VARIANTS OF DELAYED RESULTS OF ROOT APEX RESECTION (CLINICAL OBSERVATIONS)
About the author:
Nazarian R. S., Fomenko Y. V., Shcheblykina N. A., Kolesova T. A., Sukhostavets E. V.
Type of article:
Treatment of chronic periodontitis is a problem of modern dentistry, which still has no universal solution. The share of complicated caries among diseases of the teeth hard tissues has a significant spread, and conservative treatment is not always effective, it is necessary to use complex treatment. When an error in the treatment of pulpitis happens (poor quality enlargement or obturation of the root canal) microflora spreads to the periapical tissues with subsequent development of periodontitis. In the treatment of periodontitis success rate is lower than in the treatment of pulpitis. 15 years ago, according to the Borowski, proportion of poorly sealed channels in treatment of complicated caries was 81. 2 %. And in spite of using modern techniques, tools and materials in endodontic therapy, it cannot always improve the results of conservative treatment, especially it concerns teeth with several roots. Keeping teeth with destructive changes in the periapical tissues was always actual task in finding both conservative and surgical methods of treatment. Today there are several methods of surgical interventions, avoiding tooth extraction. Synthesis of all these methods of surgical treatment have led to such concepts as “teeth preserving operation. ” Such conservative and surgical treatment of chronic periodontitis includes resection of the root apex. The operation is performed on a single-rooted teeth, rarely – on the premolars and molars. It can be explained by the complexity of access to the periapical inflammatory lesion, difficult filling of narrow root canals, traumatic surgery, as well as the danger of damage of maxillary sinus and the contents of the mandibular canal. Indications for such treatment are: • Ineffective conservative endodontic treatment - increasing or keeping periapical destructive changes after conservative endodontic therapy. • Endodontic treatment errors, such as incomplete filling of the root canal, perforation, broken instrument in the channel or excessive pushing of the filling material to the periodontium. • Anatomical features - impassable, curved root canals. • Fracture of the upper third tooth root. The result of root resection is usually good, teeth with resected roots tops operate for many years, participating in chewing and being a support for removable and fixed prostheses. Fundamental changes in the technique of the root resection was brought by the introduction of the surgical operating microscope and ultrasonic instruments, letting endodontic surgery rise to a new, more rational level. The result of this technical innovation was microsurgery. Anatomical details with microscope application are clearly visible on the root surface. The probability of surgical errors is greatly reduced or even eliminated. Basis of microsurgery are lighting, magnification and instrumental equipment. Microscope and new micro tools, specifically designed for this purpose, make microsurgery a practical reality. Now, surgical procedures can be performed at root apex with precision and confidence. The unsuccessful outcome of comprehensive treatment makes wonder specialists of both surgical and therapeutic profile. A single protocol of tooth retreatment after unsuccessful treatment still does not exist. Thus, resection of the root apex, which often is the last opportunity to save the tooth, may not always succeed. Error at any stage, whether therapeutic or surgical, may lead to future complications and perhaps the removal of the tooth. The prevention of this situation must be strict compliance with all stages of treatment. In the therapeutic step the root canal must be sealed to the working length modern filling materials which do not dissolve the tissue fluid. The quality of sealing should be checked by means of X-ray diagnostics, and if necessary - computer tomography. On the surgical stage it is important to perform a retrograde filling with Pro Root MTA or its modern counterparts. The quality of therapeutic and surgical stages of the root resection significantly increases due to applying of operating microscope.
the root apex resection, poor root canal obturation
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 part 2 (108), 2014 year, 035-040 pages, index UDK 616. 314. 165-089. 87