PERIAPICAL SURGERY: THE ISSUE OF RETROGRADE OBTURATION

  • Marina Kacarska Depratment of Oral surgery, Faculty of Dentistry, Ss Cyril and Methodius University in Skopje, R.North Macedonia

Abstract

The primary objective of periapical surgery is to eradicate the etiological agents of periapical lesions, to obtain hermetic apical seal, so the parodontium is restored to a state of biologic and functional health. Uncertain clinical and radiographic evaluation of canal obturation, coronary permeability that can’t be detected during clinical investigation, are main arguments in favor of routine retro preparation and obturation. Reported clinical study aimed to evaluate particular preoperative and intraoperative tooth related aspects as potential predictors of retrograde obturation. Patients who were referred for periapical surgery of 45 teeth with chronic periapical inflammation associated with endodontic treatment were included in this study. Preoperative radiographs were evaluated for quality and extent of the canal obturation, as well as root and canal morphology. During periapical surgery, using visual enhancement, the following intraoperative aspects were evaluated: resected root surfaces, root contour, canal morphology, presence of iatrogenic mistakes, canal obturation in relation to retrograde obturation. The preoperative results showed prevalence of inadequate canal obturation (91,1%) in teeth with one root and one canal structure (93,3%). The intraoperative evaluation demonstrated prevalence of oval root surfaces (74,0%) with unobturated one canal structure (70,8%). Where obturation was present, leaking was detected (28,6%). Such findings undoubtedly pointed in favor of retro preparation. Preoperative evaluation of canal obturation in conjunction with intraoperative examination under visual enchantment of resected root surface confirmed the need for retrograde obturation. Therefore periapical surgery of teeth with periapical inflammatory lesions associated with canal treatment should include retrograde obturation thus primary goals are accomplished.


Keywords:  periapical surgery, chronic periapical inflammation, retrograde obturation, canal obturation, radiography, root and canal morphology, resected root surface.


https://doi.org/10.55302/JMS2251132k

References

1. Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique. J Endod 2006;32: 412– 6.
2. Gutmann JL, Harrison JW. Surgical endodontics, 1st ed. Cambridge: Blackwell Scientific Publications, 1991;216 –30.
3. Wadhwani KK, Garg A. Healing of soft tissue after different types of flap designs used in periapical surgery. Indian Endod J. 2004; 16: 19-22.
4. Chong BS, Rhodes JS. Endodontic surgery. Br Dent J. 2014; 216: 281-90.
5. Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. Journal of Endodontics 2006;32:601-23.
6. Watts JD, Holt DM, Beeson TJ, Kirkpatrick TC, Rutledge RE. Effects of pH and mixing agents on the temporal setting of tooth colored and gray mineral trioxide aggregate. J Endod. 2007; 33 (8): 970-973.
7. Hirsch JM, Ahlstrom U, Henrikson PA, Heyden G, Peterson LE. Periapical surgery. Int J Oral Surg 1979; 8: 173–85.
8. Friedman S, Lustmann J, Shaharabany V. Treatment results of apical surgery in premolar and molar teeth. J Endod 1991; 17: 30–3.
9. Rapp EL, Brown CE Jr, Newton CW. An analysis of success and failure of apicoectomies. J Endod 1991; 17: 508– 12.
10. August DS. Long-term, postsurgical results on teeth with periapical radiolucencies. J Endod 1996; 22: 380–3.
11. Von Arx T, Hardt G & N: Periradicular Surgery of molars: A prospective clinical study with a one – year follow up. International Endodontic Journal 2001:34;520-525 .
12. Kratchman S. I: Endodontic Microsurgery. Compendium of continuing education in dentistry 2007:25;20-26
13. Abedi HR, van Mierlo BL, Wilder-Smith P, Torabinejad M: Effects of ultrasonic root end cavity preparation on the root apex. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 1995;80,207-13.
14. M.A Hungaro Duarte, A Locci, I Tanomaru, M Filh. Apical gaps after apicoectomy procedures performed on teeth filled with gutta-percha or Resilon. (2009) Braz J Oral Sci. 8(3):141-144.
15. Friedman S, Rotstein I, Koren L, Trope: Dye leakage in retrofilled dog teeth and its correlation with radiographic healing. J Endod 1991;17:392-5.
16. Khabbaz MG, Protogerou E, Douka E. Radiographic quality of root fillings performed by undergraduate students. Int Endod J 2010;43:499-508.
17. Yasin-Ertem S, Altay H, Hasanoglu-Erbasar N. The evaluation of apicectomy without retrograde filling in terms of lesion size localization and approximation to the anatomic structures. Med Oral Patol Oral Cir Bucal. 2019 Mar 1;24 (2):e265-70.
18. Bumberger U, Kunde V, Hoffmeister B, Statistische Erhebungen zu 9446 Wurzelspitzenresektionen, Dtsc. Zahnärztl Z. 1987;42:224-5.
19. Taylor GN, Bump R. Endodontic considerations associated with periapical surgery. Oral Surg Oral Med Oral Pathol.1984; 58: 450-5.
20. Chong, B.S., Pitt Ford, T.R., and Kariyawasam, S.P. (1997) Tissue response to potential root-end filling materials in infected root canals. International Endodontic Journal 30: 102-114.
21. Frank C. Setzer and Bekir Karabucak. Essential endodontology: prevention and treatment of apical periodontitis. 3rd ed. Chapter 12. Surgical Endodontics, 2019.
22. Kim, S. and Kratchman, S. (2006) Modern endodontic surgery concepts and practice: a review. Journal of Endodontics 32: 601-623.
23. Gutmann JL, Pitt Ford TR. Management of the resected root end: a clinical review. Int Endod J 1993;26:273– 83.
24. Hsu YY, Kim S. The resected root surface. The issue of canal isthmuses. Dent Clin North Am 1997;41:529 – 40.
25. Carr GB. Microscope in endodontics. J Calif Dent Assoc 1992;20:55– 61.
26. Gutmann, J.L. Surgical endodontics: Past, present, and future. Endod. Top. 2014, 30, 29–43.
27. von Arx, T. Apical surgery: A review of current techniques and outcome. Saudi Dent. J. 2011, 23, 9–15.
28. Endal, U.; Shen, Y.; Ma, J.; Yang, Y.; Haapasalo, M. Evaluation of quality and preparation time of retrograde cavities in root canals filled with GuttaCore and cold lateral condensation technique. J. Endod. 2018, 44, 639–642.
29. Gutmann JL. Saunders WP. Nguyen L, Guo IY, Saunders EM. Ultrasonic root end preparation. Part 1. SEM analysis. Int Endod J. 1994: 27:318-324.
30. Cheung GS. Endodontic failure- changing the approach. Int Dent J.1996:46:131-138.
31. Hancock HH III, Sigurdsson A, Trope M, Moiseiwitsch J. Bacteria isolated after unsuccessful endodontic treatment in a North American population. Oral Surg Oral Med oral Radiol Endod 2001:91:579-586.
32. Pinheiro ET, Gomes BP, Ferraz CC, Teixeira FB, Zaia AA, Souza Filho FJ. Evaluation of root canal micro-organisms isolated from teeth with endodontic failure and their antimicrobial susceptibility. Oral Microbiol Immunol 2003:18:100-103.
33. Portnier I, Waltimo TMT, Haapasalo M, Enteroccocus faecalis – the root canal survivor and ‘star’ in post -treatment disease. Endodontic Topics 2003: 6: 135-159.
34. Engstro B. The significance of enterococci in root canal treatment. Odontol Revy 1964:15: 87-106.
35. Kratchman S. Intentional replantation. Dent Clin North Am 1997; 41(3):603–17
Published
2022-05-04
How to Cite
KACARSKA, Marina. PERIAPICAL SURGERY: THE ISSUE OF RETROGRADE OBTURATION. Journal of Morphological Sciences, [S.l.], v. 5, n. 1, p. 132-144, may 2022. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol5-no1-18>. Date accessed: 03 dec. 2022.
Section
Articles