Friday 22 July 2011

Photo Essay; Apicoectomy of Right Maxillary Incisors

Notice the facial swelling

I've outlined the extent of the bony defect

The abscess is clearly visible as a swelling

Initial incision with a No 15 Bard Parker blade

Notice the thick stream of blood and pus

I've indicated the reflected flap

The arrow shows the defect in the bone over the root tips

Drilling away the bone over the defect

The arrows show the tips of the affected tooth roots

Drilling cavities in the root tips for retrograde restorations

Curretting away granulation tissue

Placing the retrograde restorations at the root tips
Retrograde restorations in place

After carving the restorations: you can see one as a white spot

Placing the bone graft analogue

Defect filled by bone graft analogue


Surgery site closed by suture

Post operative X ray with retrograde restorations marked
This young woman had had root canal treatment done on her upper front teeth and crowns placed a year or so ago. Unfortunately the root canal treatment wasn't done especially well, and speedily failed with pain and swelling over the gum, and a fairly large pus-filled cavity in the bone at the root tips, which extended internally up to the palate. Removal of the crowns risked fracturing the teeth, and I decided that the circumstances warranted a surgical approach through the gum and bone instead.

The idea was to remove diseased bone and tissue, expose the root tips, place fillings at the root tips to prevent the passage of bacteria to or from the canals, and then packing of the defect with a bone graft analogue. Once completed, the flap I'd raised at the outset would be closed with black silk sutures.

The surgery was completely successful, recovery uneventful, and there has been no recurrence of the problem.


  1. Kind of grisly, but also very interesting. I'm fascinated by the mechanics of various dental and surgical procedures.

    But yeah, not for the weak of stomach ;)

  2. You have done a very good job. Well, sometimes root canal treatment can lead to big problems like the above case. People should maintain the oral health properly. It is good to maintain a good monthly dental check up. If there is any problem then the dentist can start the treatment in the initial stage. The procedure will be simple and less painful for the patient.


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