Endodontics | Surgical Treatment | INBDE, ADAT — Transcript

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1. 0:00hey everyone Ryan here and welcome back
2. 0:02to our series on endodontics like all my
3. 0:06videos I'm gonna be focusing only on the
4. 0:08highest yield topics and now that we've
5. 0:10talked about non-surgical endodontic
6. 0:12treatment namely root canal therapy
7. 0:15naturally we can talk next about
8. 0:17surgical endodontic treatment all right
9. 0:23so from an endodontic treatment planning
10. 0:25perspective we have basically three
11. 0:27options our first option is conventional
12. 0:31root canal treatment that we talked
13. 0:34about in the last video and this is
14. 0:36ortho grade when I mean ortho grade I
15. 0:39mean it's done in the normal direction
16. 0:42accessing the root canal from the
17. 0:45coronal aspect of the tooth next we have
18. 0:49endodontic re treatment and this
19. 0:52involves re accessing the canal removing
20. 0:55all the root canal materials in the
21. 0:58canal re instrumenting it and finally
22. 1:01refilling it and our third treatment
23. 1:04option is surgical root canal treatment
24. 1:07and that's when there is a persistent
25. 1:09infection around the apex of the tooth
26. 1:12and it involves enlarging and osseous
27. 1:15window with a ver removing that infected
28. 1:18tissue cutting off the root tip
29. 1:20instrumenting in a root and retrograde
30. 1:23direction and filling in the tip of the
31. 1:26canal all things you can look forward to
32. 1:28us talking about in this video
33. 1:32so root canal treatment is the first
34. 1:35treatment option for irreversible
35. 1:37pulpitis poplu necrosis and or some
36. 1:41epical diseases all of those diagnosis
37. 1:44classifications we talked about in the
38. 1:46second video of this series so if that's
39. 1:50our first treatment option these two are
40. 1:53our backups and they're things that we
41. 1:55do if the root canal treatment is a
42. 1:58failure so you would retreat if the root
43. 2:02canal treatment fails and the problem is
44. 2:04in the canal surgical root canal
45. 2:08treatment otherwise known as micro
46. 2:10surgery is done if the root canal
47. 2:12treatment fail
48. 2:13and the problem is at or just outside
49. 2:17the apex so root canal treatment is our
50. 2:21go-to and these second two are our
51. 2:24options if the first one fails and the
52. 2:27decision about which one to do is based
53. 2:30on where the problem originates all
54. 2:36right so let's talk about incision and
55. 2:38drainage which is an important procedure
56. 2:41in the surgical world so this procedure
57. 2:44involves a surgical opening in soft
58. 2:47tissue to release exudate and pressure
59. 2:50and it's best for localized and
60. 2:53fluctuate swellings one like in this
61. 2:57image here there's a flexural mass
62. 3:00filled presumably with pus and
63. 3:02granulation tissue and it's involving
64. 3:05the soft tissue and so the operator is
65. 3:07taking a blade looks to be a number 11
66. 3:10blade and is performing an incision and
67. 3:14allowing that exudate and build-up to
68. 3:17drain out and so in this image the
69. 3:21operator is using a hemostat to grab and
70. 3:23tug out that granulation tissue to
71. 3:26achieve a drain from the source of
72. 3:29infection and you can actually place a
73. 3:32drain of some surge of some surgical
74. 3:35sterilized material to allow for that
75. 3:38pressure build-up to leak out over time
76. 3:41so incision and drainage is done in soft
77. 3:44tissue now there's a very similar
78. 3:46procedure and it's called trephination
79. 3:48and that's where a surgical opening is
80. 3:51made into hard tissue into bone to again
81. 3:54to release exudate and pressure so for
82. 3:58the board exams
83. 3:58remember incision and drainage is
84. 4:00pertinent to soft tissue whereas
85. 4:03trephination is a word regarding hard
86. 4:06tissue same process just involving
87. 4:08drilling into bone alright so finally we
88. 4:13have periapical microsurgery which is a
89. 4:17technical term for the complete surgical
90. 4:19endodontic treatment process so in
91. 4:24conventional root canal treatment our
92. 4:26goal was to
93. 4:28access the Pope space from the coronal
94. 4:30aspect of the tooth creating an access
95. 4:33preparation and then instrumenting and
96. 4:35finally sealing the canal through that
97. 4:37access opening and in a surgical root
98. 4:41canal treatment the approach is the
99. 4:44exact opposite
100. 4:46now we're achieving access through the
101. 4:48bone by the apex of the tooth and
102. 4:51accessing and instrumenting and finally
103. 4:54sealing this through that apical access
104. 4:57note that for this procedure the coronal
105. 5:00aspect is already sealed so it's already
106. 5:03had an ortho grade root canal treatment
107. 5:05done with gutta-percha and sealer and a
108. 5:08restoration on top and now we're aiming
109. 5:11to attain a better seal apical e so
110. 5:15after the patient is sufficiently
111. 5:17anesthetized we start by opening a soft
112. 5:20tissue flap and drilling through the
113. 5:23bone if you're choosing to perform this
114. 5:25treatment there probably is some apical
115. 5:28infection here so this is a great
116. 5:30opportunity to clean that out as we
117. 5:32talked about basically like the treffen
118. 5:35trephination stage then you resect three
119. 5:40millimeters of diseased root tip which
120. 5:43you can see embedded in this infected
121. 5:46tissue that process of root end
122. 5:50resection is known as a picot ectomy so
123. 5:55a picot ectomy is often used to describe
124. 5:58this whole process but apical ectodermal
125. 6:09microsurgery so removing three
126. 6:14millimeters of root tip is the most
127. 6:16important thing to remember and the
128. 6:18second most important thing to remember
129. 6:20is concerning the angle or the bevel at
130. 6:23which you cut off that root tip so I'm
131. 6:26going to jump ahead to the next step for
132. 6:28a second the conventional way to
133. 6:31instrument the canal and instrument the
134. 6:35canal once the root tip is section would
135. 6:37be with a round bur and that would
136. 6:39require a 45 degree
137. 6:42Bevell but the problem is the steeper
138. 6:44the angle the greater the chance of
139. 6:46leakage which is exactly what we're
140. 6:48trying to avoid so modern micro surgical
141. 6:52technique involves using an ultrasonic
142. 6:55tip to instrument the canal and we can
143. 6:59now use a much shallower bevel so zero
144. 7:03to ten degrees is ideal and about what
145. 7:06you're seeing in this image here so
146. 7:10after cutting off the root tip at a
147. 7:12shallow bevel you instrument the canal
148. 7:15in a retrograde fashion with an
149. 7:17ultrasonic instrument and you prepare
150. 7:20three millimeters of root end so it's
151. 7:24nice and easy to remember you have three
152. 7:26millimeters of root tip that you're
153. 7:28cutting off and then what you're left
154. 7:30with you instrument three millimeters
155. 7:32into that root end and finally you retro
156. 7:37fill with an excellent biocompatible
157. 7:40material known as mineral trioxide
158. 7:43aggregate or MTA for short so that's
159. 7:48what you see here as the root end the
160. 7:50filling and then you suture the soft
161. 7:53tissue and allow the bone to heal and
162. 7:56now you have a root canal system that's
163. 7:59ideally sealed from both an ortho grid
164. 8:02or a coronal direction and retrograde or
165. 8:05apical direction so pretty cool right so
166. 8:10the ultimate hope is that kill as many
167. 8:12bacteria as possible and starve the ones
168. 8:15that are left over by sealing the canal
169. 8:18system completely alright everyone so
170. 8:23that's it for this video I hope you
171. 8:25found it helpful and interesting if you
172. 8:27did please leave a like subscribe to my
173. 8:30channel if you haven't already for more
174. 8:32on endodontics and all things dentistry
175. 8:35thanks so much for watching everyone and
176. 8:37I'll see you all in the next video