Treatment

As a general rule, conventional (or orthograde) rather than surgical (or retrograde) endodontics should be performed if possible-not only because additional trauma results from the surgical approach but also because apicoectomy adversely affects the crown/root ratio and thus the support of the planned prosthesis. If an existing post prevents access to a recurrent periapical lesion, the post can usually be removed. (A Masserann kit has shown some success with this-see Chapter 12.) When a post-and-core restoration is needed in an endodon-

Fig. 6-12. Commonly seen periapical lesions. A, Widened periodontal ligament space. B and C, Large radiolucencies (established granulomas or cysts). (Courtesy Dr. G. Taylor.)

tically treated tooth, 3 to 5 mm of apical seal should be retained (see Chapter 12).

Performing elective endodontics may be desirable in the following situations: when there are problems in obtaining a compatible line of draw between multiple abutments, when it is impossible to gain adequate retention in a badly worn or damaged tooth, and when the endodontic prognosis of an abutment tooth is compromised and additional preparation is likely to further jeopardize its longevity.

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