**11. Root end resection/prepertion/restoration**

Apical third of the root is most likely the most difficult part to obturate properly. Presence of accessory canals increases at the apex as well, which may have not been initially cleaned and debrided, thereby leaving a source of continued infection. In general, approximately 2 to 3 mm of the root is resected more if necessary for apical access or if an instrument is lodged in the apical region; less if too much removal would further compromise stability of an already short root.Fig:5

**Figure 5.** Root resection

handpiece with sterile saline solution. Enough overlying bone should be removed to expose the area around the apex and at least half the length of the root. Good access and visibility are important; the bony window must be adequate. The clinician should not be concerned about the bone removal because once the infection resolves, the bone will reform. The exposure of the root is done before resecting the root to avoid the potential of blending the root in with the bone and losing surgical orientation. This is especially critical in the mandible where the bone is dense. Lower incisor roots are carefully exposed because the proximity with adjacent teeth

Granulomatous, inflamed tissue around the periradicular area should be removed to gain access and visibility of the apex, to obtain a biopsy for histologic examination (when indicated), and to minimize hemorrhage. If possible, the tissue should be enucleated with a suitably sized

Apical third of the root is most likely the most difficult part to obturate properly. Presence of accessory canals increases at the apex as well, which may have not been initially cleaned and

could lead to treatment of the wrong apex. Fig:4

214 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**Figure 4.** Periapical exposure

**10. Curettage**

sharp curette. Fig:5

**11. Root end resection/prepertion/restoration**

**Figure 6.** Root preperation for retrograd filling

**Figure 7.** Suturing after retrograd filling

An angled micro handpiece and micro round bur or ultrasonic tip can be used for retropre‐ paration. The bur or tip is placed at the apical opening of the canal and guided gently deeper into the canal as it cuts. Once the retropreparation is completed the prepared cavity is inspect‐ ed. The gutta-percha at the base is recondensedwith small 0.5 mm microplugger (Fig:6). After that orot end filling material can be applied. The aim of placing root end filling material is to establish an apical seal that inhibits the leakage of residual irritants from the root canal into the surrounding tissues (Fig:7).

## **12. Flap replacement and suturing**

After finishing surgical procedures the flap is returned to its original position and is held with moderate digital pressure and moistened gauze. Primary closure of the elevated flap is gained by basic or interrupted sutures. Absorbable monoflament or sling suture material is commonly used. After suturing, the flap should again be compressed digitally with moistened gauze for several minutes to express more hemorrhage. This limits postoperative swelling and promotes more rapid healing and adequate positioning of the flap.
