[Periapical surgery of the molars].

INTRODUCTION

If loss of a great number of teeth occurs, one molar in the lateral segment is of great importance. Contemporary techniques and materials provide extremely successful conservative treatment of pulpal diseases and apical periodontitis. In some cases, however, surgery is indicated.

INDICATIONS

Indications for periapical surgery used to be a matter of double standards. If periapical surgery is indicated in incisors, it is performed without delay, but if it is indicated in molars, it is often exchanged for extraction. Surgical access in the region of upper and lower molars is specific in regard to much more frequently operated incisors due to anatomic structures at the surgical site. Canal filling techniques, implants, endodontic surgical procedures are of importance and can provide better healing. High quality canal filling is condition sine qua non in treatment of apical periodontitis. It is performed prior surgery, by conventional orthograde endodontic techniques, during surgery by orthograde technique and/or retrogradely. Implants provide better bone healing and are recommended in surgery of molar apex. Surgical packing has numerous advantages (better psychological and mechanical care).

CONCLUSION

Good knowledge of anatomy and surgical techniques is a pre-requisite for molar apicoectomy. Careful establishment of indications and good relations with the patient provide good prognosis of this therapeutic method.