Follow up of root canal patient

Follow up of root canal patient

Before treatment

Immediately After Treatment

Eight months After Treatment

Todays case with unerrupted parapremolar with obturation with lower first molar

Todays case with unerrupted parapremolar with obturation with lower first molar

Bone density classification

Bone density classification

   1. dense compact (D-1) bone

   2. dense to thick porous compact and coarse trabecular (D-2) bone

   3. porous compact and         fine trabecular (D-3) bone

   4. fine trabecular (D-4) bone

Division of available bone

Surgical technique

Surgical technique

   Patient sedation, local anesthesia, and preparation of an aseptic environment

   Antiseptic mouth rinse : Chlorhexidine scrub and rinse may be used

   Iodophor compounds ( Betadine ) are a most effective antiseptic, but inhibit the osteoinduction of demineralized bone

Regional anesthesia

   Blocking maxillary nerve (v2 ) : 1.8 ml

   Hemimaxilla, side of nose, cheek, lip, sinus area

   Long-acting anesthetic : Bupivacaine 0.5 % or Etidocaine 1.5 % with EPI 1:200,000

Local infiltration

   Labial mucosa and palatal region

   Complete hemostasis

   Lidocaine 2 % with EPI 1:100,000   

Patient evaluation treatment planning for edentulous posterior maxilla

Patient evaluation treatment planning for edentulous posterior maxilla

   The SA-2 to SA-4 surgical procedures the sinus should be free of infection

   In addition, a thorough history and clinical evaluation of the maxillary sinus are conducted.

   Potential infection in the region of the sinuses may result in extremely severe complication

   Physical examination

   Radiography

   Conventional :OPG, water’s view

   CT

   MRI

   CT is currently the modality of choice

   Any sign of acute sinusitis, root tips, cysts or tumors complicate the procedure and mandate further evaluation

   Known diseases of the antrum should be treated before sinus grafts

Treatment planning for edentulous posterior maxilla

   The maxillary ostium opening in the medial wall                            and near the superior aspect of the sinus

   The cilia beat toward the ostium at 15 cycles/minute

   Adequate manipulation of the membrane and placement of graft material are possible without impeding the drainage of the sinus

Treatment planning for edentulous posterior maxilla

Maxillary Sinus Anatomy & Sinus membrane

Maxillary Sinus Anatomy

Pyramidal shape

Roof                : floor of orbit

Floor               : alveolar bone and palatine process

Anterior wall  : facial surface of maxilla

Posterior wall : infratemporal  surface

Medial wall        : lateral wall of  nasal cavity

Sinus membrane

Schneiderian membrane

Mucoperiosteum cansists 3 layers

1.Epithelium lining : pseudostratified columnar ciliated epithelium

2.Lamina propria           can stripped easily from

3.periosteum                         underlying bone

There are numerous globlet cell

Most of the serous and mucous glands found in the lining are located near the maxillary ostium