Implantology has modified treatment planning dramatically in odontology. However, the operating microscope and its new armamentarium in endodontics have so broadened what can be treated, both surgically and non-surgically, with success and predictability that a comparison with studies done before the microscope's introduction is difficult. Rotary NiTi files have standarized the cleaning and shaping of canals, reduced the ledges, blocks, zips, tear-drops and perforations, and increased the success rate of endodontic treatments and retreatments.
It is important for the surgeon to understand that the final result will never be better than what they can establish when placing the implant as support for the prosthetic construction; so the implant should be considered the apical extension of the restoration, and the preferred design of the restoration (screwed or cemented) should dictate the surgical placement of the implant. The implant should be placed within the tooth position.
Rud et al classified, clinically and radiologically, the healing patterns after endodontic surgery as complete, incomplete or scar, uncertain or unsatisfactory, and failure. They found that "apical marginal periodontitis
" is one of the main reasons for failure, and incomplete bone healing was a standard result of the through-and-through osseous defect, due to ingrowth of connective tissue into the bone defect.
The endodontic lesion always produces some kind of periodontal lesion, be it microscopic or macroscopic, but it can be completely reversed by root canal treatment.
There may be initially nothing to see on the radiographs if the injury is small and affects buccal or palatal sites. In order to improve visualization, two strategies are available: either obtain two views with different horizontal projections, or remove the canal obturation and leave the canal empty.
A VRF is a frustating accident for both the dentist and the patient, for several reasons. First, the diagnosis may be difficult because of a lack of specific clinical signs and symptoms and/or typical radiographic features. The differential diagnosis from endodontic or periodontic entities is a challenge.
Subjective information is that the patient does not report spontaneous pain episodes. Objective information includes an intact tooth with gingival
inflammation, bad buccal hygiene, but no fistula.
This occurs in a non-vital tooth with retrograde periodontitis. Attention should be paid to diagnostic tests in order to make the correct lesion classification. Subjective information includes past history of spontaneous pain episodes localized in a particular area.
In order to understand this process, we start from the assumption that there are only two origins: endodontic or periodontic.
The pulp and the periodontium
have a common embryological development, and their ways of communication are the same: lateral canals, dentin tubules, and apical foraminas. Therefore their anatomical-functional interrelationships are going to be very close, in good health as well as in physiopathological disease.