#D3/S2/W9
#Endo

WHY

Prevention and treatment of apical periodontitis

Prognosis

Pocket cyst vs true cyst

actinomycosis

• yellow granule
• has ability to wall itself off and form cyst

Reality

• no way to find cause of persistent lesion before surgery

WHEN

• when non surgical not feasible, practical nor desirable
• should address biological causes

• address potential biological casues
• remove potential causes, clean and seal root canal from apical approach
• clean and disinfect, then obturate

• methylene blue staining for crack detection
  

HOW

steps

• med hist
  • bleeding disorder etc
• pre-emptive ibuprofen 600mg 30 mins prior
• LA 20-30mins prior
  • 2% lidocaine 1:50,000 epinephrine haemostatic purposes
  • very important, medullary bone
• flap design
  • incision, reflection
• bone access
• haemostatic control - ferric sulphate
• curettage granulation tissue
• inspect root end
  • methylene blue to stain pdl (to see if full cover or not)
• retro endo retreat with ultrasonic tip
• fill with MTA using MAP system
  • minimum thickness for MTA is 3mm
• irrigate with saline
• suture close