11. Flap Design / Root Resection And The Beveled R
11. Flap Design / Root Resection and the Beveled R
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11. Flap Design / Root Resection and the Beveled Root Surface / Root End Preparation Techniques || with 100% Errorless Solutions.
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11. Flap Design / Root Resection and the Beveled R
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11. Flap Design / Root Resection And The Beveled R
The design of a flap for endodontic periapical surgery is dictated by many factors. correct answers 1. Amount of attached gingiva
2. Number of teeth involved
3. Depth of periodontal pockets
4. Length of the roots involved
5. Amount of access needed
6. Presence of pathosis
7. Dimensions of the...
11. Flap Design / Root Resection and the Beveled Root
Surface / Root End Preparation Techniques || with 100%
Errorless Solutions.
The design of a flap for endodontic periapical surgery is dictated by many factors. correct
answers 1. Amount of attached gingiva
2. Number of teeth involved
3. Depth of periodontal pockets
4. Length of the roots involved
5. Amount of access needed
6. Presence of pathosis
7. Dimensions of the pathosis
8. Presence of anatomic structures
9. Esthetic considerations
10. Patient factors
Basic Principles of Flap Design correct answers 1. Maintain maximum blood supply.
2. Place lines of incision over sound bone.
3. Insure adequate size.
4. Avoid sharp corners.
5. Avoid incision over bony eminence.
6. Insure proper placement of horizontal incision.
7. Use care in retracting and handling tissues.
8. Carefully analyze periodontal condition
Gutmann & Harrison (1991)- Surgical Endodontics correct answers Reactive Hyperemia: The
rebound phenomenon - At a point in time, the concentration of vasopressor decreases to a level
that no longer produces an alpha-adrenergic effect. Instead of going back to normal, the blood
flow increases due to beta-adrenergic effects. It is not actually a beta effect but a result of
localized tissue hypoxia and acidosis caused by the prolonged vasoconstriction.
Lubow, Wayman, & Cooley (1984)- Endodontic flap design: Analysis and recommendations for
current usage. (Papilla Based Incsion) correct answers The horizontal component of this flap is
directed at and along a straight line drawn across the most apical extent of the facial gingival
scallop. In other words, the incision would be initiated in the gingival sulcus at the cervical
region of each tooth; however, as the sulcus curves coronally in the interproximal area, the
incision proceeds in a straight line to connect with the cervical area of the adjacent tooth.
-First to describe papillary sparring flap design with straight horizontal line
Kramper, Kaminski, Osetek & Heuer (1984) - Comparative study of wound healing of 3 types of
flap designs in periapical surgery. correct answers The submarginal incision demonstrated better
results than the semilunar or intrasulcular incisions, except in the area of scar formation
, Velvart (2002, 2004)- Papilla base incision: a new approach to recession-free healing of the
interdental papilla after endodontic surgery. correct answers The results demonstrated
preservation of interproximal tissue height following apical surgery.
-Less recession for PBI at 1, 3 and 12 mo compared to standard flap design
Von Arx (2007) - Changes of periodontial parameters following apical surgery: a prospective
clinical study of three incision techniques. correct answers The intrasulcular incision technique
had more recession of the gingival margin and greater loss of attachment (vs papilla based
incision and submarginal incision)
Gutmann & Harrison 1991 (Editors) - Surgical Endodontics correct answers Indications and
rationale for root-end resection: Removal of pathologic processes, removal of anatomic
variations, and removal of operator errors in nonsurgical treatment such as ledges, blockages,
zips, perforations and separated instruments. Removal of the soft tissue lesion is enhanced.
Access to the canal system where the major canal system is blocked for whatever reason as with
a post and core is made possible. Evaluation of the apical seal and/or creation of an apical seal
are possible. Also, reduction of fenestrated root apices and evaluation for aberrant canals and
root fractures can be done.
Cambruzzi & Marshall (1983)- Molar endodontic surgery. correct answers -Incidence of
isthmus:
MB root max molars 30%
M root of man molar 60%
D root of man molar 15%
--Recommend the use of methylene blue staining at the time of root end resection to enhance the
outline of the resected root surface and to aid in the detection of isthmuses.
Weller, Niemczyk, Kim (1995 ) -Incidence and position of the canal isthmus. Part 1.
Mesiobuccal root of the maxillary first molar. correct answers 100% of MB root had full or
partial isthmus at 4 mm level (so we prep all roots between 2 canals), at 3 mm was 90.5%
Von Arx correct answers Isthmus MB root 76%, M root man molar 83%, D root man molar 36%
Vertucci & Beatty (1986)- Apical leakage associated with retrofilling techniques: A dye study.
Must do a root end filling correct answers 1st to show patent dentinal tubules allow apical
leakeage under root end filling (45 degree bevel)
Tidmarsh & Arrowsmith (1989)- Dentinal tubules at the root ends of apicected teeth: A scanning
electron microscopic study correct answers Angle of the bevel should be kept to a minimum and
retrograde root fillings should extend back into the canal, preferably beyond the most coronal
aspect of the bevel. 19-48K tubules per sq mm close to pulp. 13K near DCJ.
Craig & Harrison (1993)- Wound healing following demineralization of resected root ends in
periradicular surgery correct answers Improved healing observed after demineralization of the
dentin surface was a result of the smear layer removal and exposure of the organic tooth
structure.
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