1060H
Fig. 15.27 An orthodontic implant
placed in the mid-line of the palate and
used to provide anchorage. (Image kindly
supplied by Straumann Ltd.)15.5.4 Apical surgery
Apicectomy is rarely performed in children. As with adult patients the best treatment
for pulpal pathology is normally conventional endodontic therapy. However, there are
some indications for the technique, most commonly teeth with intransigent open
apices. A number of different flap designs may be used. The best is the triangular flap
involving the gingival margin and vertical relief incision described above for the
removal of buccally placed buried teeth. Principally this is because the extent of
apical pathology is often more extensive in children than is suggested
radiographically, and use of the semilunar flap can lead to parts of the incision being
left over a bony defect at the end of surgery.
Technique
The surgical technique is identical to that used in adults but there are a number of
points of difference when placing the apical seal. In teeth with immature open apices