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This was my first apicectomy. It was done on a very nervous patient who normally required IV sedation for conventional dentistry. I persuaded her to try this procedure without sedation, because I believed I could do it wothout having to use a drill or a scalpel. I booked her for 50 minutes. She was walking out of the surgery in 30 minutes!! I could not believe how wasy it was.
Initial incision T4 .75W 11%A 10%W. The flap was elevated using a periosteal elevator.
Initial access using a G6 Tip 2.5W 50% A 30%W. All the rest of the preparation including removal of the granulation tissue, amuptation of the root tip and cutting the apical retrograde cavity was done at this setting. No charring at any point in the procedure.
I have now reduced the air/water a bit more to help avoid the splattering that occurs at 50% A. (I needed to change scrubs after this first case, but it was fun and the patient was over the moon about how easy it was)
Accurate removal off the soft tissue was very easy with the Laser. You can still see some of the lobulated erosion of the bone that is visible in the initial PA.
As an aside, I have done several since this case and in two cases, ran into severe sparking when removing the GP for the retrograde cavity. I believe this is from cement like AH26 that has a very high silver content with the metal content of the cement causing sparking.
I just used a diamond tipped ultrasonic to remove the cement from the ccanal walls befoer finishing the prep.
Cheers
CheersI have now got two month follow-up Xrays.
Here is the post op Xray and then the follow-up at 2 months.
I have to say I am impressed at the healing that has occured already.Cheers
(Edited by Graeme Milicich at 3:29 pm on Oct. 21, 2003)
Here is my first max molar apico.
Patient had endo done and redone but pain persisted. Endodontist believed MB root probably sticking through buccal plate and needs apico. I told her I would do it with Waterlase. I used .5Carpule 2% lido 1:100,000epi.
outlined semilunar incision at .25W, then incised at .5W 11A 0W.
Flap elevated and sure enough there was the MB root. At 1.5W 15A 15W I enlarged the opening in bone, curetted granulation tissue, bevelled root and sterilized area. As patient has trouble taking oral meds I filled bone cavity with atridox, then sutured.
Patient did great, procedure was quick and post op was uneventful and her pain is gone.(I an not very good at posting photos. I hope the sequence is correct.)Robert.
