APICOCECTOMY

 Apex removal
 RETROGRADE FILLING / ROOT END FILLING
 Done if re-infection seen even after re-RCT
 Indication
o To gain access to are of pathosis – like say a cyst
o Poorly filled apical portion
o Severe root curvature / non- negotiable canal ends / blockage
o Infection after post & core cases – most common cause of opting for apicocectomy
o cyst formation cases
o Complications happened during RCT –
Instrument separation / ledging /
perforation
o Biopsy
 Method: raise flap – curette the apical area – root end resection – condition with EDTA – fill with MTA – then place flap – suture tightly
 Grey MTA ( with ferric content, as its not moisture sensitive ) is the material of choice
 Success lies in
o proper placement of flap
o type of flap

 Root end resection:
o Can cut up to middle 3rd
o Flap-- full mucoperiosteal – best flap
o 3mm retrograde filling into canal
o Usually ideal measurement is about 3-4mm
o Ideal angulation is 10° or acute angle
o Commonly cut at 45°
o Condition – clean – MTA pack – flap – suture