[Allen Ali Nasseh]

An efficient retrofilling is important at a time when we’re fighting bleeders and difficult management in a small space. Dr. Nasseh sets out to explain the most efficient method of retrofilling he has developed over the past 10 years: The Lid Technique.
[See the full post at: The Lid Technique for Retrofilling]

[Mounir Mallek]

Hi Dr.Nasseh, beautifully done case as always!

I wanted to ask what would be your recommendations to safely remove bone so as not to damage the live tissues ?
And what’s your philosophy when it comes to post-surgical prescriptions for otherwise healthy patients ?

[Allen Ali Nasseh]

@Mounir Mallek: I’m not sure what you mean by removing Bone without damaging Live tissues. Clearly bone is a live tissue. So, are you talking about accessing the apex without damaging adjacent teeth and roots? If that’s the question then the answer is really studying the preoperative CBCT and radiograph and looking at bony eminences on the alveolar bone and looking at the CEJ and the placement of entry of the root into the alveolar process. The rest is having perceptual ability and knowing your anatomy.
The second question is I usually prescribe some anti-swelling medications and for pain they need mostly NSAIDs. Antibiotics are recommended if a patient is immune compromised or vital structures were exposed (sinus, etc.) Otherwise, most healthy people don’t need antibiotic coverage and heal normally. But I do prescribe Chlorohexidine oral rinse for 5 days post op.

[Mounir Mallek]

Sorry for the poor wording, what I meant were tips (preferred speeds, burs, etc…) to preserve the tissue surrounding your access, for example from heat damage which might cause necrosis of the bone.

[Allen Ali Nasseh]

@Mounir Mallek: that’s the whole surgery course I teach at our school and is hard to answer in a comment. But the key is the handpiece, water port, and then the motion. Most importantly to not torque and heat up the bone. This way it has a chance to regenerate once the source of infection is addressed through a proper apico and retrofilling procedure. My favorite bur for this is the Lindaman Bur and a surgical round #6. I’m a minimalist whenever possible. 🙂

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