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Journal of Oral Science & Rehabilitation No. 1, 2018

F l a p d e t a c h m e n t a n d r e t r a c t i o n i n p e r i a p i c a l s u r g e r y Fig. 5A Radiograph of a right central incisor with internal root resorption with an apical lesion. Fig. 5B Tomographic scan of the internal resorption and apical bone defect. Fig. 5C Radiograph after orthograde endodontic treatment insufficient to solve root resorption. Fig. 5D Intraoral photograph of the anterior maxillary zone. Fig. 5E Flap retraction. Note the retractor resting stably on the bone tissue. Fig. 5F Access to the apical lesion, care being taken not to affect flap integrity or the lesion. Fig. 5G Soft-tissue healing with a minimal scar, typical of a submarginal flap. Fig. 5H Radiograph showing complete retrograde filling of the internal resorption and cavity. A D G Figs. 5A–C Figs. 5D–F B C E F Figs. 5G & H H Flap retraction Retraction serves to separate the flap, allowing the surgeon to visualize and access the bone without damaging the flap or the adjacent tissue.2 The edges of the tissue retractor should rest upon the bone and must not affect flap integrity or the lesion. In order to correctly posi- tion the retractor, the flap should be raised suf- ficiently to adequately expose the bone over the periapical tissue of the affected root (Figs. 5A–H). Different types of retractors are available. Some authors advocate the use of retractors designed with a saw-tooth zone to prevent displacement.4 Such instruments are not very comfortable to use, however, and have poor stability, thereby causing surgeon tension throughout the oper- ation. Other authors prefer large retractors with designs adapted to the different dental groups and anatomical structures.5 28 Volume 4 | Issue 1/2018 Journal of Oral Science & Rehabilitation

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