Endodontic Surgery (Apicoectomy)

Endodontic Surgery (Apicoectomy) In this modern times patient increasingly wish to preserve their natural dentition and often reluctant to get there teeth extracted . Endodontic surgery (apicoectomy) is the treatment performed on the root apices of an infected tooth, and its resection and removal of pathological tissues around the apices followed by placement of a filling (retrofilling) to seal the root end. Endodontic surgery offers patient a second chance or the final chance to save there tooth. Success of Root end surgery had a poor prognosis and success rate in the past but due to recent advances Endontics due to the surgical operating microscope and new tecniques the rate is much higher than before success Its indications are as follows 1 RCT treated tooth that has severe periapical inflammation despite of a satisfactory RCT 2 Tooth with persistant periapical inflammation and inadequate RCT and has the following problems a Severely curved root canals where access is an issue to reach the apex b Completely calcified root canals C Presence of post and cores in root d Breakage of small instrument or filling material where it is not retrievable and an infection is still present in the apical region. Teeth with periapical inflammation where completion of endodontic therapy due to 1 Foreign body present in the periapical tissues 2 Perforation of the inferior wall of the pulp chamber 3 Perforation of the root 4 Fracture of the apical third of the root 5 Dental anomalies (Dense in Dente ) 6 Access for periradicular curettage A non healing endodontic lesion is recognized by persistent pain and/or swelling, possibly with radiographic changes indicating increasing periapical bone loss. Non healing endodontically treated teeth that do not appear to be healing are not automatic indications for extraction and replacement with an implant. Persistent nonhealing cases can be saved by endodontic microsurgery with a predictably favorable prognosis Nonsurgical endodontic treatment has a high rate of clinical success despite the anatomic and pathologic challenges of the procedure. Success in case of tooth without periapical extension of pathosis is more than 90%. On the other hand, studies show that infected root canals with an extension of pathosis into the periapical space have a reduced healing capacity . previously the conventional endosurgery has very low success rate . it was recorded as low as 37.4 % but now with recent advancement in endodontic surgery the success rate has improved significantly. According to a study conducted by shimon Friedman and Chaim Mor ( success of endodontic therapy -healing and functionality) in patients were endodontic surgery is performed the chances of healing after retreatment is between 74 to 86 %and their chance of being functional overtime is 91 to 97 % .Another study ( modern endodontic surgery concept and practice by syngcuk Kim and Samuel Kratchman)said that the traditonal apical surge rybased on clinical symptoms and radiographic findings ranges from 44% to 90%.it has even higher success rate with the endodontic microsurgery. . According to another study (outcome of surgical endodontic treatment performed by a modern technique A meta anlysis conducted by Igor Tsesis , Surgical endodontic treatment have a success rate of 91 .4 % when followed up in a year time . According toa study named Outcome of endodontic micro re- surgery by Minju song and team à ¢Ã¢â€š ¬Ã‚ ¦. When an endodontic surgery fails we need to identify the problem and find the reason for failure. To solve the problem further treatment like retreatment with surgery and, extraction are the viable options. Some studies in the past have documented poor success rate if we have to redo a failed surgery again. But this study said that with the new microscope and microsurgical devices the success rate can be as high as 92.9 %. Most of the reason for failure is poor technique,poor seal at the apical region and not using biocompatible materials like MTA and super PBA in the past. In another recent study it was found that, at least in America, endodontic surgery was the least expensive intervention for failed RCT when compared to endodontic re-treatment and crown, extraction and fixed partial denture, or extraction and implant (Kim Solomon, 2011). When primary `endodontic treatment fails retreatment should be done and when retreated and if there is severe inflammation in the periapical tissues then endo surgery can be an option using advance techniqies and good operationg skill can add to the success of endo surgery. 1 Microscope The microscope will provide good visualization, identification and treatment of infected canals, isthmuses and variant anatomy not reachable with traditional instrumentation techniques. Microscope can reach to more different locations and narrow spaces, by providing a clear field of vision. Good visualization also prevents damage to anatomical structures. Microscopic techniques significantly decrease complications and expand the case applicability for performing this procedure on teeth adjacent to these structures. With increased magnification and illumination, differentiating the root surface from the surrounding bone is also enhanced .A main cause of nonsurgical endodontic failure results from the inability to clean and sterilize the apical canal space, which is a complex anatomical entity. 2 ultrasonic tips That allow accurate preparation along the long axis of the root canal with clear visualization of the preparation . This technique will allow us to do root-end fillings in the proper position to seal the root canal to sufficient filling depth and thickness to effectively seal the canal, dentinal tubules and accessory canals. Ideal ultrasonic tip length is 3mm long. A minimum of 3mm preparation depth is needed to prevent leakage. 3 Surgical advances A smaller osteotomy will reduce bone removal (approximately 3-4mm) in diameter reduced bone and permits quicker uneventful postoperative healing postoperative healing. By removing less bone in the coronal direction, buccal bone can be preserved and subsequent periodontal sequelae that may lead to the loss of the tooth are prevented. Root-tip resection of 3mm is needed to eliminate lateral canals and apical ramification- A study shows that the resection of 3mm of apex eliminates 98 percent of apical ramifications and 93 percent of lateral canals. Root section bevel angle is reduced to 0 -10 degrees Clear examination of the resected root surfaces for fracture and anoatomical variations Root-end fillings with MTA (Mineral Trioxide Aggregate- It has excellent biocompatibility, osteo- and cemento-inductive capabilities, effective antibacterial and sealing properties, and faster radiographic healing in comparison to SuperEBA and IRM. MTA will not cause soft tissue discoloration that can otherwise result from root-end filling materials like amalgam Magnification Eyes or Loupes (1-4x) Microscope (4-24x) Illumination Dental light Bright focused light Armamentarium Macro-instruments Micro-instruments Osteotomy Size Large (7-10mm diameter) Small (3-3mm diameter) Bevel Angle Acute (45-60 degree) Shallow (0-10 degree) Root-end Preparation Non-axial Axial to long axis of tooth Depth of Root-end prep 1mm non-axial 3mm axial Inspection resected root surface None Always Root-end filling material Amalgam MTA Success rate over 1 year Less than 50% Over 90% Summary There are many factors to consider when choosing to perform microsurgery  on a tooth versus performing other treatment options such as  nonsurgical retreatment or tooth extraction. Fortunately for the patient,  the ability to perform endodontic microsurgery is an effective and highly  successful procedure that produces minimal discomfort, alleviates periradicular  pathosis, maintains restorations and provides for function and  aesthetics as shown in Figure 6.33,34

Experience That Has Significantly Shaped Your Life

26 July 2005 – A usual day at junior college when I was day dreaming through another lecture. In the background I could hear heavy rains lashing down. The skies were remarkably dark for even a monsoon day in Mumbai. I checked my clock there were just another 15 minutes to the lecture. After the lecture, I and my friend Sahil left for Matunga station to take a local train home. Now my college is about 15 miles from where I stay and we usually travelled by the local trains to and fro. As expected, the trains were delayed because of the monsoons.More than an hour and there were still no trains. Finally there was announcement that the trains have been cancelled indefinitely till the water clears out. We panicked and tried getting a cab to no avail. Buses were stuck due to water logging on the road. The situation worsened as cell phone network went down. We could not connect to anyone for help neither could we assure them for our safety. It was utter chaos. There were thousands of people on road walking their way through the water. We had the option of walking back the entire way of home.But it was extremely unsafe due to open manhole covers which would be invisible over the accumulated water. We were scared and clueless on what we should do during such a disaster. College was the safest place that we knew of nearby. College had no electricity and there was water to the knee level. It was extremely dark and the winds with thunderstorms gave it a spooky eerie feeling. There were others like us who had taken shelter in the college. Some were crying and some others were consoling them.It was heart touching to see humanity in such drastic times. Some arranged for food from what was left in the canteen. Some got candles from the college store room. Ordinary people turned into unexpected Samaritans by helping complete strangers endangering their lives in process. The next day was not as sunny and bright I as I had liked it to be. The rain had reduced. The water lev el had receded. I and Sahil decided to start on the way home. It was a memorable journey in itself. The water had not receded enough for trains and buses to start.We had to walk a few miles, climb behind a lorry for another few and use a rubber dinghy to ferry for remaining some. Finally we reached our respective homes. I cried as I hugged my mother. The experience changed my life in so many ways. I learned to respect â€Å"Mother nature† and devastation caused from her wrath. It strengthened my love for family and friends and it gave meaning to the feeling â€Å"we cannot do this alone†. Many people lost lives, loved ones and belongings. I started appreciating what little God has given me. I felt lucky to have survived such tough times.

Accounting Environment Essay

Learning Outcomes At the end of this chapter the students should be able to: ?Explain the meaning and purpose of accounting ?Describe the role of accounting as a information system ? Describe why accounting is considered as the language of business ? Assess the impact of external environmental factors on accounting Introduction Accounting has evolved and emerged as most other fields of human activity in response to the social and economic needs of society. Today accounting is moving away from its traditional procedural base, encompassing record keeping and related activities towards the adoption of a role which emphasizes its social importance. In this context, this introductory chapter of the course manual deals with the definition of accounting, use of accounting as an information system and the language of business, users of accounting information and the impact of external environment on accounting. Definition of Accounting The question what is meant by accounting has not been answered precisely. Instead there are many definitions on accounting. Some of these definitions are considered in this section to identify the purpose and functions of accounting. The Committee on Terminology of the American Institute of Certified Public Accountants (AICPA) formulated the following definition on accounting in 1941. Accounting is the art of recording, classifying and summarizing in a significant manner and in terms of money, transactions and events which are, in part at least, of a financial character, and interpreting the results thereof. This definition of AICPA, USA has been quoted for many years. However, it defines accounting only from the point of view of what it does. Hence, it does not clearly establish the purpose of accounting. On the other hand, the following definition provided by the American Accounting Association (AAA) in 1961 emphasizes the broader perspective of accounting. This definition focuses on accounting as an aid to decision-making. Accounting is the process of identifying, measuring and communicating economic information to permit informed judgements and decisions by users of the information. In 1970, AICPA of USA provided the following definition on accounting with reference to the concept of information. The term ‘quantitative information’ used in this definition is wider in scope than financial or economic information used in previous definitions. Accounting is a service activity. Its function is to provide quantitative information primarily financial in nature about economic activities that is intended to be useful in making economic decisions. Both definitions of AAA and AICPA show that accounting is considered not merely with record keeping. Instead it involves with a whole range of activities. These two definitions emphasize on using accounting information for decision making purposes. Both internal parties of an organization (e. g. managers) and outside parties (e. g. owners, creditors, government) use accounting information in making decisions that affect the organization. Although these definitions have looked at accounting from different perspectives, they have been able to set the boundary of accounting. They have established the nature of accounting and the purpose for which it is used. Hence, based on these definitions, it can be said that accounting is primarily concerned with the provision of information to various stakeholders of an organization to be used in decision making. Accounting as an Information System AAA definition on accounting implies two phases: (1) identifying and measuring economic information and (2) communicating economic information to users (stakeholders of an organisation) for decision making purposes. These two phases show that accounting acts as an information system in an organisation. The accounting process involves recoding and processing of transactions and events of an entity that had occurred during a specific period of time, and communicating the information relevant to processed transactions and events to aid decision-making of various users of accounting information. As an information system, accounting links an information source or transmitter (preparer/s of information), a channel of communication (financial and other statements/reports) and a set of receivers (users of information/stakeholders of an organization). The Figure 1 shows how accounting functions as an information system in business and economic decisions. In the accounting system, transactions and events are the input and the statements of reports given to decision-makers are the output. Figure 1 Accounting as an Information System in Business and Economic Decisions Data Source: Lal, J. (2005), Corporate Financial Reporting: Theory and Practice, second edition, Taxmann Allied Services (Pvt) Ltd, New Delhi. Accounting as the Language of Business Accounting is often called the language of business because it is considered as the main mean of communicating information about a business. This reference to accounting as the language of business is observed by Ijiri (1975) as follows: As the language of business, accounting has many things in common with other languages. The various business activities of a firm are reported in accounting statements using accounting language, just as reported news events are reported in newspapers, in the English Language. To express an event in accounting or in English we must follow certain rules. Without following certain rules diligently, not only does one run the risk of being misunderstood but also risks a penalty for misinterpretation, lying or perjury. Comparability of statements is essential to the effective functioning of a language whether it is in English or in Accounting. At the same time, language has to be flexible to adapt to a changing environment. A language broadly has two components: symbols and rules. In accounting too, these two components are available. In accounting, numerals and words, and debits and credits are accepted symbols and they are unique to the accounting discipline. The rules in accounting refer to the general set of procedures followed in creating financial information for an entity. Anthony and Reece (1991) draw a parallel between accounting and language as follows. Accounting resembles a language in that some of its rules are definite whereas others are not. Accountants differ as to how a given event should be reported, just as grammarians differ as to many matters of sentence structure, punctuation and choice of words. Nevertheless, just as many practices are clearly poor English (language), many practices are definitely poor accounting. Languages evolve and change in response to the changing needs of society, and so does accounting. Users of Accounting Information There is an array of users (or stakeholders) who make use of accounting information for decision making. These user groups include present and otential investors, managers, employees, lenders, suppliers, customers, analysts, media, government, and the general public. However, with the broadening of the accountability of organizations, they are accountable to a large group of stakeholders, some of them not clearly known or identified by the organizations. These users can be broadly categorized as internal and external users of accounting information. The term ‘internal u sers’ refers to parties within an organization that make decisions directly affecting its internal operations and this category usually includes managers and employees of an entity. All other users can be grouped under the term ‘external users’, which refer to parties outside the organization that make decisions concerning their relationship to the organization. These two major classifications of users have led to a distinction between two main areas of accounting: financial accounting and management accounting. The primary concern of financial accounting is to provide information to external user groups. On the other hand, the management accounting is primarily concerned with the provision of information to internal user groups. These users have diverse information needs. However, among these diverse needs too, there are common information needs. The financial statements of an entity that provide information about its financial performance, financial position, and changes in financial position address these information needs common to all users. As these financial statements are prepared to meet the information needs of a cross-section of users, they are known as common-purpose (general-purpose) financial statements. However, these financial statements do not provide all the information that users need to make decisions since they largely portray the financial effects of past transactions and events. The responsibility to prepare and present financial statements lies with the management of an entity. As general-purpose financial statements meet the information needs of users who are unable to command the preparation of financial reports of an entity, the government has imposed regulations to govern these financial statements. These regulations are intended to protect the public interest. External Environmental Factors influencing Accounting The pace and change in external environmental factors have a profound influence on business organizations and the way in which they are managed. These factors could be social, economic, political, legal or technological. Accounting, as the language of business and its information system is also affected by these changes. The changing conditions in the external environment have confronted accounting with a number of challenges that should be recognized, accepted and addressed to ensure its relevance and usefulness. This has made accounting to change and grow over the years to meet social requirements and to guide business and industry requirements. Thus, understanding accounting requires understanding the environment within which accounting operates and which it is intended to reflect. The society has been subjected to political, social, economic and technological change. These changes have resulted in globalization, the rise of informed and selective customers, the development of information technology and etc. These changes in the external environment factors are reflected in business organizations through the shift in business types and cost profiles, increase in strategic decision making and greater emphasis on survival. The changing conditions within business organizations lead accounting to change in order to meet the new requirements resulted from these changes. The areas requiring changes in accounting include selection of data, information processing, dissemination of information, role of accounting standards, assumptions and perspectives of accounting, and uses and impact of accounting information. Thus, today’s rapidly changing environment is forcing accounting to reassess its role and function both within the organization and society. Although challenges imposed by different environmental factors on accounting could be discussed separately, they should be viewed from a holistic perspective. This is because the power of potential improvement lies in the cohesion of the changes rather than in individual items. The changing conditions in the business environment will shape the future for accounting. The environment within which business and accounting function operate has become increasing complex. One of its characteristic features is that many social, economic, political, legal and technological influences that create continual change in that environment and these in turn impact on accounting and its product, accounting information. However, it is sometimes criticized that accounting has not been able to keep pace with this changing conditions in the external environment. Summary This chapter provides an overview of accounting based on its nature and purpose, users of accounting information and impact of external environment on accounting. The primary objective of accounting is to provide information that can be used by the stakeholders of an organization (users of accounting information) in making their decisions. These decisions could have a bearing on the resource allocation process in the country and thereby on the economic growth and development of the country. However, the role and functions of accounting cannot be considered in isolation from the social-political-economic context within which it is operating. The rapidly changing external environment is posing many challenges to accounting and it needs to adapt to these changing conditions. This requires a continual process of renewal and improvement in accounting. References American Accounting Association (1966), A Statement of Basic Accounting Theory, AAA. American Institute of Certified Public Accountants (AICPA) (1941), Review and Resume, Accounting Terminology Bulletin, No. . American Institute of Certified Public Accountants (AICPA) (1970), Basic Concepts and Accounting Principles underlying Financial Statements of Business Enterprises, Accounting Principles Board Statement No. 4, Anthony, R. N. and Reece, J. S. (1991), Accounting Principles, Richard D Irwin. Ijiri, Y. (1975), Theory of Accounting Measurement, Research Report, No. 10, AAA. Lal, J. (2005), Corporate Financial Report ing: Theory and Practice, second edition, Taxmann Allied Services (Pvt) Ltd, New Delhi.

Freedom as It Is in Literature Essay - 578 Words

Throughout the course of time, humans have known freedom, or the lack there of. Literature can help us learn about others views on freedom and how they know it, or don’t know it. Comparing these pieces of literature can be useful to help us understand more about freedom. Although many Americans have a substantial amount of freedom, some of us were not so fortunate, such as, Frederick Douglas. In Douglass’ Biography, we learn about his hardships as a slave. He talks about how hard is job was to keep his master happy, but then, how one day he decided he wanted to be free. So, he went to get a â€Å"root† to put in his pocket that would give him power and make it so his master would no longer be able to lay a hand upon him. â€Å"You have seen how a†¦show more content†¦Montag in Fahrenheit 451 starts to question authority. He does so by hiding and reading books, which is highly illegal. It all started when he met a girl named Clarisse. She got Montag to think and to crave freedom. At first Montag was happy with his life of no freedom, but then he realized that he was being enslaved by the fire department and the government, who will punish you for being different and questioning society. Montag, too, took a stand and once was caught, ran from them. Although, he almost died in the process, he found a safe place to stay with people that were just like him. â€Å"We’re book burners too. We read the books and burnt them, afraid they’d be found. Microfilming didn’t pay off; we were always traveling, we didn’t want to bury the film and come back later. Always the chance of discovery. Better to keep it in the old head, where no one can see or suspect it.† This shows how they were afraid, yet they were going to risk it for what they believed in. â€Å"Montag looked at the river. We’ll go on the river. He looked at the old railroad tracks. Or we’ll go that way. Or we’ll walk on highwa ys now, and we’ll have time to put things into ourselves.† This showed how Montag was finally taking his well deserved freedom, just like Douglas, both willing to risk their lives for what they believed. Throughout the course of time, humans have known freedom, or the lack there of. Literature can help us learn about othersShow MoreRelatedThemes Of Love And Freedom In World Literature837 Words   |  4 PagesLove and freedom! Where do Love and Freedom show up in the same place? They come together as themes in World Literature. World Literature is the diverse variety of genres in books that have been spread worldwide and have become well known. It is important to know about these two themes to share and understand everyones unique perspectives. The large collection of striking viewpoints creates many diverse and intriguing themes. Two of the biggest themes that can be found in books are Love and FreedomRead MoreRealism and Freedom in Literature of Dwight D. 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