Curettage

The aim is to remove pathological tissues, foreign bodies and bone particles from the periradicular or lateroradicular areas. Curettage provides visibility and accessibility to the apex or lateral canal.

The 5 mm osteotomy window is big enough to remove a huge amount of granulation tissue in one piece, especially when there is a capsule-like structure. The microscope is used at medium magnification (10-16x)24.

Curettage should be as clean and fast as possible because the surgical hemostasis is directly related to a complete curettage. However, because inflammatory tissues are histologically similar to healing granulation tissues, if the irritant can be readily identified and eliminated, it is not always necessary to remove all the inflammatory tissues25. This is important when complete removal might result in injury to neural or vascular tissues.

Lingual-palatal bone crypt walls are the most difficult areas to clean.

Armamentarium

• Lucas bone curette, 33L spoon excavator, and Molt curettes for medium and large lesions
• Columbia #13/14, Molt, Jaquette 34/35 curettes for small lesions.

Technique

A sharp, concave curette is placed against the bone walls of the bone defect, but not against the granulation tissue, trying to peel away the lesion that quickly collapses and allows more space to curette the lingual-palatal walls. These walls are the most difficult to clean; curettes Columbia #13/14 first and Jacquette #34/35 later on should be used for that purpose.

After curettage, the apex will be clearly seen for its resectioning. But some authors propose doing the apicoectomy first in order to facilitate removal of the granulation tissues of the lingual-palatal walls.

Bleeding will stop only when all granulation tissue has been removed and the crypt has been irrigated thoroughly with physiologic saline.