Procedure for a root tip resection

introduction

At a Apical resection it is the removal of the lowest part of the Tooth root. It comes into question if one Root canal treatment has been carried out, but the hoped-for success, freedom from pain, has not materialized.

This process is over 100 years old and is 75-90% successful. Not every dentist has the appropriate expertise to carry out such a treatment. Often one has to see an oral surgeon or a specialist in the field for an apicectomy.

Read detailed information on the subject: Root canal treatment

Procedure for a root tip resection

After a proper explanation of the costs and benefits by the practitioner, a local anesthesia administered. Following will be Gums and Periosteum cut through and a flap formed with which one can cover the defect at the end. Now a hole is drilled in the bone in the area of ​​the root tip with a bone milling machine until the inflamed tissues is discovered. The root tip is then increased by approx. 3 mm shortened. Now the root canal may have to be treated - if this has not already been done. There are several options, depending on whether the tooth had already received a root canal treatment before the apex resection or not.

1. The tooth has not yet had a root canal treatment: The canal is now prepared and enlarged using small files, followed by disinfection, drying and filling with gutta percha pens (a rubber-like material.

2. The tooth was previously treated at the root: The previous root filling is checked Tightness. If the filling is tight, nothing happens; if not, the filling can be renewed or it becomes one retrograde root filling carried out. Retrograde means that the filling is introduced from the tip of the root and not, as is usually the case, over the crown. Furthermore, there is only about 1/3 of the channel with the material MTA (Mineral trioxide aggregate) filled. If the tooth is completely treated, it will granulomatous, so inflamed, Tissue removed from the bone cavity and then using rinsed sterile saline solution. Then the soft tissue can be folded back into the right place and fixed there with several sutures. The success of the procedure can be checked with an X-ray. Finally, the root treatment is condensed again from the crown and the temporary closure the tooth crown takes place. The sutures are removed after approximately 8-10 days. This provisional can be pain-free by a definitive closure be replaced.

Preparation for apicectomy

The apicectomy only provides one last rescue attempt for the diseased tooth. As a rule, the tooth has already been treated at the root and the Root canal filled. Often this filling was even renewed because there were always complaints or on the X-ray image inflammation is still evident. If the pain persists, apicectomy may be considered. Before doing this, it should be ensured that the root treatment carried out does not contain any errors. An x-ray should also be taken. In patients with Bleeding disorders or when taking anticoagulant drugs a bandage plate must be made. This can very easily bring bleeding under control after the procedure and prevent rebleeding. A change in medication is then not necessary! When a patient has an elevated Endocarditis risk has to do this beforehand antibiotic be taken. Endocarditis is inflammation of the lining of the heart. Medical conditions that cause an increased risk for this condition include one more innate or acquired heart defect or a Mitral valve prolapse.

Follow-up treatment for an apicectomy

After the apex resection, a few precautions must be taken to allow the wound to heal properly. You should take care not to exert yourself too much and not to drink coffee in the first few days after the procedure. Cooling the region relieves discomfort and reduces swelling. Controlled wound healing is very important for healing.

You might also be interested in these topics:

• How often does inflammation occur after apicectomy?
• Swelling after an apicectomy

Cystectomy

A cystectomy is the surgical removal of a whole cyst. It can, but does not have to, be accompanied by a root resection. A cyst is a capsule lined with epithelium, ie "surface tissue", within the tissue - often bone on the tooth. The capsule can have one or more chambers and can be filled with a secretion. The cyst must be removed as soon as it is detected, otherwise it can continue to grow and the bone can be badly affected.

In a cystectomy, the cyst and its bellows are completely removed and a tight wound closure is then applied. Then the cavity created can heal through a blood clot (blood plug). This works problem-free with cavities up to 1 cm. However, if the cavity is larger than 1 cm, the defect must also be filled. This can be done with a collagen sponge or an autologous bone graft. Blood filling alone would not be enough here. Finally, the bone defect is covered with the gum flap to ensure adequate wound healing. Depending on which tooth is being treated, the correct approach to the cyst must be decided. If the cyst is present on the tooth on which the apex resection is to be performed, both can be performed in one.

You can find more information here: Cystectomy on the tooth

Another visit to the dentist after about a week is mandatory. The sutures must be removed by the practitioner so that they do not grow together with the gums. The wound must also be checked. In some cases, profuse bleeding can occur on the same day after the treatment. This usually cannot be stopped at home without outside help. Patients with a are particularly at risk here Bleeding disorder or patients who blood-thinning drugs to use. It is also important to make a dressing plate beforehand in order to be able to compress the area well. This prevents the patient from having to go back to the practice or even to the emergency service on the same day.

Instruments

There are various instruments that are used in apicectomy. These are listed below together with their tasks.

With the scalpel the gum flap required for wound treatment is formed, for this the gums and periosteum are severed. With a Rasparatory the resulting flap can be detached from the bone and folded to the side. With a Lindemann- or Bone cutter the bone is cut down to the root of the tooth to make the root visible.

Through a dental drill the root tip is then removed. So-called Root canal files are needed to widen the root canal and remove the damaged tooth material. Various Douches are necessary to wash away the ablated tissue and to remove it there disinfect. The extended channel is then made using Gutta Percha or retrograde filled with MTA. There are also special curved and angled ones spatula and root canal instruments so that the root can also be scanned and treated from the lower side. This shape is necessary because the hole that is drilled is very small and does not have enough space to use normal dental instruments. With needle and thread the flap can finally be fixed and the defect covered.

Duration of an apicectomy

The duration of treatment depends on how severe the inflammation was. But the doctor's ability also plays a certain role. The most important thing, however, is whether the root canal treatment of the tooth is carried out at the same time as the tip resection or whether this is already available. If it still has to be done, a longer treatment time must be expected. On average, apicectomy takes about 30 minutes per root. In the case of a multi-rooted tooth, 30 minutes x the number of resected roots. If complications arise, the procedure may take longer. The required local anesthesia will, however, last about 2 hours beyond the duration of the treatment. During this time, nothing hot should be consumed to avoid burning your tongue, lip or cheek. Pain in the next few days is quite normal and can last for about a week.

Read more on the topic: Pain after an apicectomy