Endo Microsurgery

Surgical retreat of a 11 (8), Single vertical releasing incision on the level of the mucogingival junction. 📋

👉 When the periosteum is not intact, muscles separation and excision of the deeper tissues is required. Despite the bleeding, hemorrhage control was achieved for retroprep and retrofil while subsequent grafting and sutures worked great.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

An amazing 3-days course in Bologna, Italy. 🙌

Full immersion into soft tissues management around teeth and implants by the wizard of perio, Giovanni Zucchelli.📋 While returning back to the Netherlands, apart from knew knowledge, I realize that it is the inspiration that I got and makes me want to go back to the practice and apply all these techniques in endodontic microsurgery.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

2 months after the non-surgical retreats of all lower incisors, patient presented with intraoral swelling. Allogenic particulate graft material combined with two collagen cross-linked membranes were used to prevent epithelial ingrowth upon healing. 📋🦷

1 year later, patient is fully asymptomatic and functional while remodelling of the bone was evident.✔

Histology results: Apical granuloma

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

Two very important advantages of Piezo surgery were revealed in the study of Bharathi et al. 2021. Compared to conventional handpiece, the use of Piezo, resulted to less swelling and post-op pain. 🙌

Both outcomes are very important to the patients. 📋
👉 Bharathi et al 2021. Effect of the Piezoelectric Device on Intraoperative Hemorrhage Control and Quality of Life after Endodontic Microsurgery: A Randomized Clinical Study.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

While the endodontic part of the surgery does not present any special interest, performing that with this minimally invasive flap, does.🦷 Both papillae spared while sutures 8-0 achieved primary closure.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

Setzer et al. in their first systematic review of the endodontic surgery series tried to compare the two groups. “In group TRS, root-end preparation was made by using burs, root-end fillings with amalgam, and 0x to 4x magnification. In group EMS, ultrasonic root-end preparation and root-end filling were IRM, SuperEBA, or MTA, and high-power illumination and magnification were 10x and higher. 📊

👉 Within the limitation of the primary studies included (mainly selection bias, small sample size and attrition bias), a superiority of EMS was revealed. While Risk of Bias is a reason to downgrade the certainty of evidence of the study, the “large magnitude of effect” (OR=10) is a reason for upgrade.

👉 Setzer et al. 2010 Outcome of endodontic surgery: a meta-analysis of the literature--part 1: Comparison of traditional root-end surgery and endodontic microsurgery

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Tooth 36 (19) was retreated surgically 6months ago. A broken file apically of ML canal and a ledge by the MB made me chose surgery over orthograde retreat. Although I grafted the area, it seems that some of my material washed out leading to small loss of volume apically.📑🦷

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

Case 15: Surgical retreatment of tooth 12 (7). Bony lid was harvested by means of piezo. Native collagen membrane was placed against the palatal defect first and then allogenic particulate graft was used to support the bony lid. Thick gingival phenotype allowed for simultaneous CAF (without CTG) to improve the recessions by the lateral and central incisor. Normally for the coverage of these recessions, a completely different flap design and approach accompanied by a connective tissue graft would be needed. At 3 months recall, the recessions have been slightly improved. 📋

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

🔔 Reminder: Thrilled to be part of Endodontic Master Series 2024

Uncover the latest advancements and cutting-edge insights through a series of extremely useful lectures for the clinical activity in the endodontic field: 🔬 Endodontic Microsurgery - last resort or minimally invasive solution 🌐 CBCT unleashed - the endodontic crystal ball 👀 Apical Patency: Ensuring Endodontic Success 🚦 Endodontic Missteps: Learning from errors ⏱ Endodontic Efficiency 🔄 Endodontics vs Implants: the increasing risks of overtreatment 📊 Latest Direct Outcome Studies in Endodontology Don’t miss this unique opportunity to enhance your knowledge and network with experts in the field! 🤝💡 📅 Date: April 13th, 2024

📍 Location: Intercontinental Athenée Palace Bucharest Book your spot today!

[email protected] https://rccendo.eu/curs-endodontic-master-series-2024/

Let’s elevate the standard of endodontic practice together!

📑 Case 14: Surgical retreatment DB and P fused root of tooth 16 (3). Bony lid (2 pieces) was harvested by means of piezo. Slight sinus lift elevation was performed to facilitate visibility. 1y Follow-up revealed great healing.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

An interesting failure (Previously posted Case 3)🦷. Apical periodontitis is healing while tooth 22 (10) presents signs of inflammatory root resorption. Deep pockets (8-9mm) were revealed palatally upon probing. Extraction was advised. Interested in hearing your opinions. What could be the cause?

🗂 For more info about the case, check Case 3.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

Case 13: Surgical retreatment of tooth 34 (21). Careful elevation in the area of mental nerve bifurcation. Bony lid was harvested by means of piezo. 📋

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

1y follow up of Case 2. Great healing achieved a year later. Cortical plate perfectly healed while the allograft is still remodeling. 🦷

🗂 For more info about the case, check Case 2.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

A great surgical course in Tijuana, Mexico offered by . Learned different techniques on guided bone regeneration and implants. Had the privilege to be supervised by the best duo ( and ) while meeting some great dentists from Canada.
"𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

Tawil et al found that in failing RCTs, dentinal defects were far more prevalent in retreated teeth compared to primary RCTs. 🦷

👉 This finding is very important upon decision making in failing RCTs, as dentinal defects significantly downgrade the chance for success of surgery. Non-surgical retreat is, thus, not always the only solution in cases with a good restoration and well addressed anatomy; surgical retreat should also be considered directly.

"𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

Thrilled to be part of Endodontic Master Series 2024

Uncover the latest advancements and cutting-edge insights through a series of extremely useful lectures for the clinical activity in the endodontic field: 🔬 Endodontic Microsurgery - last resort or minimally invasive solution 🌐 CBCT unleashed - the endodontic crystal ball 👀 Apical Patency: Ensuring Endodontic Success 🚦 Endodontic Missteps: Learning from errors ⏱ Endodontic Efficiency 🔄 Endodontics vs Implants: the increasing risks of overtreatment 📊 Latest Direct Outcome Studies in Endodontology Don’t miss this unique opportunity to enhance your knowledge and network with experts in the field! 🤝💡 📅 Date: April 13th, 2024

📍 Location: Intercontinental Athenée Palace Bucharest Book your spot today!

[email protected] https://rccendo.eu/curs-endodontic-master-series-2024/

Let’s elevate the standard of endodontic practice together!

6months follow-up of Case 1. Patient is asymptomatic while the cortical plate has already healed. The cancellous bone where the area was grafted is still remodeling as allograft was used. 📋

👉 For more info about the case, check Case 1.

"𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"

In 2014, I, Thanos Fasoulas, earned my dentistry degree from Aristotle University of Thessaloniki, Greece. 📃

📍 By 2016, I relocated to the Netherlands, commencing work in general practices. Concurrently, I achieved a Master's degree in Medical Research Methodology from the Medical School of Aristotle University of Thessaloniki, Greece. In 2021, I successfully completed my dental endodontist training at the University of Ghent, Belgium.

✔ I work in Endo en Zo, an endodontic referral practice in Amsterdam, while my passion lies in endodontic microsurgery. I proudly hold memberships with the Dutch Society of Endodontology and the American Association of Endodontists.

Come along and follow my journey to "𝘔𝘪𝘤𝘳𝘰𝘴𝘶𝘳𝘨𝘦𝘳𝘺 𝘊𝘩𝘳𝘰𝘯𝘪𝘤𝘭𝘦𝘴: 𝘉𝘦𝘺𝘰𝘯𝘥 𝘵𝘩𝘦 𝘳𝘦𝘢𝘭𝘮 𝘰𝘧 𝘦𝘹𝘵𝘳𝘢𝘤𝘵𝘪𝘰𝘯"