What is a root apex resection?

tooth intended to root apex resection procedure

Root apex resection is a procedure consisting in cutting off the apex of the tooth root and cleaning the surrounding bone from all lesions and inflammations. It is performed when there is no possibility of re-treating the canal or the periapical changes do not undergo such treatment.

The symptom that testifies to the development of inflammation of tissues surrounding the tooth root is primarily the pain intensifying during biting. This pain persists and very often is accompanied by swelling of the cheek, the presence of bulges on the gum and subfebrile state. Depending on type of tissue inflammation, the pain may be mild or pulsating. Periapical inflammation is the body’s reaction to the appearance of bacteria in the root canal. Inflammatory tissue appears in place of bone near the root apex.

The course of treatment

The course of treatment
APICAL ROOT RESECTION

When repeated root canal treatment is not possible, or periapical lesions cannot undergo such treatment, the only possible procedure is apical root resection.

The procedure is performed under local anesthesia. The resection involves removing the root fragment that contains the uncleaned and unfilled section of the canal. During the procedure, the surgeon opens soft tissues around the root to expose the bone and remove the infected or inflamed  tissue, including the tip of the root. The end of the duct is filled with special cement (MTA) to seal it. After surgery, there is often significant bone loss, which should be supplemented with bone substitute biomaterial and covered with a special membrane.

1. rising of gingival flap, creation acces to the periapical area       2. removal of inflamed tissue

         3. cutoff of root tip                                     4. retrograde root canal filling

         5. biomaterial introduction                              6. placement of protective membrane

After resection surgery, as with any surgical procedure, minor pain and swelling may occur. These symptoms usually disappear within a few days. In cases of prolonged or intensifying pain, swelling, bleeding or fever, please contact your dentist.

Indications

  • After treatment it is recommended to apply cold compresses to the cheek area.
  • Consume only cold or cool food.
  • Take the medications prescribed by your doctor regularly.
  • Brush your teeth gently, avoiding the area of surgery. For the first week, clean the treatment area with only your finger and toothpaste.
  • Use a recommended antiseptic fluid (e.g. Eludril).
  • It is important to drink plenty of fluids. Avoid drinking thick liquids through a straw, as this can intensify bleeding.
  • Avoid excessive physical exertion for 12 hours after surgery.
  • Inform the doctor about any disturbing symptoms.

Indications and contraindications

Indications for the procedure:

  • chronic periapical inflammation (granulomas, root cysts)
  • difficulties in conservative or endodontic treatment (curved, narrowed root canal)
  • pathological abnormalities (dentinomas)
  • dentist errors (perforations of the canal wall, breakage of the tool in the canal)

Contraindications:

  • milk teeth
  • teeth incorrectly positioned in the arch
  • acute inflammation of the tooth
  • inflammation of the mouth and throat
  • viral conditions (herpes of the lips)
  • women in the first trimester of pregnancy
  • systemic and organ diseases (including diabetes and kidney disease)
  • advanced periodontosis (periodontitis)