Endodontic Surgery: A Conservative Solution in Some Cases for Preserving Natural Teeth
20/07/2024
Fellow
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A patient recently visited our clinic with a complaint of persistent pain in the upper right lateral incisor. Upon examination, we discovered a granuloma at the root of the affected tooth. After careful evaluation, we proposed endodontic surgery as the most conservative solution to address the issue. This approach aims to preserve the natural tooth structure while effectively eliminating the source of pain and infection.
Fig. 1
This photo shows the upper front teeth with a visible fistula above the right lateral incisor. The fistula indicates an underlying infection, likely associated with a granuloma at the root of the tooth.
Fig. 2
Surgical exposure of the problem
"Apical resection”
In this case, it was decided to consume the apex rather than make a clean cut to have better control over the amount of root to remove.
retro preparation with dedicated ultrasonic tip
Retro obturation with SuperEBA and apical surface finishing
Fig. 3
The importance of proper apical resection and the use of adequate magnification allow us to be as conservative as possible.
Finally, to prevent visible scars, proper management of soft tissues is required, along with the use of appropriate sutures (in this case, non-absorbable 6-0 sutures).
The picture show the healing after two week
Fig. 4
Final x-ray
Fig. 5
DR. Francinelli Jacopo
- Degree with honors in Brescia in 2018
- Numerous private courses in the field of endodontics
- 2020 2nd level post-graduate Master in Clinical and Microsurgical Endodontics at the University of Brescia with full marks and honors
- from 2019 he is clinical tutor in the 3rd year of Dentistry alongside Prof. Salgarello
- from 2021 he is tutor for the aforementioned university master
- He collaborates with the Spedali Civili of Brescia as a freelancer
- He has published articles in national and international journals
- Contract professor for the University of Brescia
- Member of the Italian Academy of Microscopic Dentistry
- Collaborate with colleagues in some private courses focused on endodontics
- He carries out his freelance activity in the province of Brescia dedicating himself mainly to micro-endodontics
Conclusions
In some cases, when orthograde retreatment would be problematic due to the presence of intra-radicular obstacles such as custom posts, retrograde surgical solution is the most conservative approach to avoid potential issues when initiating retreatment or when the patient has limited economic resources.
Before proposing this surgical treatment, however, the adequacy of the coronal seal must be carefully evaluated.
Bibliography
Setzer, F. C., & Kratchman, S. I. (2022). Present status and future directions: Surgical endodontics. In International Endodontic Journal (Vol. 55, Issue S4, pp. 1020–1058). John Wiley and Sons Inc. https://doi.org/10.1111/iej.13783
S. Friedman. The prognosis and expected outcome of apical surgery. Endod Topics, 11 (2005), pp. 219-262
