Microsurgery in Endodontics

Microsurgery in Endodontics provides the definitive reference to endodontic microsurgery, with instructive photographs and illustrations.

• Provides a definitive reference work on endodontic microsurgery

• Includes contributions from pioneers and innovators in the field of microsurgical endodontics

• Describes techniques for a wide range of microsurgical procedures

• Includes more than 600 instructive illustrations and photographs

Auteur

Syngcuk Kim, DDS, PhD, MD (Hon), is Louis I. Grossman Professor and Chairman Emeritus in the Department of Endodontics and Associate Dean for Global Affairs at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, USA, and maintains a private practice in New York, New York, USA.

Samuel Kratchman, DMD, is Clinical Associate Professor and Assistant Director of Graduate Endodontics and Director of Microsurgery
in the Department of Endodontics at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, USA, and maintains three private practices limited to endodontics in Exton, West Chester, and Paoli, Pennsylvania, USA.

Associate Editors

Bekir Karabucak, DMD, MS, is Chair and Associate Professor of Endodontics, Director of the Postdoctoral Endodontics Program,
and Director of the Division of Advanced Dental Education at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, USA, and maintains a private practice in Philadelphia, Pennsylvania, USA.

Meetu Kohli, DMD, is Clinical Associate Professor of Endodontics and Director of the Continuing Education and International Program
in the Department of Endodontics at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, USA, and maintains two private practices limited to endodontics in Oaks and Gilbertsville, Pennsylvania, USA.

Frank Setzer, DMD, PhD, MS, is an Assistant Professor, Clinical Director, and Pre-Doctoral Program Director in the Department of
Endodontics at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, USA, and maintains a private practice in Philadelphia, Pennsylvania, USA.

Résumé

Microsurgery in Endodontics provides the definitive reference to endodontic microsurgery, with instructive photographs and illustrations.

• Provides a definitive reference work on endodontic microsurgery
• Includes contributions from pioneers and innovators in the field of microsurgical endodontics
• Describes techniques for a wide range of microsurgical procedures
• Includes more than 600 instructive illustrations and photographs

Contenu

Contributors xiii

Preface xv

Acknowledgements xvii

**1 The Dental Operating Microscope 1
**Frank Setzer

1.1 Benefits of the Operating Microscope 1

1.2 Key Features of Operating Microscopes 1

1.3 Customizing a Microscope 3

1.3.1 Light Source 3

1.3.2 Documentation 5

1.3.3 Individual Microscope Adjustment (Parfocaling) 5

Suggested Readings 7

**2 Microsurgical Instruments 9
**SeungHo Baek and Syngcuk Kim

2.1 Examination Instruments 9

2.2 Incision and Elevation Instrument 9

2.3 Tissue Retraction Instruments 11

2.4 Osteotomy Instruments 14

2.5 Curettage Instruments 14

2.6 Inspection Instruments 15

2.7 Ultrasonic Units and Tips for Root End Preparation 17

2.8 Microplugger Instruments 20

2.9 Suturing Instruments 20

2.10 Miscellaneous Instruments 22

**3 Medication-Related Osteonecrosis of the Jaw and Endodontic Microsurgery 25
**Chafic Safi and Bekir Karabucak

Suggested Readings 29

**4 Indications and Contraindications 31
**Bekir Karabucak and Garrett Guess

4.1 Introduction 31

4.2 Surgical Success Dependent on Ability to Perform Ideal Protocols 31

4.3 Etiology Assessment through Examination and Treatment 31

4.4 Periodontal Considerations and Surgery 33

4.5 Influential Patient Factors 33

4.6 Condition of Previous Endodontic Treatment 37

Suggested Readings 38

**5 Anesthesia and Hemostasis 39
**Siva Rethnam-Haug, Aleksander Iofin, and Syngcuk Kim

5.1 Armamentarium 39

5.1.1 Epinephrine 39

5.2 Presurgical Phase 40

5.2.1 Administration of Local Anesthetic 40

5.2.2 Injection Techniques 40

5.2.3 Topical Anesthesia 41

5.2.4 Additional Techniques 41

5.2.5 Maxillary Anesthesia 41

5.2.6 Mandibular Anesthesia 43

5.2.7 Bilateral Mandibular Surgery 43

5.3 Surgical Phase 44

5.3.1 Topical Hemostatic Agents 44

5.3.1.1 Epinephrine Pellets 45

5.3.1.2 Ferric Sulfate 45

5.4 Summary of Hemostatic Techniques in Endodontic Microsurgery 46

5.5 Postsurgical Phase 46

Suggested Readings 48

**6 Flap Design in Endodontic Microsurgery 49
**Francesco Maggiore and Frank Setzer

6.1 Armamentarium 49

6.1.1 Flap Outline 49

6.1.2 Papilla Management 52

6.1.3 Incision 54

6.1.4 Flap Elevation 54

6.1.5 Flap Retraction 55

Suggested Readings 56

**7 Osteotomy 57
**Francesco Maggiore and Syngcuk Kim

7.1 Armamentarium 57

7.2 Osteotomy 57

7.2.1 Distinction between Bone and Root Tip 57

7.2.2 Clinical Situations for Endodontic Microsurgery 58

7.3 Intact Cortical Plate without a Radiographic Periapical Lesion 59

7.4 Intact Cortical Plate with a Periapical Lesion 60

7.5 Fenestration through the Cortical Plate Leading to the Apex 60

7.5.1 Optimal Osteotomy Size 61

7.5.2 Key Hole Osteotomy Modification 61

7.5.3 BoneWindow Technique 61

**8 Root End Resection 67
**Spyros Floratos, Fouad Al-Malki, and Syngcuk Kim

8.1 Armamentarium 67

8.2 Root End Resection 67

8.3 Root End Resection: Steep Bevel versus Shallow Bevel 69

Suggested Readings 72

**9 Inspection of the Resected Root Surface: Importance of Isthmus 73
**Spyros Floratos, Jorge Vera, Fouad Al-Malki, and Syngcuk Kim

9.1 Armamentarium 73

9.1.1 Methylene Blue Staining (MBS) 73

9.1.2 Isthmus 77

9.1.3 Types of Isthmus 77 9.1.4 Incidence 77&lt...