Endodontic surgery is a surgical procedure performed to remove or correct the causative agents of radicular and peri-radicular disease & to restore these tissues to functional health.

1. DEPARTMENT OF CONSERVATIVE DENTISTRY &
ENDODONTICS
Presented By:
Ashish Kumar
B.D.S. Final year
Batch: 2011-16
INSTITUTE OF DENTAL STUDIES & TECHNOLOGIES,
MODINAGAR
ENDODONTIC SURGERY
PART-1
Under guidance of:
Prof. Dr. Sumeet Sharma
Dr. Rishi Manan
Dr. Nikhil Puri
Dr. Surbhi Anand
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2. CONTENTS
 Introduction.
 Historical aspect in endodontic surgery.
 Terminology.
 Objectives & rational for surgery.
 Indication.
 Contraindication.
 Treatment planning & presurgical notes for
periradicular surgery.
 Stages in surgical endodontics.
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3. INTRODUCTION
 What is surgery?
 Surgery is the first and
the highest division of
the healing art, pure in
itself, perpetual in its
applicability, a working
product of heaven and
sure of fame of earth.
- Sushrutra (400 B.C.)
A statue dedicated to Suśruta at
Haridwar.
“We are what we repeatedly do. Excellence, then, is not an
act, but a habit.” - Aristotle
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4. HISTORICAL ASPECT IN ENDODONTIC SURGERY:
 The first recorded
endodontic surgical
procedure was incision
and drainage of acute
endodontic abcess
performed by AETIUS, a
Greek physician-dentist,
over 1500 years ago.
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5. HISTORY..
 Father of endodontic is
Dr. Louis Grossman
 G. V. Black in 1886,
Farrar in 1884 and
Grayston in 1887 also
recommended for
amputation of root in
neglected long term
abcess.
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Dr. Louis Grossman

6. ENDODONTIC SURGERY
 Endodontic surgery is a
surgical procedure
performed to remove or
correct the causative
agents of radicular and
peri-radicular disease &
to restore these tissues
to functional health.
 It is the LAST HOPE for
retention of a tooth and
therefore require the
greatest skill.
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7. TERMINOLOGY
 APICOECTOMY: removal of only apical region
and retrograde filling.
 RADISECTOMY: removal of a single root.
 ROOT END RESECTION: is used to describe the
removal of apical part of the root.
 ROOT END FILLING: describe the procedure of
placing a filling into a prepared apex.
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8. TERMINOLOGY
 APICOECTOMY:
removal of only
apical region and
retrograde filling.
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10. OBJECTIVES & RATIONAL FOR SURGERY
 To ensure placement of a proper seal between
periodontium and root canal foramina.
 Now a days multiple treatment planning options are
available for root treated teeth that develop
recurrent periapical lesions that fail to heal
following adequate root canal treatment.
“Surgery is always the second best. If you can do
something else, its better”- John Kirklin (a
American cardiac surgeon)
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11. INDICATION
 Need for surgical
drainage.
 Failed nonsurgical
endodontic treatment
1. Irretrievable root canal
filling material.
2. Calcific metamorphosis
of the pulp space.
3. Procedural errors.
 Instrument
fragmentation.
 Root perforation.
 Symptomatic overfilling.
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12. INDICATION
 Failure of non surgical endodontic retreatment.
 Failure of previous surgery: due to lack of
employing microsurgical instruments &
magnification aids. Resurgery is indicated in such
case.
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13. INDICATION
 Horizontal apical root
fracture: occurs due to
traumatic injury,
surgical intervention is
needed if apical
segment become
necrotic and non-
surgical treatment is not
possible.
Horizontal apical
root fracture
Necrosed pulp
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14. INDICATION
 Iatrogenic errors:
caused during RCT
may include-
 Blockage from debris.
 Overfilling of canal
leading to foreign body
reaction.
 Apical canal
transportation.
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15. INDICATION
1. Anatomic variations
or problems:
 Root dilaceration:
endodontist unable to
reach apical
constriction due to
blocked canal.
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16. INDICATION
 Exploratory surgery and biopsy:
 Rare
 When a fracture is suspected or in a teeth with vital
pulp with radicular radiolucency as in patient with a
previous history of malignancy.
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17. INDICATION
 Periodontal
considerations:
 Periodontal support of root
goes beyond repair.
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18. CONTRAINDICATIONS
 Inadequate periodontal
support & active
uncontrollable
periodontal disease.
 Poor restorability with
postendodontic
restoration
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19. CONTRAINDICATIONS
 Lesion situated very
close to important
anatomical structure
such as lingual nerve,
inferior alveolar nerve,
mental foramen,
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20. CONTRAINDICATIONS
 Systemic
complications:
 Bleeding disorder.
 Immunocompromised
patient.
 Severe heart disease
such as myocardial
infarction.
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21. CONTRAINDICATIONS
 Practitioner’s skill and experience
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22. TREATMENT PLANNING & PRESURGICAL NOTE
FOR PERIRADICULAR SURGERY
 Proper planning is required presurgically before
deciding to subject patient to surgical endodontics.
 Endodontic procedure must be carried out by-
 Qualified, well trained, experienced endodontics.
 Endodontics must know his/her limitations of
clinical skills before performing endodontic
surgery.
 Informed consent is mandatory.
 All the surgical procedures have to explained in
details to the patient.
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23. TREATMENT PLANNING & PRESURGICAL NOTE
FOR PERIRADICULAR SURGERY
Case diagnosis
Preoperative surgical
note
Anesthesia/hemostasis
STEPS IN ENDOSURGERY
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24. CONTINUE…
Management
of soft & hard
tissues
Surgical
access or
osteotomy
Periradicular
curettage 24

25. CONTINUE…
Access to
root structure
Root-end
preparation
Root-end
resection 25

26. CONTINUE…
Root-end preparation
Root-end filling
Soft tissue repositioning
& suturing
Postsurgical care 26

27. PREMEDICATION
 Necessary when patient remains overly
anxious by preoperative consultation.
 CLINICAL NOTE:
 For swelling or pain: Adv. 400 or 800 mg
ibuprofen per day immediately prior to
surgery & mostly advise to continue for 48
hrs postoperatively.
 For anxiety: Adv. 5 mg valium on previous
night of surgery & morning of surgery.
 For immunocompromised patient: Adv.
Antibiotics prophylaxis is mandatory. BUT
generally antibiotics prescription should be
avoided.
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28. STAGES IN SURGICAL ENDODONTICS:
 MANDATORY
INVESTIGATIONS PRIOR TO
SURGERY:
 Clotting time.
 Bleeding time.
 Prothrombin time.
 Thrombin time.
 Partial thromboplastin time.
 Activated thromboplastin time.
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