to place
• Less technique sensitive
• Biocompatible
• Easy to retrieve
• Be esthetic
• Not expensive

Root End Filling  Core:

• Biocompatible
• Easy to manipulate
• Sufficient strength
• Stable
• Cheap
• Easily available

Root End Filling  Materials:

Root End Filling  Post:

• Gold
• High platinum
• Co-Cr-Mo alloys
• Stainless steel
• Titanium
• Carbon fiber
• Zirconium
• Glass fiber
• Plastic

Root End Filling  Core:

• Dental amalgam
• Resin modified GIC
• Composite resin
• Cast core

Question 5. Effect of Dental Procedures on Pulp.
Answer.

• Effect of Dental Caries: 

• Effect of Tooth preparation: Causes aspiration of nuclei of odontoblast
• Remaining Dentin Thickness [RDT]: Dentin permeability increases with decreased RDT
• Effect of Local Anaesthesia:
  • Reduces blood flow
  • Increases irritants
• Calcium Hydroxide:
  • Causes demineralization
  • Stimulate fibroblast
  • Reparative dentin formation
• Zinc Oxide Eugenol:
  • Reduce nerve impulse
• Zinc Phosphate:
  • Toxic to pulp
• GIC:
  • Antocariogenic
• Amalgam:
  • Inflammation
  • Inhibition of reparative dentin formation
  • Cytotoxic effect
  • Copper is toxic
• PIN Insertion:
  • Dentinal fractures
  • Irritation to pulp

Question 6. Replanation/Intentional Replanation.
Answer.

Replantation/Intentional Replantation

It is the intentional removal of the tooth and its reinsertion into the socket after retrograde obturation and resection of the root tip.

Replantation Indications:

• Broken instruments in canals
• Calcified canals
• Over filling
• Curved canals
• Presence of foreign body in periapical tissue.

Replantation Contraindications:

• Medically compromised
• Periodontal involvement
• Missing buccal/lingual plate
• Nonrestorable tooth

Replantation Technique:

Question 7. Types and indications of Periradicular surgery.
Answer.

Peri-Radicular Surgery:

• Curettage
• Biopsy
• Root end resection
• Corrective surgery
• Replacement surgery
• Implant surgery

Peri-Radicular Surgery Indications:

• Surgical drainage
• Failed non-surgical treatment
• Calcified metamorphosis of pulp space
• Horizontal fracture at the root tip
• Iatrogenic errors
• Anatomic variation
• Biopsy
• Corrective surgery
• Replacement surgery
• Implant surgery
• Exploratory surgery

Peri-Radicular Surgery Contra-Indications:

• Mobile tooth
• Pockets
• Leukemic patients
• Cardiac surgery
• Uncontrolled hypertension
• Uncontrolled bleeding disorders
• Immuno-compromised patients
• The first trimester of pregnancy
• Apprehensive patient
• Short root length
• Proximity to vital structures
• Non-restorable tooth
• Non-strategic tooth

Question 8. Indications of endodontic surgery.
Answer.

Indications of endodontic  Surgical drainage:

• Failed non-surgical treatment
• Calcified metamorphosis of pulp space
• Horizontal fracture at the root tip
• Iatrogenic errors
• Anatomic variation
• Biopsy
• Corrective surgery
• Replacement surgery
• Implant surgery
• Exploratory surgery

Surgical Endodontics Short Questions And Answers

Question 1. Flaps in Endodontics.
Answer.

Flaps in Endodontics Classification:

• Full mucoperiosteal flap
• Triangular
• Rectangular
• Trapezoidal
• Horizontal
• Limited mucoperiosteal flap
• Sub-marginal curved
• Sub-marginal scalloped rectangular

Question 2. Ochsenbein – Luebke flap.
Answer.

Ochsenbein – Luebke flap

• By Neumann

Ochsenbein – Luebke flap Design:

• Vertical incision on either side of the surgical site
• Horizontal incision along attached gingiva.

Ochsenbein – Luebke flap Advantages:

• Unaltered attachment level
• Unexposed bone
• Accessibility
• Good healing

Ochsenbein – Luebke flap Indications:

• Gingivitis/periodontitis
• Bony dehiscence

Ochsenbein – Luebke flap Disadvantages:

• Disturb blood supply
• Flap shrinkage
• Limited apical orientation
• Scar formation
• Difficult wound closure

Surgical Endodontics Viva Voce

• Excessive hemorrhage during apical surgery is controlled by placing epinephrine epinephrine-containing solution in the surgical site
• In apicoectomy, a typical surgical flap used should extend one or two tooth/teeth laterally
• Parallel port is the best-preferred post
• Splinting should be removed in 7-10 days
• Hanks balanced solution is an isotonic salt solution used for preserving avulsed teeth
• Apical surgery is done with great caution on mandibular bicuspids because of their proximity to the mental foramen
• Paraesthesia is common in the mandible, especially in the premolar and molar region
• Ecchymosis results in skin discoloration from extravasation and the breakdown of blood adjacent to the surgical area
• Endodontic surgery should be avoided on lingual surfaces of molars or external oblique ridge of the mandible due to inaccessibility and difficulty in gaining access to the surgical site