CONTEMPORARY APPROACH TO ENDODONTIC SURGERY

U slučaju neuspjeha ortogradnog endododontskog liječenja zub se može pokušati sačuvati u čeljusti kirurškim pristupom. Najčešći endodontski kirurški zahvat je apikotomija kojom se uklanja apikalni dio korijena zajedno sa svim okolnim patološki promijenjenim periapikalnim tkivom. Razvojem struke endodontska je kirurgija doživjela niz promjena, tj. poboljšanja koja su doprinijela povećanju postotaka uspješnosti liječenja. U radu su prikazane različite faze postupka apikotomije, uspoređujući tradicionalne tehnike s novijima, od preoperativne pripreme, preko odizanja režnja, resekcije vrha korijena, kontrole krvarenja pa do suvremenih materijala za punjenje retrogradnih kaviteta. Suvremeni pristup podrazumijeva resekciju vrha korijena pod kutom od 0° do 10° pri čemu su uključeni lateralni kanali i apikalne ramifikacije, za razliku od nekadašnje resekcije pod kutom od 45°. Danas se retrogradni kaviteti optimalno izrađuju ultrazvučnim i zvučnim instrumenatima u dubinu od 3 mm. Materijal za retrogradno punjenje koji danas najčešće koristimo je MTA. MTA djeluje formativno na periradikularna tkiva. Uporaba mikroskopa osigurava bolju vizualizaciju operativnog područja što omogućuje veću preciznost, ali zahtijeva dodatnu edukaciju i nabavu skupe opreme.In case of an unsuccessful ortogradical endodontic treatment, the tooth could possibly be kept inside the jaw by surgical approach. The most common endodontic surgical procedure is apicoectomy, which is used to remove the lower apical part of the root, along with the surrounding pathologically altered periapical tissue. Due to the professional development, endodontic surgery has experienced numerous changes, i.e. improvements that contributed to higher treatment success rate. In this paper we presented various apicoectomy stages and compared traditional with contemporary techniques, including preoperative procedures, dental lobe uplifting, root apex resection, hemorrhage control, and modern retrograde cavity fillings. Contemporary approach implies root apex resection being performed at 0 to 10 degrees angle, which includes lateral canals and apical ramifications, whereas former resections had been performed at a 45 degrees angle. Nowadays, retrograde cavities are optimally being created by ultrasound and sound instruments at the depth of 3 mm. Currently used retrograde material is MTA due to its formative effect on periradicular tissues. Microscope usage, which ensures better visualization of the surgical area and thus allows greater precision, requires additional education as well as purchase of expensive equipment