{"id":15723,"date":"2020-05-04T09:05:22","date_gmt":"2020-05-04T14:05:22","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=15723"},"modified":"2020-05-06T12:24:00","modified_gmt":"2020-05-06T17:24:00","slug":"periodontal-pearls-for-the-endodontist","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/periodontal-pearls-for-the-endodontist\/","title":{"rendered":"Periodontal Pearls for the Endodontist"},"content":{"rendered":"

By Dr. Joseph K. McCombs
\n<\/em>
\nCertain biologic principles govern all living things. These principles were not created but exist as an independent reality.\u00a0 Cecil DeMille, director of the movie, The Ten Commandments<\/em>, once said, \u201cIt is impossible for us to break the law.\u00a0 We can only break ourselves against the law\u201d. Successful surgeons build on these foundational biologic principles to consistently attain great outcomes.\u00a0 Unsuccessful surgeons disregard biology and have many more complications and failed results. It really is that simple. This article will highlight five periodontal principles to consider when performing endodontic surgery.
\n<\/u><\/p>\n

Principle #1:\u00a0 Determine the periodontal prognosis first.<\/u><\/strong><\/h3>\n

Periodontal stability should be determined prior to endodontic treatment.\u00a0 Referral to a periodontist should be considered when \u22656 mm probing depths and bone loss to the middle third of the root are present at at least 2 sites. Other site related factors which downgrade prognosis include furcation invasion, mobility, and and deep subgingival restorations.\u00a0 Additionally, poor oral hygiene, sporadic periodontal maintenance, diabetes and especially smoking downgrade the periodontal prognosis.<\/p>\n

Principle #2:\u00a0 Detect and manage furcation invasions<\/u><\/strong>.<\/h3>\n

Bone loss in the furcal region is one of the most common factors associated with periodontal abscess formation and eventual molar tooth loss.\u00a0 Bone-sounding utilizing a Nabor\u2019s probe increases the accuracy of furcation detection. If furcation invasion is encountered surgically, the diseased root surface should be debrided with ultrasonic and hand instrumentation since retained calculus in the furcal region may jeopardize healing.\u00a0 Chemical decontamination utilizing a tetracycline or doxycyline slurry is also frequently employed. If attempting furcal regeneration, suitable materials include allografts or bovine xenografts with resorbable collagen membranes.<\/p>\n

Principle #3:\u00a0 Respect the zone of supracrestal fiber attachment<\/u><\/strong>.<\/h3>\n

As a general rule, the distance from the apical extent of the restorative material to the alveolar crest should be at least 3 mm.\u00a0 Additionally, the distance from the restorative margin to the cusp tip should be at approximately 9 mm. If these distances are not present, the tooth should be evaluated to determine if crown lengthening is possible.\u00a0 If a restorative material is placed in this zone of soft tissue attachment, chronic inflammation and bone loss will eventually occur.<\/p>\n

Princple #4:\u00a0 Know what factors lead to recession in the esthetic zone<\/u><\/strong>.<\/h3>\n

Mid-facial and papillary recession in the esthetic zone can lead to unacceptable esthetic results.\u00a0 Cortical bone in the maxillary anterior region is often very thin or non-existent and full-thickness flap reflection dramatically reduces blood supply to the bone and may lead to soft tissue recession.\u00a0 Also, when planning incisions in the anterior region, it is important remember that the greater the distance from the contact point to the alveolar crest, the more likely a patient is to experience papillary recession if the papilla is transected.\u00a0 Finally, during endodontic surgeries, findings such as vertical root fractures or non-restorable invasive cervical resorption frequently necessitate same-day extractions. While ridge preservation may not be necessary in areas of thick cortical bone, it is nearly always required in the anterior zone to help maintain hard and soft tissue contours.<\/p>\n

Principle #5:\u00a0 Navigate the palate carefully<\/u><\/strong>.<\/h3>\n

With the advent of fully-guided apicoectomies, palatal surgery for endodontists will become increasingly common.\u00a0 Some of the major anatomic challenges include: 1. Thick, rigid, bone-bound, keratinized tissue; 2. Palatal tubercles; 3.The greater palatine artery and branches.\u00a0 The greater palatine artery exits the greater palatine foramen apical to the maxillary third molar and lies in a groove at the junction of the alveolar and palatine processes.\u00a0 When hemorrhage occurs, pressure and suction should be applied to allow visualization. For minor, non-pulsatile hemorrhage, various hemostatic agents may be applied such as oxidized cellulose, gelatin matrices, microfibrillar collagen, fibrin sealant and topical thrombin.\u00a0 For severe or prolonged palatal hemorrhage, a compression suture applied posterior to the hemorrhage is often the only effective method for obtaining hemostasis. This can be accomplished with a 4-O chromic gut suture on a large needle. The suture should contact bone to ensure compression of the offending vessel.\u00a0 Blood loss from an arterial palatal hemorrhage can quickly become life-threatening if not addressed.<\/p>\n

In conclusion, endodontic surgery is an important treatment option which can help individuals maintain their natural dentition in health, comfort, esthetics and function for many years.\u00a0 Successful surgical therapy occurs when correct biologic principles are understood and applied.<\/p>\n

Joseph K. McCombs, D.D.S., M.S., Diplomate, American Board of Periodontology, is\u00a0 a\u00a0periodontist in Post Falls, Idaho.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr. Joseph K. McCombs Certain biologic principles govern all living things. These principles were not created but exist as an independent reality.\u00a0 Cecil DeMille, director of the movie, The…<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[292],"tags":[],"feature":[202],"class_list":["post-15723","post","type-post","status-publish","format-standard","hentry","category-periodontology","feature-communique"],"yoast_head":"\nPeriodontal Pearls for the Endodontist - American Association of Endodontists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aae.org\/specialty\/periodontal-pearls-for-the-endodontist\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Periodontal Pearls for the Endodontist - American Association of Endodontists\" \/>\n<meta property=\"og:description\" content=\"By Dr. Joseph K. McCombs Certain biologic principles govern all living things. 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