restoration in the root apex. The dentist may use an ultrasonic or a high-speed handpiece with a bur to prepare the blunted apex for the filling. When the preparation is complete, the surgical site is irrigated carefully with saline solution and aspirated until it is dried thoroughly. Hemostatic agents such as bovine collagen or ferric sulfate may be placed to control bleeding and to catch scraps during the placement and condensation of the root end filling material. Intermediate restorative material such as ZOE, or super EBA cement (ethoxybenzoic acid) is mixed and placed into the recessed preparation of the root apex. The retrograde filling is condensed and smoothed even with the tip of the amputated root surface. The hemostatic agents are carefully removed to avoid dropping scraps or cement into the incision. The site may be irrigated and aspirated again.
A radiograph is exposed to determine the absence of any filling particles in the tissue at the surgical site. When it is determined that the filling is satisfactory and that all particles of the filling material are removed, sutures are placed to close the incision. The surgical portion of the apicoectomy is done quickly. The longer the patient is subjected to a surgical procedure, the more likely it is that there will be swelling and discomfort. Follow-up appointments usually are scheduled periodically for radiographs of the restored tooth. 7-16