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You're faced with a beautiful crown with what seems like a decent root filling - but there's an apical infection present. Is the answer always endodontic re-treatment? When should we instead consider apical surgery so we can clear the infection WITHOUT drilling through the crown or having to dismantle posts?\n\n\n\nIn this episode, specialist endodontist Dr. Peter Raftery and his associate Dr. Manpreet Dhesi will be talking about the Apicoectomy procedure that can be used to treat root-filled teeth using a 'retrograde' approach. They will discuss about how it fits into general dentistry, its indications and contraindications, its cost analysis vs implants and and the entire protocol for performing Apicoectomy\n\n\n\n\nhttps://youtu.be/sZOsLuuf-Vo\nWatch PDP148 on Youtube\n\n\n\nProtrusive Dental Pearl:\xa0The periradicular surgery guidelines issued by BES and the Royal College of Surgeons. Download the guidelines about periradicular surgery or on the app under the Protrusive Vault (where all the different files and infographics and the different things that you get as a Protrusive premium member)\n\n\n\nBES-RCS-Peri-Radicular-Surgery-GuidelinesDownload\n\n\n\nDownload\xa0Protrusive App\xa0on\xa0iOS\xa0and\xa0Android\xa0and Claim your Verifiable CPD/CE by answering a few questions + You can get EARLY ACCESS to the episode + EXCLUSIVE content\n\n\n\nNeed to Read it? Check out the Full Episode Transcript below!\n\n\n\nHighlights of this episode:\n\n\n\n1:37 The Protrusive Dental Pearl\xa03:32 Dr. Peter Raftery\u2019s introduction4:05 Dr. Manpreet Dhesi\u2019s introduction5:16 What is Apicoectomy?6:29 Oral Surgeons vs Endodontists?8:48 Is a Microscope mandatory for Apicoectomy?10:08 Apicoectomy for posteriors11:00 Isolation Protocol for Anterior Apicoectomies11:35 Apicoectomy Protocol15:03 Disinfection Protocol18:41 Moisture control from the bleeding20:43 Risk of surgical emphysema - Is special handpiece needed?21:52 Indications and Contraindications for Apicoectomy\xa027:46 Endodontic Re-treatment29:05 Cost benefit analysis of Apicoectomy31:20 Success rate for Apicoectomy34:19 Case Scenario 1: 82-year old patient with a singular crown, root filling and a radicular pathology42:10 Retrograde fillings of choice\xa0\xa044:09 Grafting after Apicoectomy - is it needed?45:04 Equipments for Apicoectomy47:11 Learning more about Apicoectomy\n\n\n\nApical Microsurgery Instrument Kit- the mirror, the pluggers, and the little curettes by Hu-Friedy UK\n\n\n\nApical-Microsurgery-Instrument-KitDownload\n\n\n\nIf you enjoyed this episode, check this another episode by Dr. Peter Raftery: How to Save \u2018Hopeless\u2019 Teeth with the Surgical Extrusion Technique\n\n\n\n\n\n\n\nClick below for full episode transcript:\n\n\n\nJaz's Introduction: Root canals are not 100% successful. Let's face it, nothing in dentistry is a hundred percent predictable, and sometimes we are confronted with a scenario such as a beautiful central incisor crown and it's a root filled tooth, or worse yet a tooth and incisor, usually with a long thick post inside of it.\n\n\n\nJaz's Introduction:Now, just because it looks good on the radiograph doesn't mean it was a good quality x-ray. We all know that. But anyway, let's say it looks like a decent root filling. There are no voids in it, and now you're really questioning whether it's really feasible to go down a root canal re-treatment, or is there another option?\n\n\n\nAnd sometimes that other option, which really comes into play in these scenarios is an apicoectomy where a flap is raised, the infection is curetted, and a bit of the root, a bit of the apex is chopped away, and then boney healing takes place. Now this is known as microsurgical endodontics. It used to be done a lot by oral surgeons in the UK at least many years ago.\n\n\n\nAnd now endodontists have reclaimed this territory and suggest that actually this is the way we do it to get high predictability. And that's exactly what we're got to discuss in this episode. Hello, Protruserati. I'm Jaz Gulati. I'm joined in this episode by Dr. Peter Raftery,