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I 21 clinical report _ apical microsurgery series I roots3_2010 Thesutureshavecompletedtheirtaskafter24hours and, in fact, then become foreign bodies that can cause irritation and excessive inflammation, be a source of infection and ultimately result in a retardation of the healing process.2 For those that doubt the 24-hour suture removal theory, try the following easy exercise: 1. At the next surgery, place at least five sutures. 2. After24hours,havethepatientinandremovethe suture that looks the worst, the one you think is not healing as well as the others. 3. The next day, remove the next suture that looks the worst. 4. Thenextday,dothesame,andsoon.Attheendof thefifthday,theareathatlooksthemostinflamed will be around the remaining suture(s). If that does not convince you, nothing will. Post-operatively, the usual result is little, or no, painorswelling.Thepost-operativeinstructionsare icepacks—15minutesonandthen15minutesoff— for the first six hours only, gentle rinsing with Peridexforthenext24hoursandsutureremovalthe following day. Experience has demonstrated that prescribing 600mg of Ibuprofen every six hours, along with one to two tablets of over-the-counter Tylenol (taken between the doses of Ibuprofen), has a very effective anti-inflammatory effect. It is the exception, rather than the rule, that a patient requires a stronger medication for post-operative pain. Antibiotics are not usually prescribed. If everything is within normal limits, the patient is instructed to begin gentle cleaning of the area— using a facecloth over their index finger—on the third day and gentle brushing with a soft brush on the fifth day. The patient is scheduled for a follow- up visit two weeks after surgery. At the two-week visit, the incision is generally barely visible and, on most occasions, can hardly be detected (Fig. 5). Awordofcaution:notallpatientsrespondtotreat- ment as well as others. Do not be in a hurry to treat a problem that may not exist. On a few occasions, patients may be slower than normal in response to treatment, sometimes taking several weeks to heal. If there is any doubt, place the patient on an anti- biotic and an anti-inflammatory for a week as a precaution, but what is really desired is more time for delayed healing to occur. The apical microsurgical technique described in the previous six parts of this series has become the new standard of care in endodontic treatment and raisesendodonticapicalsurgerytoanewandexcit- ing level. For the first time, apical surgery can be performed with predictable results. These results, however,canonlybeachievediftheproperprotocol is followed meticulously. Each step must be fol- lowed without compromise. Much more could have been written, but hope- fully enough of an overview has been given to encourage even one more operator to begin using the OM. It is the finest tool our profession has ever beengiven.Apicalmicrosurgerycanbeanenjoyable part of the daily regimen, for both the operator and the newly involved dental team!_ Editorialnote:Alistofreferencesandcopiesofallprevious partsofthisseriesareavailablefromthepublisher. Dr John J.Stropko 14770 N.Brenda Rd. Prescott,AZ 86305 USA E-mail:topendo@aol.com _contact roots Fig. 9_The suture knot is pushed away from the incision. Fig. 10_The vertical releasing incision should be sutured loosely. Fig. 9 Fig. 10