Post on 08-Apr-2018
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Reported by
O.R.Ganesh
M.Sc.D Endo
Journal of Oral Surgery and Research2010 Jul 1;15 (4):e628-32.Berta Garca-Mira, Barbara Ortega-SnchezProfessor of Oral Surgery. Director of the Master of OralSurgery and Implantology.
University Medical and Dental School. Valencia, Spain
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In periapical surgery (PS), in order to eliminate the
inflammatory apical tissue, form the root-end cavity
and achieve proper sealing of the apical foramen
with rootend filling, it is necessary to eliminate the
periapical bone via ostectomy. This removal should
be the minimum necessary to allow access to the
entire lesion and enable visual control of the apicesto the affected roots.
Ostectomy
surgical removal of all or part of a
boneOsteotomy
a surgical operation in which a bone
is divided or a piece of bone isexcised (as to correct a deformity)
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Due to the greater thickness of the vestibular
cortical in this region, access to the mandibular
molar root apices requires a large ostectomy,occasionally leaving extensive bone defects.
The aim was to make a preliminary study of the
morbidity and prognosis following PS using
ostectomy or by osteotomy with repositioning ofthe vestibular cortical
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Study sampleRetrospective clinical study of patientsundergoing PS between May 1999 and June2004. Inclusion criteria were mandibular molarsapicoectomized using ultrasound, with aminimum follow up of 12 months and adequate
completion of the follow-up questionnaires.Patients who did not follow the postoperativeinstructions were excluded.
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Two groups were considered
Patients in Group1 (G1) were treated with
ostectomy
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Group 2 comprised patients treated by
osteotomy with repositioning of the cortical
bone when the vestibular cortical was intact and
the teeth apices were more than 8 mm from the
mandibular canal The osteotomy was made
creating a bony lid in the vestibular cortical witha trephine burr, which was repositioned
following the apicoectomy and root-end filling.
This cortical bone is only obtained using the
osteotomy technique, and only in these cases is
repositioned subsequent to PS.
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under local anesthesia
0.27 mm round tungsten carbide drill
irrigation with sterile physiological serum raised with the aid of a surgical hammer and
chisel.
Ultrasound tips for periapical surgery
All patients were the same postoperativemedication: amoxicillin
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size of the ostectomy and osteotomy was
measured using a digital caliper
sizes were classified asLess than 1 cm2,
Between 1 and 2 cm2.
Greater than 2 cm2.
postoperative pain was recorded
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postoperative pain was recorded
1 absence of pain
2 slight
3 moderate
4 intense pain.
Swelling was recorded1 absent (no swelling)
2 slight (intraoral swelling at the operated area)
3 moderate (moderate intraoral swelling at the
operated area)
4 intense (intensive extraoral swelling extending
beyond the operated area).
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One week after surgery the patient was
examined and the sutures removed. The
appearance of any postoperative complicationssuch as hematoma, wound opening, infection or
postoperative neuropathy was noted
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Success was determined by panoramic
radiographic
study using a digital orthopantomographSuccess criteria
1 failure
2 improvement
3 success.It was also noted if the tooth remained in the
mouth
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The SPSS v15 program for Windows was used,
making a descriptive analysis of each of the
variables. A mixed ANOV
A study with 2 factorswas made. Statistical significance
was considered for values of p.0.05.
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In the osteotomy group, pain peaked at a maximum on
the second day, while in the ostectomy group pain
remained level during the first 48 hours. Kvist et al.
also found maximum pain during the first 24postoperative hours. Regarding perceived swelling, a
maximum peak was found on the 2nd postoperative
day; similar to results obtained by Garca et al.after
operating on 102 patients. Patients undergoingostectomy presented greater swelling during the
postoperative period than the patients with osteotomy
and repositioning of the vestibular cortical
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Although the success rate of PS on mandibular
molars was 58.4% after 12 months follow-up, a
high number of teeth remained in the mouth
(94.5%); similar to results obtained by Pearrochaet al,who achieved 90.4% clinical and 54.8%
radiographic healing after operating on 31
mandibular molars. Rud et al,on 834 mandibularmolar roots obtained 92% complete healing, 1%
uncertain and 7% failure; while von Arx et al,
found a 94% success rate in 16 mandibular molars
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Ostectomy was used to access the tooth roots in
the majority of the lesions (91.6%). Osteotomy
allows the repositioning of the vestibular
cortical after surgery, but brought no benefits in
the few cases of this preliminary study.
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