Root End Surgery on Premolars
RETREATMENT of previously treated teeth is routinely performed in endodontic practices. Retreatment can be performed through a surgical or non-surgical approach. With the advent of surgical operating microscopes, surgical retreatment has a 95 percent success rate, and non-surgical retreatment has an 85 percent success rate.
There are restorative and anatomic limitations that have to be considered before choosing between the two approaches, and the patient has to be part of the decision-making process.
The following case shows two upper right pre-molars that were previously treated endodontically and had posts and crowns placed on them as final restoration (Figure 1). Both crowns had good marginal integrity without any detectable caries around the margins. Initial diagnosis of both teeth based on the result of pulp testing was: previously treated, symptomatic apical periodontitis.
After being given an explanation of the surgical and non-surgical approaches, the patient elected the surgical approach. Since the posts placed in the teeth were large, removing the posts through an occlusal access would most likely damage the crowns to the point that new crown fabrication would be necessary to insure sufficient coronal seal. This made the surgical approach more cost-effective and less time-consuming in this case.
Surgery was performed on both premolars in the same visit. Root ends were prepared using ultrasonic microsurgery jet tips. MTA was placed as an apical seal in all root ends using the MAP system under a surgical operating microscope. It was expected that each tooth would have one or two root ends, but, as is clearly visible on the post-operative radiograph (Figure 2), the upper right second premolar has three separate root ends, which could have been detected pre-operatively using a CBCT scan.
The following would not have been achievable without a microsurgical approach in this case:
- completing treatment in one visit
- preserving the existing crowns and posts
- limiting treatment cost
- limiting treatment time
- achieving a higher success rate
July - September 2013