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Acta Scientific DENTAL SCIENCES (ISSN: 2581-4893)

Apical Surgery: New Concepts

Younes Kalakhy

Oral Surgery Department, Targa Dental Clinic, Marrakech City, Kingdom of Morocco*Corresponding Author: Younes Kalakhy, Oral Surgery Department, Targa Dental Clinic, Marrakech City, Kingdom of Morocco.

Abstract

Apical surgery is a technique developed for the surgical treatment of apical lesions of pulpal origin, some authors speak of surgical endodontics or endodontic surgery.The surgical protocol consists of the surgical approach of the periapical region, tissue debridement and removal of granulation or cystic tissue and then proceed to the resection of the root apex and finish by filling the apex with a material ensuring apical hermetic-ity, we speak of retrograde filling. This technique has seen a lot of improvement especially with a new generation of materials such as MTA (Mineral trioxide aggre-gate) and bioceramics as well as the advent of piezosurgery and the operating microscope In this paper , we will focus on the defini-tion, indications, contraindications as well as the principle and the surgical protocol.

Keywords : Apical Surgery; Periapical Pathology; Retrograde Filling; Flap Design; Resection Angle; MTA

Introduction

Apical surgery is a technique developed for the surgical treat-ment of apical lesions of pulpal origin, some authors speak of sur-gical endodontics or endodontic surgery.The surgical protocol consists of the surgical approach of the periapical region, tissue debridement and removal of granulation or cystic tissue and then proceed to the resection of the root apex and finish by filling the apex with a material ensuring apical her-meticity, we speak of retrograde filling [26].This protocol is currently well codified with a success rate that has been significantly improved by the evolution of root end filling materials such as Mineral trioxide aggregate (MTA) and the use of piezo surgery. The success rate has increased from at least 60% to currently 90% [3,40]. However, apical surgery is not considered as an alternative to conventional root canal treatment, which should always be considered as the first-line treatment.

Periapical pathology [1-20]

Periapical pathologies are of endodontic origin in a large major-ity of cases, where pulpal necrosis will provoke a passage of the bacterial flora to the periapical space which will trigger a cascade of immunopathological reactions favored by a rich periapical vas-cularization as opposed to the pulpal space.The apical lesions go through different phases from a slightly symptomatic primary inflammation to a more important clinical manifestation with a consequent bone resorption. Studies have shown that the periapical immune response involves different non-specific and specific immunological mechanisms to contain and neutralize pathogens orchestrated by numerous chemical me-diators such as: neuropeptides, fibrinolytic agents, kinins, comple-ment, kallikrein, mast cells and specific mediators such as immuno-globulins, B and T lymphocytes, macrophages.

According to stages, Physiopathological, clinical and histological characteristics, Morse in 1977 [1] propose a classification of peri-apical pathologies:

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