Fig. 1

CBCT showing massive bone loss and infection extending laterally and eating away the labial plate of bone.

Fig. 2

Treatment Plan:

1)Endodontic treatment for all central, lateral and canine.

2)Scaling of the surgical area.

3)Incision to expose the huge cyst.

4)Remove it as one piece.

5)Proper curettage to make sure there is sound bone all around & disinfection.

Fig. 3

Huge infected cyst.

Fig. 4

Here it is possible to see how careful the debridement was.

All is clean, even the root surface had proper curettage to make sure there is no biofilm and bacteria attached to it.

Fig. 5

Time for RETRO CAVITY prep using endo surgery tips only in lower lateral. The lower central and lower canine only needed RCT without apical microsurger.

Using the reflection of highly reflective Minnesota retractor to guide me during retro prep in lower lateral, I needed here 6mm prep using AS6D. 

Fig. 6

Checking the fit of the micro plugger to see if its reaching full working length before compacting bioceramic putty in retrograde.

Fig. 7

Here after complete retrograde filling and checking the quality of the work.

Fig. 8

The patient is a dentist, so took a post operative CBCT to check the quality of retrograde obturation as its of a primary importance in healing.

Fig. 9

Post operative CBCT to check the adjacent teeth as well.

Fig. 10

Follow up showing complete healing and a very happy patient.

Fig. 11

About the author:

Dr Khaled Khalifa

B.D.S. Misr International University

Endodontic Specialist

Course Director “The Endo Formula”

Endodontic Consultant in multiple private clinics

Member of The Royal College of Surgeons England (MJDF)

Member of The American Association Of Endodontics (AAE)

Member of British Association Of Endodontics (BES)

Practice limited to Endodontics

Conclusions

Unfortunately some dentists avoid putting micro endodontic surgeries as a valuable treatment plan option.

Here as you can see we saved a critical tooth for the patient and she could not be any happier especially when she heard from many dentists that it should be removed and going through multiple surgeries to place implant.

Micro Endo Surgery when done properly is a key for many endodontic mishaps and infections that we can’t treat conventionally through the canals.

Bibliography

  • Gutmann J, Harrison J(1985) Posterior Endodontic Surgery: Anatomical consideration and clinical techniques. International Endodontic Journal 18, 8 – 34.
  • David M. Nosonowitz, Pleasant valley, N.Y.(1983) Flap designs for gaining access to periapical lesions. Oral surgery November, 537–541.
  • Gutmann JL, Harrison JW (1999) Surgical Endodontics, 1st ed. Ishiyaku EuroAmerica, Inc. St.Louis. Tokyo, All India Publishers, 17, 7, 162-167.
  • C. Barone, T.T. Dao, B.B. Basrani, N. Wang, S. Friedman. Treatment outcome in endodontics: the Toronto study—phases 3, 4, and 5: apical surgery. J Endod, 36 (2010), pp. 28-35
  • S. Friedman. The prognosis and expected outcome of apical surgery. Endod Topics, 11 (2005), pp. 219-262
  • T. von Arx, M. Penarrocha, S. Jensen. Prognostic factors in apical surgery with root-end filling: a meta-analysis. J Endod, 36 (2010), pp. 957-973
  • H.M. Eriksen, L.L. Kirkevang, K. Petersson. Endodontic epidemiology and treatment outcome: general considerations. Endod Topics, 2 (2002), pp. 1-9