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Indications for surgical endodontics and findings of an audit into referrals

From Volume 38, Issue 9, November 2011 | Pages 610-614

Authors

Zaid Ali

BChD, MFDS RCS(Ed), PhD, MSc, PGDip, PGCert

PGCert Health Research (Leeds), Associate Dentist, Lindley Dental, Huddersfield

Articles by Zaid Ali

Divya Keshani

BDS(Manchester), FDS RCS(Eng)

Associate Specialist in Oral and Maxillofacial Surgery, Bradford Teaching Hospitals Trust, Saint Luke's Hospital, Little Horton Lane, Bradford, BD5 0NA

Articles by Divya Keshani

Abstract

Peri-radicular surgery is a valuable treatment modality allowing thorough treatment of chronic infection of the peri-radicular tissues. It is important that this treatment option is prescribed appropriately and steps are taken to help improve outcomes of surgery. We discuss the indications for peri-radicular surgery, considerations when planning treatment for teeth where orthograde endodontics has failed and present the findings of an audit into the appropriateness of referrals for peri-radicular surgery to the Department of Oral and Maxillofacial Surgery at a District General Hospital.

Clinical Relevance: This article highlights the indications and contra-indications for peri-radicular surgery to general dental practitioners.

Article

Peri-radicular surgery involves the access and visualization of peri-radicular tissues including the root apex, alveolar bone and any associated chronic apical granulomatous tissue. The technique allows for removal of the root apex along with the terminal (apical) plexus of root canal anatomy, thorough curettage of the apical tissues and retrograde endodontic obturation. Peri-radicular surgery is often carried out when conventional root canal treatment has failed. Such failure may be the result of inadequate disinfection of the root canal system or subsequent re-infection due to breakdown of coronal restoration seal. Where endodontic obturation is short of the apex or poorly condensed, non-surgical orthograde re-treatment may provide an opportunity to remove necrotic tissue and disinfect the root canal system more thoroughly than surgical treatment, and there is evidence to suggest that a poor coronal seal is one of the main reasons for failure of root canal treatment.1,2 Detailed description of the technique is outside the scope of this paper.

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