Subject

Aplical Surgery

  • code 12279
  • course 2
  • term Anual
  • type OB
  • credits 1

Main language of instruction: English

Other languages of instruction: Catalan, Spanish,

Teaching staff

Head instructor

Dr. Gonzalo GÓMEZ - gomezgonzalo@uic.es

Office hours

Dr. Gonzalo Gomez - gomezgonzalo@uic.es

MSc Kala Morales - kalamorales@uic.es

Introduction

This subject makes an in-depth study of the surgical management of periapical pathologies. In addition to reading papers from endodontic microsurgery literature (ranging from classic to contemporary papers), which they present and discuss in class, students examine cases of apical microsurgery, guided bone regeneration, autotransplantation and reimplantation.

Pre-course requirements

No previous requirements

Objectives

The teaching outcomes aim to acquaint the student with:

The definition and history of endodontic microsurgery.


The differences between traditional surgery and endodontic microsurgery.


The indications and contraindications of endodontic microsurgery.


Pre-surgical considerations.


The microanatomy of hard and soft tissues.


Root apex management.


The structural changes in the root surface caused by age.


The instruments used in endodontic surgery.


The main features of the microscope.


The different positions to adopt during treatment.


Step-by-step planning of microsurgery: from flap design to suturing.


Retrograde filling materials.


The treatment of bone defects.


The indications and contraindications of intentional reimplantation.


The biological perspectives and the prognosis of intentional reimplantation.


The technique of intentional reimplantation.


Planning treatment with intentional reimplantation.


The indications and the contraindications of autotransplant.


The biological perspectives and the prognosis of autotransplant.


The autotransplant technique.


Autotransplant planning.


The indications and the contraindications of guided bone regeneration.


The biological perspectives and the prognosis of guided bone regeneration.


The technique of guided bone regeneration.


Planning guided bone regeneration treatment.

Competences / Learning outcomes of the degree programme

Students will be expected to:

Display a capacity for self-learning in the development of new instrumental techniques, in the acquisition of new scientific concepts, and in the search for new scientific information.

Become familiar with the general pathological features of the diseases and disorders that affect the organic systems, specifically those with oral repercussions.

Acquire learning skills that allow them to continue studying in a self-directed and autonomous way.

Possess and understand knowledge that provides a basis or opportunity to be original in the development and/or application of ideas in a research context.

Apply the acquired knowledge and develop their problem-solving capacity in new or little known environments within broader (or multidisciplinary) contexts related to their field of study

Communicate conclusions along with the knowledge and essential concepts that support them to specialized and non-specialized audiences in a clear and unambiguous way.

Be able to apply the appropriate diagnostic techniques and correctly interpret the results that derive from them.

Ability to integrate new knowledge gained through research and study, and to cope with complexity.

Possess and understand knowledge that provides a basis or opportunity to be original in the development and/or application of ideas, often in a research context.

Acquire the ability to perform endodontics and surgical treatments in a multidisciplinary way.

Make public presentations on their own clinical cases justifying themselves based on the scientific literature, correctly using the scientific terminology related to apical microsurgery, guided bone regeneration, autotransplantation and reimplantation.

Acquire the scientific criteria to choose the type of material for retrograde filling depending on the case, as well as to constantly update their knowledge of the dental biomaterials used in the field of endodontics, knowing their manipulation, properties, indications, biocompatibilities and toxicity.

Understand and recognise the principles of ergonomics and safety at work (including the control of cross infection, radiation protection and occupational and biological diseases).

Search, organize and analyze, with a critical spirit, using biomedical information sources, scientific literature on topics related to apical microsurgery, guided bone regeneration, autotransplantation and reimplantation, to be able to follow the process of continuous training in a self-directed and autonomous way.

Recognise and interpret the images and specialized techniques in the diagnosis of periapical diseases.

Have the autonomy to perform an anamnesis and oral exploration on patients with persistent periapical lesions.

Diagnose and prevent pulpoperiapical disorders and be up-to-date with the diagnostic and therapeutic advances that appear in the course of their professional lives

Learning outcomes of the subject

At the end of the course students will be expected to:

Diagnose a case susceptible to apical microsurgery.

Know the indications and contraindications of apical microsurgery, intentional reimplantation, guided bone regeneration and autotransplantation.

Know the differences between traditional surgery and microsurgery.

Develop a surgical protocol that fits the needs of each case.

Understand the microanatomy of the soft and hard tissues in both the upper and lower jaw.

Perform a proper root preparation according to biological criteria.

Know which instruments to use in endodontic microsurgery.

Know the materials proposed for the retrograde filling of root canals, composition, physical and chemical properties, clinical management and evidence in the literature that supports their use.

Understand the behaviour of retrograde filling materials in contact with periapical tissues.

Know the techniques of intentional reimplantation, guided bone regeneration and autotransplantation.

Know the prognosis of apical microsurgery, intentional reimplantation, guided bone regeneration and autotransplantation technique.

Syllabus

1. Introduction to endodontic microsurgery. Objectives of endodontic microsurgery

2. Indications and Contraindications of Microsurgery

3. Surgical anatomy. Surgical field with operating microscope.

4. Preoperative considerations

5. Apical microsurgery step-by-step.
5.1 Management of soft tissues and flap design
5.2 Root resection
5.3 Management of the root surface
5.4 Retrograde sealing techniques and materials

6. Post-surgical considerations.

7. Prognosis of endodontic microsurgery. Success in apical microsurgery.

8. Treatment of bone defects.

9. Tissue and bone guided regeneration.

10. Updates on autotransplantation and intentional replantation

- Teaching and learning activities

Weekly seminar with critical analysis of papers and presentations by the students.

Teaching and learning activities

In person

Weekly seminar with critical analysis of papers and presentations by the students.

Evaluation systems and criteria

In person

A written exam with short questions. In order to pass, 70% of the answers must be correct.

Bibliography and resources

Libro Microcirugía endódoncica (Enrique M. Merino).

Kim S, Kratchman S. Modern endodontic surgery concepts and practice: a review. J Endod 2006; 32:601–23. 

Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z. Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique. J Endod 2006; 32:412–6. 

Johnson BR, Witherspoon D. Periradicular surgery. In: Cohen S, Hargreaves KM, eds. Pathways of the pulp. 9th ed. St Louis, MO: Mosby Elsevier; 2006:724–85.

Gutmann JL, Harrison JW. Posterior endodontic surgery: anatomical considerations
and clinical techniques. Int Endod J 1985; 18:8–34. 

Gutmann JL. Surgical endodontics. Boston: Blackwell Scientific Publications; 1991. 

Allen RK, Newton CW, Brown CE Jr., A statistical analysis of surgical and nonsurgical
endodontic retreatment cases. J Endod 1989; 15:261–6.

Friedman S. Treatment outcome and prognosis of endodontic therapy. In:
Ørstavik D, ed. Essential endodontology: prevention and treatment of apical periodontitis. Oxford: Blackwell Science; 1998:367–401.

Carr G. Advanced techniques and visual enhancement for endodontic surgery.
Endod Rep 1992; 7:6–9.

Rubinstein RA, Kim S. Short-term observation of the results of endodontic surgery
with the use of a surgical operation microscope and Super-EBA as root-end filling
material. J Endod 1999; 25:43–8.

Chong BS, PittFord TR, Hudson MB. A prospective clinical study of Mineral Trioxide
Aggregate and IRM when used as root-end filling materials in endodontic surgery.
Int Endod J 2003; 36:520–6.

Kim E, Song JS, Jung IY, Lee SJ, Kim S. Prospective clinical study evaluating
endodontic microsurgery outcomes for cases with lesions of endodontic origin compared with cases with lesions of combined periodontal-endodontic origin. J Endod 2008; 34:546–51. 

Pecora G, De Leonardis D, Ibrahim N, Bovi M, Cornelini R. The use of calcium sulphate in the surgical treatment of a ‘through and through’ periradicular lesion. Int Endod J 2001; 34:189–97. 

Taschieri S, Del Fabbro M, Testori T, Francetti L, Weinstein R. Endodontic surgery using 2 different magnification devices: preliminary results of a randomized controlled study. J Oral Maxillofac Surg 2006; 64:235–42. 

Von Arx TJS, Hänni S. Clinical and radiographic assessment of various predictors for healing outcome 1 year after periapical surgery. J Endod 2007; 33:123–8. 

Taschieri S, Del Fabbro M, Testori T, Francetti L, Weinstein R. Endodontic surgery with ultrasonic retrotips: one-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100:380–7. 

Lindeboom JA, Frenken JW, Valkenburg P, van den Akker HP. The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study. Int Endod J 2005; 38:877–81.

Maddalone M, Gagliani M. Periapical endodontic surgery: a 3-year follow-up study. Int Endod J 2003; 36:193–8. 

Wang N, Knight K, Dao T, Friedman S. Treatment outcome in endodontics: the Toronto Study—phases I and II: apical surgery. J Endod 2004; 30:751–61. 

Von Arx T, Hänni S, Jensen SS. Correlation of bone defect dimensions with healing outcome one year after apical surgery. J Endod 2007; 33:1044–8. 

De Lange J, Putters T, Baas EM, van Ingen JM. Ultrasonic root-end preparation in apical surgery: a prospective randomized study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104:841–5. 

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