Hi there,

I typically do apicos using a scalpel for the incision. I use the laser for bone removal, because it is precise, antibacterial and possibly promotes healing. I think that MTA is probably the best material to use as it seals well and seems to have some osteogenic effect. It is, however, expensive and if you don’t have any lying around, I would suggest GIC, or I’ve even used “gasp” amalgam. Don’t have access to a CO2 laser, so can’t comment on that. My suggestion is that you try to stain the apex with methylene blue to try and find any cracks that are lurking. Most of my failures have been from cracks that I only found after the extraction. Have never heard of using tetracycline, but I do often pack with gelfoam. I don’t suppose the tetracycline will hurt, but I would worry about a foreign body reaction if there were any inert fillers in the drug. I don’t know that for a fact, but it would be my paranoid first thought unless I read a credible argument to the contrary. I don’t know what you would gain as the laser energy should probably be sufficient to decontaminate the area. Try to be as atraumatic as you can with the flap, give yourself lots of room if the lesion proves to be bigger than you thought. A little grove in the bone for the retractor to sit in will help avoid trauma caused by the retractor slipping. Suture it up tight and see the patient in a week or so. I will sometimes prescribe post op antibiotics.

I’m just a lowly GP so don’t take my word as gospel, but I have done a lot of these and they mostly work out for the good.

Best of luck.

Hubert and Bruce, great replies there and that helps alot I am sure for those individuals trying to do apicos with their erbium/CO2 lasers.

Thanks for those well thought out ideas.

Glenn

Glenn,
I like your reasoning. In this case I chose atridox for 2 reasons:
I had some and this patient absolutlely refused to take antibiotics post op.

Robert