Figure 7-19.Steps in filling a root canal with master and accessory cones.
Figure 7-20.Permanent restoration in place on completed
Along with the apicoectomy, the dentist usually
performs a periapical curettage and may place a
retrograde filling. After the patient has been draped
and anesthetized, the dentist makes a surgical incision
on the facial aspect of the alveolar ridge and a
mucoperiosteal flap is elevated to expose the apex of
the tooth to be treated. The assistant aids in retraction
of the mucoperiosteal flap with the periosteal elevator
and provides suction. This reveals the cortical bone of
the alveolus covering the apex of the tooth. The dentist
then uses a handpiece and surgical bur to remove the
cortical plate covering the apex of the tooth. Once the
root is exposed, the dentist uses the bur to remove the
apex as shown in figure 7-21. The assistant irrigates
with a saline solution and aspirates as needed. The
dentist uses a curette to curettage the surrounding
Figure 7-21.Removing apex of tooth.
periapical tissue, thus removing infectious material
from around the root tip. Figure 7-22 illustrates the
curettage procedure. If access to the canal is obstructed
from the occlusal or lingual aspect, debridement and
filling can now be done from the apex.
If indicated, a retrograde filling may be performed
to seal the apical end of the root canal by placing a
Figure 7-22.Apical curettage procedure.