Arnaldo Castellucci Endodontics Volume 3
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The retrotips are of the same size or even smaller compared to the original size of the root canal, so that the retropreparation can be easily and predictably sealed in the maximum respect of the original anatomy. The use of the specifically designed retrotips allows the operator to clean the root canal from an apical approach, leaving clean dentinal walls not only on the lingual or palatal side, but also on the buccal aspect, which was impossible to clean with the previous techniques.
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In order to do this, special ultrasonic tips were developed to enable the clinician to reach every root in all clinical situations. The introduction of the ultrasonic root end preparation made possible to obtain what is defined as the ideal retropreparation: a class 1 preparation at least 3 mm into the root dentin with walls parallel to an coincident with the anatomic outline of the pulpal space. VIDEO The smallest burs were always too big compared with the diameter of the root canals and the big cavities were therefore more difficult to seal.įor the same reason, retro-preparations often failed to include isthmus areas(Fig. Trying to give enough retention to the cavity, the risk of a palatal or lingual perforation was always present and the procedure was more and more difficult as the root canal was more and more difficult to reach from the operator (Fig. This approach had many disadvantages, mainly the impossibility to create a preparation in the longitudinal axis of the root canal and to clean the buccal surface of the root end (Fig. The ultrasonic preparation For many years the root end has been surgically prepared drilling a class 1 preparation into the dentin, using a straight slow-speed handpiece or a so called miniature contra-angle handpiece (Fig. In the last 10-15 years two important developments have been introduced in surgical endodontics: the ultrasonic root end preparation and the surgical operating microscope.
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Nevertheless, in those cases which still have the indication for surgery it is currently possible to have a notably increased percentage of success with the treatment of surgical cases compared with what could be attained up untill a few years ago, and this is thanks to recent technological progress that has happened in the field of Surgical Endodontics. Ultimately even after the indication for surgery has been established, in agreement with Weine and Gerstein, 17 it is recommended to remove as much as possible of the inadequate preceeding canal obturation material and replace it with well compacted gutta-percha: in this way lateral canals, forgotten additional canals can be filled, often removing the need for surgery (Fig 3 a,b,c). Often a high level of Surgical Endodontics experience masks the operators inability to carry out a correct cleaning, shaping and three dimentional obturation of the root canal system by non-surgical means.
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Nevertheless, even in such cases, the authors recommend filling as much of the root canal by conventional method as possible.Ĭurrently the technique and instruments for clinical retreatment of endodontic failures are so refined that the cases that for certain have to be treated surgically because they cannot be retreated by orthograde means are becoming fewer. In agreement with what Nygaard-Ostby and Schilder 8 confirmed, Surgical Endodontics must be reserved for those cases in which the preparation and obturation of the root canal appear impossible right from the beginning or when the non-surgical retreatment attempts have failed. Only in the case where this possibilit does not exist or better still after failure of the non-surgical therapy carried out to resolve the problem, only then is one authorized to intervene surgically.Īpical Surgery in other words is not a substitute for incomplete debridement and poor endodontics (Fig. Once a diagnosis of Endodontic failure has been made, it is necessary to understand what the cause of the failure was so that successively the possibility of correcting the failure by orthograde retreatment can be evaluated. For this reason it is preferable to use the term Surgical Endodontics rather than Endodontic Surgery, in as much as the procedure should be planned and carried out as an endodontic procedure via surgical access and not a surgical procedure done for endodontic reasons.
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