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. 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. Apical Surgery in other words is not a substitute for incomplete debridement and poor endodontics (Fig. Only in the case where this possibilità 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. 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. 1 a,b,c,d).įor 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. The scope of Surgical Endodontics is to achieve the three dimensional cleaning, shaping and obturation of the apical portion of the root canal system which is not treatable via an access cavity, but only accessable via a surgical flap (Fig. By Surgical Endodontics one refers to that branch of Dentistry that is concerned with the diagnosis and treatment of lesions of endodontic origin that do not respond to conventional endodontic therapy or that cannot be treated by conventional Endodontic therapy.
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