Endodontic microsurgery on maxillary and mandibular molars : new bone trepanation technique. - ROS - 2009 - Tome 38 - N°1

The introduction of the surgical operating microscope has fundamentally changed the procedures. The author firmly believes that endodontic surgery should not be performed without a microscope. Owing to this fundamental change inretrograd endodontics, we can now locate and treat second and third molars, and manage procedural errors such as overfilling inside mandibular canal. However, another way of thinking will be presented hereinafter, especially as regards the posterior sites.The operating procedure consists of three stages:
First step: Locating the root - The surgeon must find a trephination zone near the neck of the tooth where the bone is not very thick and the root, whether curved or lingually inclined, hasn't yet changed its course. Therefore, the root must be located first and not the apex itself.
Second step: Following the root - From the location point, we can gradually follow the root diagonally to its axis whatever the course may be. Within this procedure, two maneuvers must be carried out simultaneously: the surgeon has to progress in depth and width at the same time.
Third step: Grinding the apex and increasing the bone cavity - After locating the apex, the surgeon must never think of cutting out a part of the root. Instead he must grind this apex while going back up from its round border to the cervical part of the root. This technique plays also an important role when the apex is in contact with the mandibular nerve because the head of the bur is permanently in contact with the root.