With endodontic surgery, whom you see first makes all the difference. The prognosis varies significantly depending on knowledge of root canal system morphology and how this is influenced by removal of the root tip; the ability to retreat previously root-filled canals prior to surgery and the surgical technique used.
The field of surgical endodontics has undergone radical change over the past few years. The evolution of the surgical endodontic microscope, new techniques with superior materials and instruments has enabled the endodontic surgeon to dramatically improve the prognosis of procedures such as apicoectomy, internal and external resorption repair, as well as the repair of iatrogenic and pathological perforations.
Based on current techniques, the success rate of uncomplicated apicoectomy with retrofilling should approximate that of conventional endodontics and the extraction of teeth simply because of the historically unpredictable outcome of apicoectomy may no longer be considered standard of care.
At Advanced Endodontics of Westchester we specialize in all phases of conventional and surgical microendodontics maximizing treatment options and outcomes for your patients:
The ability to provide both conventional and surgical approaches to teeth with post-treatment infection allows us to select the best treatment plan. Combined approaches i.e. conventional followed by surgical, are often the only way to resolve persistent infection.
High long-term success rates for apical surgery (similar to conventional endodontics) - even when previous surgery has failed
Successful management of external root resorption and perforations
Minimal post-operative discomfort and swelling
Reduced recuperation time with patients usually able to return to work the next day
Reduced cost when combined (conventional and surgical) procedures are performed on the same tooth
Advances in Endodontic Microsurgery
Instrumentation
Operating microscope - The significantly enhanced magnification and illumination of the operating microscope allows superior visualization of root surfaces. This allows us to see fractures, missed and lateral canals, isthmuses connecting adjacent canals, perforations and resorptive defects. Retrocavity preparations can be closely inspected to insure accurate and complete placement of filling material. More thorough debridement of infected periradicular tissue is possible and placement of bone grafts and membranes is facilitated.
Ultrasonics - The introduction of the piezo-electric ultrasonic unit several years ago has opened the door to an extremely accurate method of retrocavity preparation. Several generations of ultrasonic retro-tips have evolved that enable the endodontic surgeon to prepare retrocavities that are parallel to the long axis of the root while reducing the need for a long bevel and minimizing bone removal. Ultrasonic plugger tips to facilitate condensation of retrofilling materials are currently under development.
Micro-instrumentation - Several generations of miniature instruments have evolved including explorers, mirrors, carriers, pluggers and ultrasonic tips for retrocavity preparation and obturation.
Materials
Mineral Trioxide Aggregate (ProRoot MTA) -
At Advanced Endodontics of WestchesterProRoot MTA has replaced Super-EBA as the material of choice for retrofillings, perforation repair and vital pulp therapy. (Amalgam was discarded over 20 years ago!). MTA is a hydrophilic material comprised mainly of calcium silicate compounds, calcium compounds containing iron and aluminum, and hydrated calcium sulfate. When hydrated with water, it sets to a concrete-like consistency.
Properties - MTA displays superior marginal seal and biocompatibility when compared to root-end fillings of Super EBA, IRM and amalgam. It also induces cementum formation on its surface and appears to stimulate more rapid bone healing in the surgical site.
Disadvantages - MTA is difficult to manipulate. Setting time is 2 hours 45 minutes and presents as a sand-like consistency making placement very complicated. It has a limited anti-bacterial effect and is also very expensive.
At Advanced Endodontics of Westchester our endodontic surgeons,supported by a highly trained and experienced surgical team, are committed to providing your patients with the most advanced microendodontic care available. Please contact us if you wish to discuss a patient or have any questions pertaining to the above information.
