Hemisection and root amputation
These procedures may be indicated if an adequatelyroot-filled molar has a periodontal furcation involvement, a vertical root fracture.
The lesion is managed by removing the involved root (and the overlying crown), and then sealing and preserving the remaining root and crown.
A full periodontal assessment is necessary before planning these procedures.
Other reasons for root resection include extensive resorption, root fracture or gross caries.
Root amputation followed by sealing of a tooth
Hemisection for vertical fractureIntentional replantation
The procedure involves extracting the tooth as a traumatically as possible.Performing conventional root resection and retro filling and then replanting the tooth.
This procedure is indicated if the root apices are close to an important anatomical structure, such as a mandibular molar with roots close to the inferior alveolar canal.
However, the tooth should be anatomically suitable for extraction (no root fusion) and without fracture of a root or excessive dilation of alveolar bone.
Corrective surgery
an iatrogenic defect in the surface of the root due to instrumentation can result in local infection , bleeding and inflammation, similar to a failure of apical sealing.Closure of lateral perforation
The position of the perforation is an important aspect in determining whether it is surgically accessible.parallax radiographs will help to determine the site.
Perforations in the apical third of the root may be handled by removal of the apex and sealing the canal with a retro filling. Ideally, perforations resulting from post crowns should have the offending post removed and a new one placed within the root canal.
If the perforation is directly on the mesial or distal aspect of the root, and particularly if the perforation is large or the roots are close together, access is so poor that a satisfactory result cannot be achieved.
However, such defects can sometimes be managed by conventional endodontics
Many perforations are now managed by internal perforation repair, precluding the need for surgery.
Closure of lateral perforation
These belong to four categories:
• Autografts: bone grafting involves utilizing bone obtained from the same individual receiving the graft. Autologous bone is typically harvested from intra-oral sources as the chin, mandibular symphysis, ramus, or maxillary tuberosity areas or extra-oral sources as the iliac crest, the fibula, the ribs,calvarium) .
2. Allografts: which are composed of tissues from another individual.
Bone Grafts3. Xenografts: Xenografts are derived from the inorganic portion of bone harvested from a species that is genetically different from the graft recipient, The most common source of xenografts is bovine bone
4. Alloplastic grafts: which are composed of synthetic bone substitutes, e.g., hydroxyapatite . phosphoric calcium ceramics, and oily calcium hydroxide in cream form
Complications of endodontic surgery
intraoperative• Bleeding ; can controlled by using local application of adrenaline pack , pressure pack, Gelfoam or surgical.
• Damage to the neighboring root.
• Entry into sinus/inferior alveolar canal, nasal cavity.
Postoperative
• Abscess formation.• Fenestration, sinus tract formation.
• Increased mobility of the tooth.
• Staining of the mucosa due to amalgam that remained at the surgical field.
Follow up for endodontic surgery :
Healing of the periapical area is checked every 6–12months radiographically, until ossification of the cavity is recognized.
In order to evaluate the result, a preoperative radiograph is necessary, which will be compared to the postoperative radiographs later.