The technique of apicoectomy. Apicoectomy in the region of the floor of the antrum.
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The apicoectomy with retrograde amalgam is an excellent and accepted surgical technique for salvaging teeth. Anatomic considerations in molar teeth are not a contraindication to this technique.
A gutta-percha root-filling point placed during apicoectomy may be condensed by the application of pressure to its coronal end or tension to its apical end. Scanning electron microscopy clearly demonstrates the effect that these techniques have on the adaptation of the root filling to the canal. The pressure method would appear to produce the more satisfactory result.
Apicoectomy is a frequently performed operation. In order to produce consistently good results the operation and its varieties are described, with stress being placed on correct assessment of each case prior to surgery.
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The scanning electron microscope was used to examine resected areas of eight roots of human teeth extracted after long intervals following surgical procedures. Some resorption lacunae were observed in the areas with protuberances of newly formed cementum. In the lacunae, honeycomb-like structures were found. On the resected surface, residues of ligaments and periodontal fibers, and in one of the specimens dentinal tubules with odontoblastic processes protruding above the surface were present.
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The so-called focal infections are today considered to be polyetiologic manifestations, in which there is a summation of various aggressions. Bacterial products, toxic or antigenic substances originating from different foci are but one of the elements susceptible of unleashing the disease. This explains why there are so many foci and so few results after their elimination. Scientific evidence shows that the histologic result of an apicectomy is considerably worse than the radiological evidence might lead to believe. Inflammation may persist for years before it disappears. Radiographs are therefore only a coarse criterion for judging results of healing. When facing a disease caused by focal infection, the possible foci should be eliminated quickly and as radically as possible.
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At the Department of Oral and Maxillo-facial Surgery of Heidelberg University, apicectomies in posterior teeth have long been performed in addition to implantation. We always aimed at maintaining a vital periodontium, before alloplastic materials for implantation were considered. In follow-up examinations of 247 resected roots of posterior teeth, we recorded a success rate of 90%.
A new procedure for apical closure after apical root resection with a metal filling is presented which is easy to handle with appropriately standardized equipment and ensures exact apical closure. By conical preparation of the whole root, a standardized metal peg which resists distortion can be used for anchoring the crown prosthesis without further preparation. Temporarily a standardized guttapercha peg can be used for closure. Even if renewed work on the root becomes necessary later, the apical metal closure remains firm because of its wedging.