Root‐end management: resection, cavity preparation, and material placement

By Stropko J.J, Doyon G.E, Gutmann J.L.

Date: 02/2007
Journal: JOE

  Methylene blue staining:

The dried root surface is ten stained with 1% methylene blue (MBS) for 10–15 s. MBS only discolors organic material, if there are any fractures, tissue remnants in the isthmus, or accessory canals present it will stain it Fig.4.

  REP (Ultrasonic REP):

-Requirements of REP includes:

-The apical 3 mm of the root canal is thoroughly cleaned and shaped. The prep is parallel and centred within the pulpal space. The remaining dentinal walls are not weakened

-The 1st tips made for endodontic apical surgery was CT tips made from SS and are still widely used today Fig.5.

-Diamond coated tips (efficiently remove GP), ticonium tips (easier visibility), and KiS tips (provide constant stream of water aimed at the tip) Fig.6 .

-It is important to routinely prepare the isthmus, because if the isthmus is just coronal to the bevelled surface, post-surgical remodelling of the bevelled root surface may expose the entire canal system to the periradicular tissues Fig.7.

-If difficulty is experienced in tracking the groove between 2 canals it advised to use “Dot technique (creating multiple pin point grooves in the root surface ” to eliminate the US tip slipping of the root surface Fig.8. The smear layer removed by 17% EDTA, 10% Citric acid, BioPure, or 37% phosphoric acid gel. To eradicated E.faecalis 2% CHX gel or liquid can be used for 15 s.


-REF includes: amalgam, IRM, Super-EBA, Optibond, Geristore, and MTA. Map system, Retrofill Amalgam Carrier,  Lee MTA Pellet Forming Block (simple & efficient), and Dovgan MTA Carriers are used to carry the MTA to REP Fig.9.

Clinical sig:

– There is much to consider when performing the root-end procedures, but if the above steps are

followed properly in an orderly fashion, healing should be successful and uneventful.