Methylene blue dye: an aid to endodontic surgery

By Cambruzzi JV, Marshall FJ, Pappin JB.

Date: 02/1986
Journal: JOE

Summary: 

-Methyleneblue dye is often used in general medicine to evaluate renal function

-General surgeons inject the dye into sinus tracts making the outlined tracts easier to identify and remove

-It is also used to treat methemoglobenemia due to prilocaine toxicity

-In endodontics, it is used most often in marginal leakage studies to stain those areas that not sealed by the obturating material

-Methylene blue dye can be a useful aid in endodontic surgery :

1.Outlines the root

2.Delineates root dentin from bone

3.Delineate apical (vertical) fractures

4.Demarks isthmuses between two canals in a single root

5.Outlines cysts for enucleation –

 Clinical significance:

Methylene blue dye staining has been useful aid in apical surgery procedure

The Differences between Traditional and Microsurgical Techniques in Endodontic Surgery:

The Operating Microscope: Why is It Essential for Microsurgery? :

•The surgical field can be inspected at high magnification.

•Removal of diseased tissues is precise and complete.

•Distinction between the bone and root tip can easily be made easily. •Surgical techniques can be evaluated, e.g. whether the granulomatous tissue was completely removed from the bone crypt.

•Occupational and physical stress is reduced.

•The number of radiographs may be reduced

The Operating Microscope: Why is It Essential for Microsurgery? :

•Size of Osteotomy can be reduced.

•Recordings of procedures can be used effectively for education of patients and students. 

•Communication with the referring dentists is improved significantly.

Hemostasis
Local Anesthesia: The Epinephrine Misconception 

•In endodontic surgery, local anesthesia has two distinct purposes: anesthesia and hemostasis. 

•a high concentration of vasoconstrictor containing anesthetic, e.g. 1:50,000 epinephrine, is preferred 

•The New York Heart Association suggested a maximal dose of 0.2 mg of epinephrine for cardiac patients 

Surgical Hemostasis:

Bone Wax Studies have shown that bone wax causes a foreign body reaction if left in the surgical site 

Epinephrine Cotton Pellet: Racellets are cotton pellets containing epinephrine hydrochloride. The amount of epinephrine in each pellet varies. For example, each Racellet #3 pellet contains an average of 0.55-mg epinephrine. Each Racellet #2 pellet contains 1.15 mg of epinephrine hydrochloride. 

Ferric Sulfate A dark brown or greenish brown coagulum forms immedi- ately on contact with blood 

Thrombin: The main disadvantage of topical thrombin is that it is difficult to handle and to deliver to the bleeding site. It is also expensive. 

Atraumatic Tissue Retraction and the Groove Technique 

•One of the key factors in postoperative tissue swelling is because of frequent slippage of the retractor during surgery 

•A 15-mm long horizontal groove is cut into the water-cooled bone with a Lindemann bur or a #4 round bur.