Resection of the apex of the tooth root - indications, stages of treatment, contraindications

Methods of modern dentistry are aimed at preserving the dental unit. Removal is resorted to as a last resort if gentle treatment techniques are ineffective. Resection of the apex of the tooth root (apicoectomy) is a microsurgical intervention for excision of tissue affected by infection with part of the injured tooth root. The operation is performed if the inflammation has taken the form of a cyst or granuloma. The main condition for the success of such a surgical intervention is the timeliness of the patient’s visit to the dentist. If the pathological process spreads to most of the root, the tooth will have to be removed.

Indications for surgery

Poor endodontic treatment leading to inflammation of the root apex;
the presence of a cyst, granuloma or other neoplasm, no more than 1 cm in diameter;
perforation of the root walls during filling;
pin or stump inlay in the dental canal;
obstruction of the dental canal due to a congenital developmental defect;
a crown or bridge placed on a tooth.

Recommendations after surgery, what you definitely shouldn’t do

After surgery, you should not additionally load the area of the dental system that has undergone surgery with food. It is important to follow all the dentist’s recommendations and not self-medicate. It would not hurt to take several control radiographs (for example, after 3, 6 and 12 months). You can disinfect the oral cavity with antiseptics or soda solution to prevent the development of purulent processes in the gums.

It is necessary to follow a gentle diet - do not eat solid foods: nuts, dried fruits, sweets, etc. Avoid sour and sticky foods.

When surgery is not performed

Like any other surgical intervention, apicoectomy has limitations and contraindications. These include:

Mobility of teeth II-IV degrees;
destruction of the crown part of the tooth (more than 50%);
the presence of cracks in the affected root;
severe curvature of the root canal (impossible to fill);
crowding of teeth, which does not allow identifying the affected root;
acute infectious, viral disease;
severe bleeding disorders;
decompensated diabetes mellitus;
severe immunodeficiency;
oncology in the active stage.

Some of the limitations to root resection are the indication for removal of the affected unit. The second part refers to general contraindications to any surgical intervention. The risk of surgery for the patient is assessed individually.

The specialists at the Ilatan Clinic make every effort to save the dental unit, if possible. But if there are direct indications for removal, for example, extensive damage to dental tissue, the doctor will not suggest apicoectomy.

Treatment of dental cyst: methods

Most often, treatment of dental cysts is carried out jointly by dentists - a therapist and a surgeon.

Therapeutic treatment of a dental cyst is aimed at sanitation, or cleaning of the root canals - it is necessary to remove the source of infection and the cause of the cyst. First, the dentist-therapist processes the root canals and fills them with antiseptic paste for a period of 1 week to 1 month, as in the treatment of periodontitis. Then he fills the root canals with gutta-percha and sealer. Sometimes, especially in young patients, therapeutic treatment of the cyst is quite sufficient.

Surgical treatment is an operation to remove a cyst from bone tissue, sometimes this operation is accompanied by resection of the apex of the tooth root. The technique of apex resection is generally simple, but the operation is a complex surgical procedure and, like any operation, it must be taken seriously.

If resection is not done in time, the infection will spread upward through the root canals and can spread to the entire jaw. The consequence is that you may have to schedule the removal of all inflamed teeth. Therefore, you should not joke with such inflammations!

Resection stages

Formation of access
- the dentist cuts through the gum, exposing the jaw bone. Forms a small hole in the bone tissue (in the projection of the root apex), gaining access to the pathological focus. Often, the bone tissue has dissolved in the projection of the cyst; there is no need to cut out a hole.
Excision of tissues and correction of the apex
- the doctor removes the source of inflammation along with the dead apex of the root, cutting it off perpendicular to the upper dental axis (to the level filled with the filling mass). The empty space is filled with osteoplastic material (bone volume is restored faster).
Suturing
- suturing the wound area is sometimes performed with the installation of drainage for the outflow of ichor. Drainage is installed between the seams and is removed after 1-2 days.

Root resection takes 40-60 minutes, depending on the location of the tooth. It is easier to intervene on canines and incisors than on multi-rooted units.

What do patients say about apex resection? Reviews are usually only positive!

“Resection of the top of the tooth took about an hour, the operation was performed under pain relief. It didn’t hurt very much near the tooth for about a month. A few months later I had to take an x-ray, the doctor showed that all the tissues had been restored."

“The cyst grew, they told me to remove it, it was a little unpleasant, but quite tolerable - the doctor quickly and accurately carried out the procedure. Everything was restored soon, now it’s completely unnoticeable that there was anything there.”

At Ritsa Dentistry, cyst removal operations are performed by experienced surgeons with extensive experience in performing such procedures. Therefore, you can rely on our professionalism and entrust the treatment of the cyst to our doctors.

Recovery period

The entire operation lasts about an hour, the recovery period takes up to six months or more, depending on how quickly the bone tissue regenerates. In the first 1-2 days after the surgical procedure, the patient is bothered by moderate pain, swelling, and redness of the gums. After 3-4 days, the unpleasant symptoms decrease and the condition improves. To ensure that the postoperative period passes quickly and without problems, the doctor will give the necessary recommendations for care, prescribe painkillers, as well as a short course of antibiotic therapy.

When is it recommended to remove part of a tooth root?

Most often, resection is performed when:

the formation of a cyst on or near the root of the tooth;
proliferation of granulomas or multiple granulomas on the root part or in the area nearby;
anatomically incorrect position of the tooth canals.

It is important! To successfully perform the operation and rehabilitation after it, a prerequisite is the presence of a sufficient volume of bone tissue in the operation area (approximate tissue thickness - from 5 mm). If these indicators are lower, there is a high risk of bone injury during the removal of granulomas or cysts.

What is important, the manipulation is performed under local anesthesia; If the patient is very distressed, premedication may be administered. In any case, the procedure is not accompanied by discomfort and is easily tolerated.

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Care after tooth resection

Do not chew on the operated side.
Until the wound heals, avoid irritating, solid foods (food should be warm and soft).
Do not use a hard toothbrush, aggressive pastes, or mouthwash.
Take antibiotics prescribed by your doctor to prevent infection.
Rinse your mouth after eating with an antiseptic solution.
For the first week after surgery, limit physical activity to moderate, and exclude extreme, contact sports.
Do not visit the bathhouse, swimming pool, sauna until the wound is completely healed.
Avoid eating too hard foods until the bone is completely restored (at least 3 months).
Visit your surgeon regularly to evaluate the results of the operation.

Possible complications after cyst removal

Removing a cyst is a necessary procedure; the longer the treatment of a cyst is delayed, the more likely complications are to develop. There is no need to be afraid of removing a cyst; according to statistics, the percentage of possible adverse consequences is immeasurably less than complications from an unoperated cyst (abscess, phlegmon, sepsis).

After cystectomy, the service life of the tooth is not reduced. Both after therapeutic and surgical treatment of cysts, dynamic monitoring of the condition of the bone tissue is required.

To avoid complications, it is important to maintain oral hygiene, follow your dentist's recommendations, as well as eat a healthy diet and avoid alcohol, smoking, carbonated drinks and solid foods in the first days after surgery.

Possible complications

Root resection is a micro-operation, the purpose of which is to preserve the full functionality of the affected tooth. Usually, the risk of complications is minimal, but they cannot be completely excluded. Sometimes the following complications are possible:

Bleeding due to injury to nearby vessels;
infection of a postoperative wound;
recurrence of cysts, granulomas (if all affected tissues were not removed);
perforation of the maxillary sinus, nasal passage;
damage to the nerve passing along the alveolar ridge;

Sometimes complications are caused by structural features of the jaw, for example, the proximity of the roots to the maxillary sinus. Complications caused by non-compliance with medical recommendations include swelling and tissue inflammation. Ignoring advice on limiting physical activity is fraught with the development of bleeding, and failure to maintain hygiene can lead to wound infection.

Pain relief during tooth root resection

The bone tissue of the upper jaw has a more porous structure. Therefore, if the operation is planned on the upper teeth, then infiltration anesthesia is used. By injection, an anesthetic drug (lidocaine, ultracaine, etc.) is injected into the submucosa of the gums.

Thanks to diffusion, the solution penetrates through the soft tissue into the bone, blocking the nerve fibers of these deep areas.

Conduction anesthesia is used for the lower jaw. The injection is made in the area of the trigeminal nerve. In this case, the anesthetic drug permeates the nerve fiber itself, as well as the tissues surrounding it.

Cost of tooth root resection

The price of root resection is determined depending on the volume of surgical intervention, the cost of consumables, and anesthesia. The result of the procedure fully justifies the money spent. After all, it is cheaper than removal with further implantation and prosthetics. The doctor will tell you exactly how much tooth resection costs after examination and diagnosis.

Contraindications (when root apex resection should not be performed)

Alternative treatment methods are prescribed in cases of:

The patient has deep damage to the periodontal tissue; exposure of the neck of the tooth or its root;
Acute form of periodontitis;
If there is damage to a large part of the root system, for example, due to inflammatory processes;
Too high tooth mobility (grade 3-4);
The top of the tooth or the tooth itself are destroyed;
The size of cysts and granulomas exceeds 10 mm (other methods of surgery are used);
Malignant formations in the oral cavity;
The close proximity of healthy and diseased tooth roots, which significantly increases the risk of tissue damage during surgery.

You should also pay special attention to the state in which a person approaches the operation.

Surgery is strictly not recommended if:

The patient feels unwell, there are signs of somatic diseases (autoimmune diseases; blood diseases; diabetes mellitus, etc.);
The patient’s condition does not allow for surgery (acute period of illness; fever; respiratory viruses, etc.);
The presence of severe pathologies of the cardiovascular system.

How is the apex resection procedure performed at the Bionic Dentis dental clinic?

This operation may require 30-60 minutes.

The fact is that the duration largely depends on the location of the affected area. For example, when performing treatment in the area of the front teeth, less time is required and the entire process is much easier. When foci of inflammation affect the back teeth, surgical intervention may be delayed due to difficult access.

It is important how many roots are affected by the inflammatory process. If it is one root, the operation will be shorter than three roots.

In any case, local anesthesia is performed before the procedure. We use only the German painkiller Ultracain DS Forte (made in Germany), which allows us to perform the operation without discomfort and pain.

When tooth root resection is planned on unfilled canals, they are first filled. If it is possible to re-treat the canals for at least 2/3 of the root length, they are re-treated.

To fill canals, the Bionic Dentis clinic uses a special technique - 3D canal filling.

Here's what it looks like:

The canals are expanded and infected tissue is removed from them mechanically using a nickel-titanium M2 instrument. For this purpose, a computerized root canal system from the German company WDV is used.

After mechanical cleaning, the channels are sterilized with a medicinal preparation, a sodium hypochlorite solution activated by ultrasound. We use the SIEMENS SIROSONIC ultrasound system. Penetrating into the wall of the canal, the disinfectant kills microbes and opens microscopic tubules, clearing them of infection.
After disinfection, the canal is dried.
A small amount of epoxy resin, created for use in dentistry, is injected into a dry and clean canal.
A gutta-percha pin is inserted into the canal and melted under pressure. Melting, gutta-percha fills all the pores in the canal and micro-branches.

Next, the channel is filled with molten gutta-percha under pressure from an injector.

The use of this technique is standard in Europe. We also follow this method.

Alternative to apicoetomy

Not in every case, surgical intervention is the only and mandatory method for eliminating granulomas and cysts. Apicoetomy is considered mandatory only in the presence of cysts measuring 1.5-2 cm or larger. The structure of the cyst shell is quite thick and dense and does not disappear completely even with the highest quality therapy.

In the presence of small pathogenic formations, dentists carry out therapeutic treatment. First, the doctor removes the source of infection from the root canals, after which he fills the canals with a special medicinal paste.

After a few months, the patient is sent for an x-ray, based on the results of which the doctor assesses how much the cyst has decreased in size. If everything is normal, then the dentist installs permanent fillings.

The disadvantage of this method is the need for multiple visits to the dentist. It should also be noted that conservative treatment does not always provide the desired effect, since the problem unit periodically becomes inflamed. Therefore, it is much easier and more expedient to eliminate the cyst by cutting off the root tip or completely removing the tooth root.

Wound healing time

The oral mucosa takes approximately 2 weeks to heal. After this period, all symptoms of surgical intervention disappear, and chewing loads do not cause pain. Complete healing of bone tissue requires more time - from 6 to 12 months. During this period, the hole in the bone heals. To monitor this process, radiography should be performed regularly. This diagnostic procedure is prescribed a few days after resection and 6-7 months later.

Recommendations for recovery

After resection, for successful recovery it is necessary to follow the following recommended measures:

Take medications prescribed by your doctor. These can be antibiotics, anesthetics, anti-inflammatory, antiseptic and other drugs.
Eat soft pureed foods. You can start taking solid foods only after the wound has completely healed.
Avoid foods that irritate the mucous membranes of the mouth.
Avoid physical activity.
Try not to be nervous.
Do not overheat the body: avoid hot baths, steam baths, saunas, solariums and other thermal treatments, do not sunbathe, and do not drink too hot drinks.
Perform regular oral hygiene with a soft toothbrush using antiseptic paste and mouthwash.
The first meal can be taken 2-3 hours after surgery.

Contraindications to the procedure

Surgery is not performed in the following cases:

Inflammation of periodontal tissues.
An advanced stage of periodontal disease, when the neck of the tooth is exposed and the unit itself has become mobile.
Tight adherence of the roots of adjacent healthy teeth to the source of infection.
Poor blood clotting.
Excessive tooth mobility.
Weakened immunity.
Cancerous formations in the tooth area.
Active form of the inflammatory process.
Pregnancy period.