Periapical surgery

 The objective of apical surgery is to surgically maintain a tooth that has an endodontic lesion which cannot be resolved by conventional endodontic (re-)treatment (von Arx 2005). The evaluation of a case referred for apical surgery must always include a careful weighing of the advantages and disadvantages of surgical and non-surgical intervention, i.e., the possibility of a conventional root-canal (re-) treatment should be considered as a therapeutic option

In the present case surgery was done on lower anterior teeth. 

Tissue reflection should begin from the vertical releasing incision at the junction of the submucosa and the attached gingiva. After the tissue is reflected, it must be retracted to provide adequate access for bone removal and root-end procedures. Removal of cortical bone to expose the root apex. currettage os done to remove cyst and lining.

 

The root has a darker, yellowish color and is hard, whereas the bone is white, soft, and bleeds when scrapped with a probe. 

Resection of apical 3mm of root apex will eliminate 98% of apical ramifications and 93% of lateral canals which could contain material that could contribute to periradicular disease (Kim , JOE 2006; De Deus, 1975; Seltzer, 1966).

Retro-preparation of 3mm is done and biodentin is placed and flap is replaced and sutured.

On further follow up a good healing was observed