Monday, November 24, 2008

Endodontic Surgery in the Esthetic Zone

One of the big challenges with dental implants is working in the esthetic zone (anterior maxilla). Crestal bone loss, which often occurs with dental implants, can lead to loss of gingival papilla. Loss of the papilla will lead to dark triangles and long clinical crowns. In an areas as esthetically sensitive as the maxillary anterior, loss of crestal bone can become a big challenge.

Endodontic microsurgery may allow you to save a natural tooth and preserve the crestal bone. Since endodontic surgery is an advanced technique taught in specialty residencies, many dentists are not as familiar with the possibilities of endodontic surgery. In addition, the advancement of surgical techniques and instruments have completely changed the endodontic surgical technique and it's outcomes.

The following case is an example of endodontic microsurgery.

Pt presents with a draining sinus tract on #10. A periapical radiolucency is noted. While pt reports the RCT was completed "eons ago", the post and crown are only a year old. The silver cone obturation, while past the apex, has served this patient well for many years. Options were discussed and the patient elected to have endodontic surgery.

An Ochsenbein-Luebke flap was used to help preserve the marginal gingiva. The silver point was removed and the canal was retrofilled with MTA (Mineral Trioxide Aggregate).

Post-op radiograph

3 month recall finds complete function, significant radiographic healing & preservation of the crestal bone.


Anonymous said...

Nice result with the MTA. Is the patient aware of the impending restorative failure?

The Endo Blog said...

The patient has been referred back to the general dentist for maintenence and preventative care.

During treatment planning, it was decided that removed of the extruded silver point would have to be surgically.

As mentioned, since the crown was done within the last year, the referring dentist and patient will need to come to an agreement about when to replace the crown.

You are correct that restorative situation will need to be addressed for long term success.

Joshua Austin, DDS said...

That is a great result. You are correct...many of us underestimate the possibilities of endo surgery. Thanks for sharing!