Paraendodontic surgery of a premolar. 12-month prognosis.
Patient referred by a specialist colleague after non-remission of the fistula after successive changes of intracanal medication in the second upper right premolar. It was decided then the paraendodontic surgery with apicectomy, after the final obturation performed by the colleague. The apical resection was then performed with an ultrasound tip. 12-month follow-up showed no signs or symptoms and a radiographic image indicating the repair of the area, including the reestablishment of the normal image of the cortical of the maxillary sinus.
in: Fagundes et al. Paraendodontic surgery. Rev Odontol UNESP, Araraquara. sep./out., 2011; 40(5): 272-277.
The technical, scientific and biological evolution in root canal treatments has provided an increase in success rates. However, despite all this evolution, root canal treatments are basically performed through technical operative steps that are subject to failures, accidents and various types of complications in their clinical execution. When root canal treatment fails, retreatment is possible, but it is not always feasible.
The parendodontic surgery is one of the resources used whenever it is not possible to remove the etiologic agent via
endodonto, in an attempt to maintain the dental element. Besides offering the possibility of removing the periapical inflamed tissue, the most important thing: this surgery makes it possible to improve the cleaning, modeling and sealing of the apical portion of the root canal. There are several indications for parendodontic surgery, and it is up to the professional to choose the one that best applies
to the case in question.
Among these are: the establishment of drainage, pain relief, anatomical complications, iatrogenic problems, trauma, failures in previously performed treatments, problems during treatment, periodontal problems and the need for biopsy.
It is also indicated in cases in which the prognosis of conventional obturation would be doubtful: root perforation, incomplete or dilated apices, foreign elements in the apical and periapical region, and detection of non-unfilled canals during the trans-surgical inspection.
The most commonly used surgical modalities for the resolution of difficulties, accidents and complications in Endodontics
may vary from a simple curettage with apical smoothing or plasty to the obturation of the root canal simultaneously with the surgical act. This implies the removal of the content of the root canal, allowing its obturation more effectively, as well as eliminating the concern with eventual extrusion of septic material and extravasation of obturating material.
Moreover, Kuga et al. state that in cases of root perforation or lesions with frequent exacerbations, there is difficulty in obtaining a dry canal adequate for obturation.
Thus, these authors also report that if removing the pathological material of the periapice, it is obtained a conduit absent
of exudation, allowing the complete obturation. In this association of simultaneous obturation to the surgical act, it favors the apical repair, especially in the sealing of lateral canals, accessories and secondary.
Paraendodontic surgery
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