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Endo tips    Better Endo    Endo abstracts    Endo discussions

Surgical Resorption Repair - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Saturday, August 28, 2010 6:11 AM
Subject: [roots] Surgical Resorption Repair

Hereís an 83 year old guy I treated only internally for the ECIR in 1997.  
Ií'd call it a Type 3 Heithersay because it has tentacles extending apically 
but seems to be limited to the lingual aspect.  Iíve had limited success with
Type 3 and Type 4ís and usually start out only treating them internally if 
there is no detectable crater communicating periodontally.  If a crater is 
detected I do the surgery in addition to the endo, treating it internally 
and externally trying to cauterize and eliminate as many circulatory feeders 
as possible.  -  Terry

These are what I view to be very key management steps in these cases:

1. CBCT mapping to determine whether there is surgical access and the amount 
of osseous access required.    The transverse sections are invaluable.  
If the resorption wraps around the mesial and distal surfaces
   forget it; the root will be too weakened after the prep and too much 
   bone required for tissue support    will end up being removed.  
   An implant is a better plan.

2. Make a long sulcular incision at least a full tooth away from the tooth 
   to be treated (if necessary for    limited jaw opening go 2 teeth over). 
   Avoid release incisions on the lingual, you donít need them anteriorly.

3.Indentify the entire margins of the defect and free them of invading
  bone/granulation tissue.  If you canít clear the margins of invading bone 
  or granulation tissue treatment is going to fail.  I use a surgical length
  flame tip diamond for the gross bone removal creating at least 1 mm of 
  clean smoothed attachment free dentin   around the entire prep margin.  
  I perform the final smoothing/dentin clearing with a surgical length flame
  tip composite finishing bur.

4.The prep is treated with trichloracetic acid, rinsed with Peridex, then 
  etched with Citric Acid, then rinsed again with Peridex.

5.If necessary you can isolate the prep with Dycal, but in this case 
I didn'ít need to because the hemostasis was excellent.  I then mix Geristore 
in a needle tip Centrix tube and inject into the prep, in layers if possible
to prevent shrinkage away from the margins.

6.I contour the restoration with a flame tip diamond and cut way the excess 


7.Standard interrupted suturing.  If you donít use release incisions suturing 
is simple, the healing is predictable, and you can predictably see re-attachment 
(junctional epithelial) within a month.   I typically schedule a one month
post-surgical appt. to see how the site heals and will lightly probe to see 
if attachment is forming.

Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Lateral incisor
Churning irrigant
Cold lateral
Tipped to lingual
Acute pulpitis images

Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
Acute apical abcess
Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves