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| Year : 2006 | Volume
: 9
| Issue : 2 | Page : 81-84 |
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| Endoscope assisted endodontic surgery |
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N Shubhashini, N Meena, J Pramod, DN Naveen
Department of Conservative Dentistry and Endodontics, VS Dental College and Hospital, Karnataka, India
Click here for correspondence address and email
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 Abstract | | |
Periradicular surgery, assisted by an endoscope was performed on patients with persistent periapical lesion of endodontic origin, which were not responding to conventional root canal therapy. The objective of using endoscope was to use a cost effective alternative to surgical microscope for diagnosis, illumination and magnification of the surgical field. Endoscope helped in the assessment of the extent, direction and depth of the lesion. It provided excellent illumination, magnification of the surgical field including the root apices and the area around the root apices.
How to cite this article:
Shubhashini N, Meena N, Pramod J, Naveen D N. Endoscope assisted endodontic surgery. J Conserv Dent 2006;9:81-4 |
| Introduction | |  |
The goal of periradicular surgery is to create optimum conditions for healing through the regeneration of tissues including the formation of a new attachment apparatus. This is achieved by thorough curettage of the lesion. Parallel to the advent of micro instruments, well focused illumination and magnification was recommended as a triad of microsurgery [4] . There has been a continuous search for enhanced visualization of the surgical field.
One such device, which fulfills these requirements, is the endoscope. Since, its introduction by Hopkins in the 1960's, various diagnostic and surgical endoscopic techniques have been refined including arthroscopy, laparoscopy and endoscopy in otolarnygology, gynecology, urology and so on [3] . Only a few articles have described the intraoral applications of endoscopy in dentistry, mainly in conventional or surgical endodontics. The endoscopic system has been constantly expanded to meet the demands of the surgical team. The endoscope is mainly applied for the following procedures: periradicular surgery, surgical perforation repair, root resection and apical root fracture evaluation.
Endoscope and its uses
The endoscope can aid the operator significantly in microsurgical procedures providing visualization of areas, where in a direct line of vision is not possible. When the operator can see behind the tooth root to determine if pathosis exists, the surgical procedure has an improved prognosis [2] .
The 30 and 70 degree endoscope, [Figure 1] has been used as an adjunct to endodontic surgery involving maxillary and mandibular molars. This instrument, with angulations of 30 and 70 degree, has been found to allow visualization in previously inaccessible areas.
Surgery involving the upper second molar with roots that are many times positioned behind the disto-buccal root of the maxillary first molar can be readily visualized. Standard surgical access permits the root tips of this tooth to be identified and prepared for the acceptance of a reverse fill materials [2] .
With the 70-degree instrument, it has been possible to visualize the palatal root apices of maxillary posterior teeth. On many occasions, the surgeon has the need to visualize a full 360-degree radius of the tooth to detect root fractures, iatrogenic perforations, anomalous development phenomena, or the presence of any extraneous filling material [2] .
Other applications are for the visualization of pulp chamber to aid in the identification of the canal orifices. It is also been used in cases in which maxillary roots have been found to be directly within the maxillary sinus, the instrument aids the operator in the identification and treatment of these diseased root apices following entry into the sinus.
| Case report | | |
Case 1
A female patient aged 19 years reported to Department of Conservative dentistry and Endodontics, V. S. Dental College and Hospital, Bangalore, with a presenting complaint of fractured and discolored teeth.
Patient gave a history of trauma in childhood.
On clinical examination tooth no. 2 1 was fractured and 11 was discolored and tender on percussion. Vitality test gave negative results. Occlusal radiograph revealed periapical lesion in relation to maxillary right anterior teeth [Figure 2]. Echography was suggestive of a cyst.
After endodontic treatment the patient was kept under observation for 4 months. However due to persistent signs and symptoms the patient was posted for surgery assisted with an endoscope.
The treatment plan was briefly explained to the patient before initiating the treatment.
Following reflection of flap the perforation of the labial cortical plate and thick cystic lining, grayish white in color was noticed. The cystic content was aspirated and the cyst was enucleated.
The endoscope was used at this point to visualize the bony cavity, by literally looking around the corner. In addition to this we observed a tissue tag attached the root tip [Figure 3]. The cavity was curetted completely; failure to remove the same might have led to recurrence.
Before wound closure, the endoscope was used to examine the bony cavity and to verify that no extraneous material is left behind.
Histopathological report confirmed the echography result.
Case 2
A female patient aged 27 years reported to our department with a chief complaint of swelling in relation to upper front teeth.
She gave a history of trauma when she was 16 years old.
On clinical examination tooth no. 12 & 13 were discoloured. Vitality test of both the teeth was negative.
Occlusal radiograph showed a periapical radiolucent lesion in relation to 12 & 13 [Figure 4]. Echography was done which was suggestive of a mixed lesion.
After conventional endodontic therapy the patient was kept under observation. Radiographs taken at the first month visit showed no signs of healing and increase in the size of lesion. Patient was posted for periradicular surgery aided with an endoscope for visualization and illumination.
The entire granulation tissue was curetted out, the tip of the root was beveled and the obturation material was cold burnished.
In this case the endoscope aided in visualization of the bony cavity, root tip and the area behind the tooth root [Figure 5] and [Figure 6].
| Discussion | | |
Advantages of endoscope over surgical microscope
Non fixed field of vision: It offers the ability to visualize the operating site at various angles and distances without loosing the depth of field and focus. [3]
Versatile: The operator can visualize directly through the endoscope and operate or view through the monitor using an indirect technique. [2]
Greater clarity and greater magnification: The physical optics of a microscope is similar to that of a magnifying glass. As the object in the treatment field becomes more magnified, the perimeter of the field of view is out of focus and the overall depth of field is limited. Therefore at high magnification any movement of microscope or the patient will cause the treatment of field to become out of focus. This is the reason a microscope cannot view the treatment field from various vantage points and must remain in what is referred to as fixed field of vision in order to be effective visualization instrument in endodontic treatment. [1]
Benefits of Endoscope in Endodonties: [2]
- Improved visualization of root tips
- Magnified view of apical preparation
- Detection of any extravasation of filling material and of apical root fractures
- Direct, magnified view of the pulp chamber
- Maintain improved posture while utilizing the monitor
- Permits addition of video camera system
- Instantaneous and permanent medico legal documentation
The only shortcoming of the endoscope is fogging, which results due to soiling of the endoscope tip with blood, tissue or cooling agent.
Application of endoscopy in periradicular surgery: [3]
After Osteotomy and location of root end it allows to observe the
- Morphology of apex
- Presence of extraneous material
After root end resection it aids in visualization of
- Morphology of cut root surface
- Number and configuration of root canals
- Presence of isthmus tissue
Following root end preparation it aids in the assessment of
- Direction, dimension and depth of cavity
- Cleanliness of cavity walls
Assessment of root end filling
- Marginal adaptation of tilling
- Presence of deficiencies can be inspected.
| Conclusion | | |
The use of Endoscope will further improve the outcome of endodontic surgery. The advent of microsurgical principles has clearly optimized the results in endodontic surgery and the best possible intra operative visualization is necessary to maintain a high level of success.
| References | | |
| 1. | Bachall J & Barss J: Orascopic visualization technique for conventional and surgical endodontics. Int Endod. J 2003,36:441-447.  |
| 2. | Steven A. Held, Yi H. Kao, Donald W. Wells: Endoscope An Endodontic Application. J Endod 1996;22:327-329. |
| 3. | Thomas von Arx et al: Endoscope and video-assisted endodontic surgery. Quintessence Int 2002;33:255-259. |
| 4. | Thomas von Arx et al: Diagnostic accuracy of endoscopy in periradicular surgery a comparison with scanning electron microscopy. Int Endod. J 2003;36:691-669. |
Correspondence Address:
N Shubhashini
Department of Conservative Dentistry and Endodontics, VS Dental College and Hospital, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-0707.42363
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] |
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