Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-05-16, 11:45:19 | version 1.38.0
SOFT-TISSUE MANAGEMENT IN ENDODONTIC MICROSURGERY: Modern procedures/techniques lead to more favorable long-term therapeutic success “The ultimate esthetic result of the soft-tissue manipulation depends on several factors, such as the tissue biotype, the kind of incision per- formed, the choice of instruments used for incision, the elevation and retraction of the flap, as well as the careful reapproximation and proper suturing technique.” — Dr. Francesco Maggiore Modern endodontic microsurgery is drastically different from traditional endodontic surgery in many ways. Accu- rate diagnosis provided by cone beam computed tomography (CBCT), knowl- edge of the soft-tissue physiological principles, proper magnification and illumination provided by an operating microscope, conservative osteotomy and root resection, microscopic manage- ment of the apical third, the use of ergo- nomic microsurgical instruments such as micromirrors and ultrasonic tips, and the application of biocompatible and bioce- ramic materials are just some of the key features of current microsurgical proce- dures and promote a favorable long- term outcome. In particular, proper flap design and soft-tissue management are among the most important concepts in current endo- dontic microsurgery. The primary purposes of flap design and elevation are to provide adequate surgical access to the underlying bone and root structure and to promote scar-free soft-tissue healing. Flap design and elevation should prevent any damage to adjacent critical anatom- ical entities. The major flap designs used in endodontic microsurgery are the para- marginal and the intrasulcular flaps; the outline can be either triangular or rectan- gular. The flap outline mainly depends on the length of the roots, the proximity of anatomical structures and accessibility to the apical area of the treated teeth. Owing to the position of the roots and root apices, surgery on anterior teeth relies on direct and straightforward access to the apical lesion. Furthermore, the es- thetics of the soft tissue is a priority. In the molar region, the esthetic appearance of the soft tissue plays a secondary role, with the focus being on convenient and adequate surgical access to the root apices that allows for faster and complication- free endodontic surgery. Paramarginal flaps and incisions at the level of the papillae are preferably per- formed using a microblade, which has the advantage of minimal trauma, especially in the presence of thin or poorly keratin- ized tissue. The use of a microblade often results in scar-free healing, which is par- ticularly important when surgery is con- ducted on anterior teeth or when esthet ics plays a primary role. Once the apical microsurgery has been completed, great care has to be taken in repositioning and suturing the elevated soft tissue. The ultimate esthetic result of the soft-tissue manipulation depends on several factors, such as the tissue biotype, the kind of incision performed, the choice of instruments used for incision, the ele- vation and retraction of the flap, as well as the careful reapproximation and proper suturing technique. In endodontic microsurgery, the most commonly used suturing techniques are the single-knot suture and the continuous sling suture. Synthetic monofilament 5-0, 6-0 or 7-0 sutures are generally used to secure the flap. Figures 1 to 10 demonstrate a clinical case of soft-tissue healing after endo- dontic microsurgery performed on tooth #14. Editorial note: This article was first published in Dental Tribune Germany, Issue 7/2017. 42 — issue 2018 Endodontics Article