Endodontic Microsurgery
Microendodontic surgery, or apical surgery, is an intensive operation to restore periapical lesions not adequately healed through root canal therapy. The incorporation of high-performance magnification tools, micro-tools, and biocompatible material has greatly increased the success rate of this type of surgery.
Indications for Endodontic Microsurgery
This is a recommended procedure in situations where standard root canal treatment or re-treatment has failed. The most common indications are:
- Persistent Periapical Lesions: In case the periapical lesion persists after nonsurgical treatment, microsurgery has to be employed to eliminate infection and stimulate healing.
- Root canal anatomy: can be encountered with anatomical discrepancies, such as apical deltas, calcified canals, and accessory canals, that can interfere with proper debridement and sealing and thus necessitate a surgical procedure.
- Perforation repair: Technical failures, such as root perforation or instrument breakage, may require surgical intervention.
Insufficiency of previous root canal treatments, as evidenced by persistent symptoms or repeated infections after endodontic retreatment, can indicate the need for microsurgical treatment.
Surgical techniques and instruments
The progress of endodontic microsurgery is aided by the introduction of novel instruments and techniques that improve accuracy and reduce tissue trauma.
- Operating Microscope and Magnification: Enhanced visualization allows surgeons to view microanatomical structures and deliver accurate surgical performance.
- Microinstruments: Microsurgical instruments in the form of fine scalpels, microsurgical mirrors, and fine sutures allow precise tissue manipulation with minimum postoperative trauma.
- Ultrasonic Root-End Preparation: Ultrasonic tips enable a conservative and accurate retrograde preparation, thereby enhancing the compatibility of the filling material.
- Biocompatible materials: Materials like mineral trioxide aggregate (MTA) and bioceramics are more sealable and promote healing of the periapical region.
Procedure Overview
The microsurgical operation has a step-by-step methodology:
- Local Anaesthesia and Flap Design: Profound anaesthesia is administered, and a full-thickness mucoperiosteal flap is carefully elevated.
- Osteotomy and curettage: It involves the opening of a small osseous portal to allow entry into the periapical lesion, which is then carefully curetted.
- Apicoectomy: The operation of removal of the apical part of a tooth root to eliminate the current infection.
- Root-End Preparation and Filling: The retrograde cavity is prepared with an ultrasonic tip and subsequently the retrograde cavity is filled with a biocompatible substance like MTA.
- Suturing and Postoperative Care: Fine sutures are employed to keep the flap in place, thus facilitating the healing process.
Recovery and Interpretation
The healing pattern following endodontic microsurgery is fundamentally dependent on three patterns:
- Regeneration: Ideally, complete regeneration of periapical tissues such as periodontal ligament and bone is desirable.
- Healing in certain cases can result in the development of fibrous tissue rather than osseous regeneration.
- Incompleteness of healing: The residual radiolucency is often asymptomatic and necessitates regular radiographic follow-up.
The outcome is influenced by several factors that range from the skill of the surgeon to the patient's health and the quality of the root-end filling. Studies have established that the success rate of microsurgery is over 90%, hence the method can be termed a sure way of conserving teeth.
