Table Of ContentMicrosurgeryinEndodontics
Microsurgery in Endodontics
SyngcukKim,DDS,PhD,MD(Hon)
SamuelKratchman,DMD
AssociateEditors:
BekirKarabucak,DMD,MS
MeetuKohli,DMD
FrankSetzer,DMD,MS,PhD
Thiseditionfirstpublished2018
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LibraryofCongressCataloging-in-PublicationData
Names:Kim,Syngcuk,editor.|Kratchman,Samuel,editor.|Karabucak,Bekir,editor.|Kohli,Meetu,editor.|Setzer,Frank,editor.
Title:Microsurgeryinendodontics/editedbySyngcukKim,SamuelKratchman;associateeditors,BekirKarabucak,MeetuKohli,Frank
Setzer.
Description:Hoboken,NJ:Wiley,2018.|Includesbibliographicalreferencesandindex.|
Identifiers:LCCN2017026730(print)|LCCN2017028087(ebook)|ISBN9781119403654(pdf)|ISBN9781119403661(epub)|
ISBN9781118452998(cloth)
Subjects:|MESH:DentalPulpDiseases–surgery|Microsurgery–methods|Endodontics–methods
Classification:LCCRK351(ebook)|LCCRK351(print)|NLMWU230|DDC617.6/342–dc23
LCrecordavailableathttps://lccn.loc.gov/2017026730
CoverImages:(Mainandtopinsetimages)CourtesyofDrs.SyngcukKimandSamuelKratchman;(Leftinsetimage)Courtesyof
Dr.KanameYokota;(Rightinsetimage)CourtesyofDr.GarrettGuess
CoverdesignbyWiley
Setin10/12ptWarnockProbyAptaraInc.,NewDelhi,India
10 9 8 7 6 5 4 3 2 1
This book is dedicated to our “PENN ENDO FAMILY”; those
who were educated at Penn. Without their dedication and
practice in their schools and offices this field would not be
what it is today!
vii
Contents
Contributors xiii
Preface xv
Acknowledgements xvii
TheDentalOperatingMicroscope 1
FrankSetzer
1.1 BenefitsoftheOperatingMicroscope 1
1.2 KeyFeaturesofOperatingMicroscopes 1
1.3 CustomizingaMicroscope 3
1.3.1 LightSource 3
1.3.2 Documentation 5
1.3.3 IndividualMicroscopeAdjustment(Parfocaling) 5
SuggestedReadings 7
MicrosurgicalInstruments 9
SeungHoBaekandSyngcukKim
2.1 ExaminationInstruments 9
2.2 IncisionandElevationInstrument 9
2.3 TissueRetractionInstruments 11
2.4 OsteotomyInstruments 14
2.5 CurettageInstruments 14
2.6 InspectionInstruments 15
2.7 UltrasonicUnitsandTipsforRootEndPreparation 17
2.8 MicropluggerInstruments 20
2.9 SuturingInstruments 20
2.10 MiscellaneousInstruments 22
Medication-RelatedOsteonecrosisoftheJawandEndodonticMicrosurgery 25
ChaficSafiandBekirKarabucak
SuggestedReadings 29
IndicationsandContraindications 31
BekirKarabucakandGarrettGuess
4.1 Introduction 31
4.2 SurgicalSuccessDependentonAbilitytoPerformIdealProtocols 31
4.3 EtiologyAssessmentthroughExaminationandTreatment 31
4.4 PeriodontalConsiderationsandSurgery 33
4.5 InfluentialPatientFactors 33
4.6 ConditionofPreviousEndodonticTreatment 37
SuggestedReadings 38
viii Contents
AnesthesiaandHemostasis 39
SivaRethnam-Haug,AleksanderIofin,andSyngcukKim
5.1 Armamentarium 39
5.1.1 Epinephrine 39
5.2 PresurgicalPhase 40
5.2.1 AdministrationofLocalAnesthetic 40
5.2.2 InjectionTechniques 40
5.2.3 TopicalAnesthesia 41
5.2.4 AdditionalTechniques 41
5.2.5 MaxillaryAnesthesia 41
5.2.6 MandibularAnesthesia 43
5.2.7 BilateralMandibularSurgery 43
5.3 SurgicalPhase 44
5.3.1 TopicalHemostaticAgents 44
5.3.1.1 EpinephrinePellets 45
5.3.1.2 FerricSulfate 45
5.4 SummaryofHemostaticTechniquesinEndodonticMicrosurgery 46
5.5 PostsurgicalPhase 46
SuggestedReadings 48
FlapDesigninEndodonticMicrosurgery 49
FrancescoMaggioreandFrankSetzer
6.1 Armamentarium 49
6.1.1 FlapOutline 49
6.1.2 PapillaManagement 52
6.1.3 Incision 54
6.1.4 FlapElevation 54
6.1.5 FlapRetraction 55
SuggestedReadings 56
Osteotomy 57
FrancescoMaggioreandSyngcukKim
7.1 Armamentarium 57
7.2 Osteotomy 57
7.2.1 DistinctionbetweenBoneandRootTip 57
7.2.2 ClinicalSituationsforEndodonticMicrosurgery 58
7.3 IntactCorticalPlatewithoutaRadiographicPeriapicalLesion 59
7.4 IntactCorticalPlatewithaPeriapicalLesion 60
7.5 FenestrationthroughtheCorticalPlateLeadingtotheApex 60
7.5.1 OptimalOsteotomySize 61
7.5.2 KeyHoleOsteotomyModification 61
7.5.3 BoneWindowTechnique 61
RootEndResection 67
SpyrosFloratos,FouadAl-Malki,andSyngcukKim
8.1 Armamentarium 67
8.2 RootEndResection 67
8.3 RootEndResection:SteepBevelversusShallowBevel 69
SuggestedReadings 72
InspectionoftheResectedRootSurface:ImportanceofIsthmus 73
SpyrosFloratos,JorgeVera,FouadAl-Malki,andSyngcukKim
9.1 Armamentarium 73
9.1.1 MethyleneBlueStaining(MBS) 73
Contents ix
9.1.2 Isthmus 77
9.1.3 TypesofIsthmus 77
9.1.4 Incidence 77
9.1.5 HistologicalFindingsofIsthmus 79
9.1.6 ClinicalSignificanceandManagement 81
SuggestedReadings 82
UltrasonicRootEndPreparation 83
SpyrosFloratosandSyngcukKim
10.1 Armamentarium 83
SuggestedReadings 89
MTAandBioceramicRootEndFillingMaterials 91
SujungShin,IanChen,BekirKarabucak,SeungHoBaek,andSyngcukKim
11.1 MineralTrioxideAggregate(MTA) 92
11.1.1 AdvantagesofMTA 92
11.1.1.1 SealingAbility 92
11.1.1.2 BiocompatibilityandBioactivity 92
11.1.2 DrawbacksofMTA 93
11.2 Bioceramics 93
11.3 MTAandBioceramicApplicationDuringApicoectomy 95
11.4 OtherTypesofCementsforRootEndFilling 96
11.4.1 IntermediateRestorativeMaterial(IRM) 97
11.4.2 SuperEthoxybenzoicAcid(SuperEBA) 97
11.4.3 GeristoreandRetroplast 98
11.4.4 NewTypesofCementsforRootEndFilling 98
SuggestedReadings 98
FlapRepositionandSuturing 101
FrancescoMaggioreandMeetuKohli
12.1 SutureRemoval 101
SuggestedReadings 111
PeriapicalWoundHealing 113
IngridaDapkute,GeorgesBandelac,ChaficSafi,andFrankSetzer
13.1 PrinciplesofWoundHealing 113
13.2 HealingafterApicalMicrosurgery 113
13.3 IncompleteHealing/ScarFormation 113
13.4 EvaluationofHealingafterApicalSurgery 114
13.5 HealingEvaluationUsingCBCT 115
SuggestedReadings 118
ConeBeamComputedTomography 119
GarrettGuess,FouadAl-Malki,MeetuKohli,BekirKarabucak,andSamuelKratchman
14.1 HowCBCTWorks 120
14.2 IndicationsandClinicalApplications 120
SuggestedReadings 142
MentalNerveManagement 143
PaulaMendez-Montalvo,FouadAl-Malki,andSyngcukKim
15.1 Armamentarium 143
15.1.1 MentalForamenandNerve 143
15.1.1.1 Location 143
15.1.1.2 AnteriorLoop 143
x Contents
15.1.1.3 NumberofMentalForamina 144
15.1.2 MentalForamenDetectiononRadiographs 144
15.1.2.1 PeriapicalRadiograph 144
15.1.2.2 PanoramicFilms 145
15.1.2.3 ConeBeamComputedTomography(CBCT) 145
15.1.3 NeurosensoryAlteration 145
15.1.3.1 SurgicalTechniquetoAvoidIatrogenicMentalNerveTraumaandInjury 146
15.1.4 GrooveTechniqueUsingPiezoelectricSurgery 146
SuggestedReadings 150
MaxillaryPosteriorSurgery,theSinus,andManagingPalatalAccess 151
GarrettGuessandSamuelKratchman
16.1 MaxillaryPremolars 151
16.1.1 Access 151
16.1.2 Instrumentation 151
16.2 SinusExposure 151
16.3 MaxillaryFirstMolars 153
16.3.1 Access 153
16.3.2 PalatalApproach 155
16.4 SecondMolars 159
16.4.1 PeriodontalAspects 161
SuggestedReadings 162
SurgicalRootPerforationRepair 163
RaedKasem,SamuelKratchman,andMeetuKohli
17.1 PossibleChallengestoNon-surgicalPerforationRepair 163
17.2 FactorsthatEnhancePositiveLong-TermPrognosisforPerforationRepair 164
17.3 SurgicalPerforationRepairTechniques 166
17.4 SurgicalTreatmentforExternalRootResorption 168
SuggestedReadings 177
IntentionalReplantation 179
DavidLiandSamuelKratchman
18.1 Armamentarium 179
18.1.1 SuccessRate 179
18.1.2 Indications 179
18.1.3 ReplantationorApicoectomy 179
18.1.4 Extraction 182
18.1.5 ExtraoralPhase 183
18.1.6 StorageMedium 183
18.1.7 Replantation 183
18.1.8 Splinting 185
18.1.9 PostopInstructions 186
18.1.10 ConeBeamCTScan 186
18.1.11 RepairingProceduralMishaps 186
SuggestedReadings 191
GuidedTissueRegenerationinEndodonticMicrosurgery 193
GarrettGuessandSamuelKratchman
SuggestedReadings 202
ImplantsversusEndodonticMicrosurgery 205
FrankSetzerandSyngcukKim
20.1 HistoricalPerspective 205
20.2 BenefitsofImplants 205
Contents xi
20.3 Long-TermPrognosisofDentalImplants 205
20.4 ImplantComplications 206
20.5 Long-TermPrognosisofEndodonticallyTreatedTeethwithRootEndSurgery 207
20.6 Conclusion 209
SuggestedReadings 210
PrognosisofEndodonticMicrosurgery 213
MeetuKohliandEuiseongKim
21.1 BestAvailableEvidence 213
21.2 ParametersforSuccess:ClinicalandRadiographic2D 214
21.3 ParametersforSuccess:“Penn3DCriteria”forAssessingHealingonCBCT 215
21.4 ReversalofSuccess 215
21.5 TraditionalMethods 217
21.6 ModernTechniqueversustheCompleteMicrosurgicalApproach 218
21.7 RootEndFillingMaterials 218
21.8 CaseSelection 219
21.9 Resurgery 219
21.10 Summary 219
SuggestedReadings 219
Positioning 221
SamuelKratchmanandSyngcukKim
22.1 Armamentarium 221
SuggestedReadings 226
Index 227
xiii
Contributors
FouadAl-Maki,DDS AleksanderIofin,DMD
EndodonticResident ClinicalAssistantProfessorofEndodontics
DepartmentofEndodontics DepartmentofEndodontics
SchoolofDentalMedicine CollegeofDentalMedicine
UniversityofPennsylvania ColumbiaUniversity
Philadelphia,PA,USA AdjunctClinicalAssistantProfessorofEndodontics
DepartmentofEndodontics
SeungHoBaek,DDS,MSD,PhD SchoolofDentalMedicine
Professor/ChairmanEmeritus UniversityofPennsylvania
DepartmentofConservativeDentistry Philadelphia,PA,USA
SchoolofDentistry PrivatePractice:NewYork,NY
SeoulNationalUniversity,SouthKorea
BekirKarabucak,DMD,MS
GeorgesBandelac,DDS,MS ChairandAssociateProfessorofEndodontics
DiplomatAmericanBoardPeriodontology Director,PostdoctoralEndodonticsProgram
DepartmentofEndodontics
IanChen,DDS,MS SchoolofDentalMedicine
LecturerSchoolofDentistry UniversityofPennsylvania
NationalYang-MingUniversity Philadelphia,PA,USA
AdjunctClinicalInstructor
DepartmentofDentistry RaedKasem,DDS,MS
NationalTaiwanUniversityHospital AdjunctAssistantProfessor
PrivatePractice:Taipei,Taiwan DepartmentofEndodontics
SchoolofDentalMedicine
IngridaDapkute,DMD,MS UniversityofPennsylvania
PrivatePractice:Landsdale,PA Philadelphia,PA,USA
PrivatePractice:Clearwater,Trinity,Tampa,FL
SpyrosFloratos,DMD
AdjunctAssistantProfessor EuiseongKim,DDS,MSD,PhD
DepartmentofEndodontics ProfessorandChairman
SchoolofDentalMedicine ViceDeanforGraduateAffairs
UniversityofPennsylvania Director,OralScienceResearchInstitute
Philadelphia,PA,USA DepartmentofConservativeDentistry
PrivatePractice:Athens,Greece CollegeofDentistry
YonseiUniversity,Korea
GarrettGuess,DDS
AdjunctAssistantProfessor SyngcukKim,DDS,PhD,MD(Hon)
DepartmentofEndodontics LouisI.GrossmanProfessorandChairman
SchoolofDentalMedicine DepartmentofEndodontics
UniversityofPennsylvania AssociateDeanofGlobalAffairs
Philadelphia,PA,USA AssociateDeanforAdvancedDentalEducation
DiplomateAmericanBoardofEndodontics SchoolofDentalMedicine
PrivatePractice:SanDiego,California UniversityofPennsylvania
Philadelphia,PA,USA
