surgery San Anton 2018 boards review copy

114 Pages·2017·17.07 MB·English

University of Pennsylvania

Samuel Kratchman, DMD

Department of Endodontics

and
Microscope Training Center
School of Dental Medicine
Saving Teeth! Saving Teeth!
+90%
Conventional
Treatment
Endodontic
Therapy
Nonsurgical Surgical
Retreatment Retreatment
+80% ?
35 year history of implants
1980: Implants land in the USA and a Trying Period of acceptance
1990: EXPLOSION-implants solve all dental problems. Extract/Implant!!
2000: Extract and Implants continue with irrational exuberance
2010: It is not what it is cracked up to be…start to think! Peri-implantitis
2015: Critical Analysis of Per-implantitis…call to action to save teeth
2015: Systematic review shows peri-implant mucositis and peri-implantitis
ranges from 19%-65%
(Derks and Tomsai)
Conclusion: Teeth even compromised because of periodontal disease or
endodontic problems may have a longevity that surpasses BY FAR that of
the average implant.
(Salvi et al, 2014, Klinge et al, 2015)
Misch et al., Implant Dentistry, 2008
Dr Kim
Dr. W. Giannobile and N.P.Lang; Journal Dental Research, 2016
13,000 year follow up!!
Periradicular surgery, no matter how
sophisticated or advanced, is NOT a
substitute for conventional endodontics.
Anatomical Tables – W. Hess 1917
Why does nonsurgical treatment keep failing?
ENDO > 20 Years ago
?? Failing
Periapical Pathology
Nair, 1996, 2004
Periapical Pathology
Abscess 12%
Granuloma 73%
True Cyst 9%
Pocket Cyst 6%
According to Dr. J. Simon during the USC Conference in
2008:
24% of periapical radiolucencies are cysts which do NOT
respond to root canal therapy but need surgical intervention
along with RCT
Periapical Pathology
Pocket Cyst True Cyst
Continuity with the RC Self-sustained
6% 9%
Nair PNR Int End J 1998
An inflammatory apical cyst is a pathologic cavity in an area of apical periodontitis
lesion, and is lined by non-keratinized stratified squamous ephithelium
Radicular Cysts
Cystic cavities lined by Lumen surrounding
epithelium epithelial strands
accompanied
by granulomatous tissue

H&E, original X325 X350, inset 31000 X 31000
The epithelial lining of radicular cysts is
Accumulation of foam cells
thought to arise from epithelial cell rests of
and scattered PMNs
Malassez
Riccuci et al, OOOE, 2006
Cone Beam Computer Tomography
n = 17
Detection of liquid content in cystic cavity Histology after biopsy
13 / 17 lesions had same
diagnosis by CBCT and
biopsy
76 %
in agreement
Simon et al. J Endod 2006
Rosenberg J Endod 2010: Must biopsy/histology; dont depend CBCT
Bornstein J Endod 2015: PA films overestimated cysts 20.7%, CBCT overestimated 28.4%