Pulpal and periodontal diseases
are responsible for more than 50% of tooth mortality. Diagnosis is often challenging because these diseases have been primarily studied as separate entities and not as dynamic processes that show different phases as they evolve. It is important to understand such processes in order to institute appropriate treatment.
Endodontic surgery causes a transient bacteremia, but this does not represent a problem in healthy patients because oral tissues are highly resistant to the invasion of micro-organisms. Infections after endodontic surgical procedures, as after periodontal surgery, are extremely rare, so antibiotic therapy is seldom required and cannot be justified as part of the routine postsurgical regimen.
Narcotics are pure analgesic drugs with a central effect but no antiinflammatory properties. They are no more effective than nonnarcotic analgesics for the mild to moderate pain that usually results from endodontic surgery, but their potential for complicating side-effects is much higher. This is why they are reserved only for severe pain, when non-narcotic drugs have been ineffective.
The proprionic acid derivates (NSAIDs) have both analgesic and antiinflammatory properties. Although salicylates such as aspirin are included in this group, ibuprofen has become the drug of choice for managing dental pain. The dosage is 600 mg every 8 h. Ibuprofen should be taken with food.
Application of pressure
The surgical area should be covered with a sterile gauze and pressed with the fingers softly, firmly and constantly for 5-10 minutes, to stabilize the natural fiber bridge that will result in new clot formation1. When this manual pressure has been removed, the patient should be told to either bite the gauze (occlusive pressure) or press with the tongue on the gauze (palatine and lingual pressure). This gauze is removed before the patient leaves the office to check that there is no bleeding. A new dry gauze is put back and should remain in place completely still for 1 hour.
Oral tissues have excellent healing potential owing to the presence of cells with tissue regeneration capability, a dense vasculature, and a high turnover rate of connective tissue and epithelium. So, in contrast to the skin, wound healing in oral gingiva results in little scar formation.
The most desirable knot is the simplest one that can be made with the suture being used. The knot must be as small as possible in order to avoid an excessive tissue reaction when an absorbable suture is used, or in order to minimize the foreign body reaction when a nonabsorbable suture suture is used.
Silk is a multifilament braided suture with a high standard moisture regain: the "wick effect". This results in plaque formation within a few hours after insertion into the tissues.
Because sutures are a foreign material in the body and impede the healing process, the minimum number of stitches and the thinnest suture that provides adequate flap reattachment should be used. Sutures should be removed at the earliest biologically acceptable time (minimum 48 h, maximum 96 h).
The ideal length, size, design of the needle and suture are dictated by the flap thickness, incision location, suture technique employed, etc. No single needle shape and radius is ideal for every situation.