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
    • Trapered or parallel
      • Tapered posts
        • They are least retentive of all posts
        • Produces high incidence of root fracture
        • Concentrates stress at 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 greatest potential for root fracture
        • Recommended for post-endodontic restorations
      • Non-threaded posts
        • Produces least stress
        • Have least tendency for root fracture
    • Metallic or non-metallic
  • Stitch abscess may develop due to
    • Local laceration of tissue
    • Accumulation of debris at 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 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 curved horizontal incision with the convex portion of the incision towards the gingival crest
    • Incision begins at the mucobuccal fold and follows an half moon path
    • Indications:
      • When incisors are involved
    • Advantages:
      • Simple
      • Easy to reflect
      • Easy to maintain oral hygiene
      • Gingival attachment is not disturbed
    • Disadvantages:
      • Restricted access with limited visibility
      • Limited use
  • Luebke Oschenbein flap:
    • Named after Luebke and Oschenbein
    • It is modified semilunar flap in which a scalloped horizontal incision is made in the attached gingiva with vertical incisions
    • Advantages:
      • Greater access and visibility
      • Flap is easily displaced and sutured
      • Marginal gingiva is not disturbed
    • Disadvantages:
      • Scarring is possible
  • Triangular flap:
    • Indicates for surgery involving short rooted teeth
    • Incision along the gingival border forms the base of the triangle
    • A single vertical incision is carried far into alveolar mucosa
    • Vertical incision is made between the root eminences of teeth
    • Advantages:
      • Possibility of incision crossing the lesion is eliminated
    • Disadvantages:
      • Retraction is difficult
  • Trapezoidal flap:
    • Two oblique incisions are made and entire flap is retracted towards vestibule
    • Horizontal incisions are made to separate the flap
    • Advantages:
      • Good accessibility
      • Convenient method
    • Disadvantages:
      • Gingival tissue attachment is lost

Question 2. Apicectomy.
Answer.

Apicectomy

It is the ablation of apical portion of the root end attached 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 obevel is given
  • Reset upto 3 mm of apical portion
  • Seal the apical portion
  • Closure of flap
  • Suturing

Apicectomy Complications:

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

Endodontics Surgical Endodontics Root end preparation using straight hand piece

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

Root End Filling Materials Properties:

  • Should be well tolerated
  • Should adhere to tooth surface
  • Should be stable
  • Should be resistant
  • Should be bactericidal
  • Should be non corrosion
  • Should not stain
  • 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 rigid restorative material placed in the root of a non-vital tooth.

Root End Filling  Core: It is supragingival portion which 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:

Endodontics Surgical Endodontics Effect of Dental Caries

  • Effect of Tooth preparation: Causes aspiration of nuclei of odontoblast
  • Remaining Dentin Thickness [RDT]: Dentin permeability increases with decease 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.

Replanation/Intentional Replanation

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

Replanation Indications:

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

Replanation Contraindications:

  • Medically compromised
  • Periodontal involvement
  • Missing buccal/lingual plate
  • Non restorable tooth

Replanation Technique:

Endodontics Surgical Endodontics Replantation Technique

Endodontics Surgical Endodontics Beaks of the forceps should be away from the cementum

Endodontics Surgical Endodontics Beaks of force should rest on cement enamel junction

Endodontics Surgical Endodontics Any repair or procedure should be done as quickly as possible

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 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
  • 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 netamorphosis of pulp space
  • Horizontal fracture at 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 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

Endodontics Surgical Endodontics Ochesenbein Luebke flap

Surgical Endodontics Viva Voce

  • Excessive haemorrhage during apical surgery is controlled by placing epinephrine containing solution in surgical site
  • In apicoectomy, a typical surgical flap used should extend one or two tooth/teeth laterally
  • Parallel post is best preferred post
  • Splinting should be removed in 7-10 days
  • Hanks balanced solution is 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 mandible especially in premolar and molar region
  • Ecchymosis results in skin discoloration from extravasation and breakdown of blood adjacent to surgical area
  • Endodontic surgery should be avoided on lingual surfaces of molars or external oblique ridge of mandible due to inaccessibility and difficulty to gain access to surgical site

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