Resection of the apex of the tooth root - what after the operation? Resection of the apex of the tooth root: price, features of the operation Temperature after resection of the root of the tooth

From this article you will learn:

• When is tooth resection performed?
• photo and video operations,
• tooth root resection: patient reviews, price 2020.

The article was written by a dental surgeon with more than 19 years of experience.

Root apex resection is a surgical treatment for granulomas and cysts that form at the root apex due to a chronic inflammatory process (caused by infection in the root canals of the tooth). Granulomas and cysts are subspecies of a disease called chronic periodontitis.

They differ from each other only in size ... If the focus of inflammation at the root apex is more than 1 cm in diameter, the formation is called, and if less than 1 cm, or cystogranuloma. Visually, they are a "pus bag" attached to the top of the tooth root.

Thus, the main indications for resection is the presence of an inflammatory focus at the apex of the tooth root, which is difficult to cure using the method of conservative treatment of chronic periodontitis. The latter consists in temporary filling of the root canals with preparations based on calcium hydroxide (for a period of 2-3 months).

How is a root resection performed?

The meaning of the resection operation is to cut off the top of the tooth root along with the “purulent sac” with a drill. And many patients are therefore immediately interested in the question - how long will the tooth last after resection. It must be said that the operation does not affect the life of the tooth in any way, because. the size of the removed part of the root is very small.

Resection of the tooth root is a fairly simple operation, and it usually lasts from 20 to 40 minutes. The anterior teeth are operated on faster, which is associated with the convenience of visual control of the operation, but the lateral teeth (6-7 molars) require more effort and time from the doctor. On the animation below you can see all the main stages of the operation.

Tooth resection: animation

1. Preparation for the operation -

Tooth resection can be performed only if there is no active purulent inflammation in the area of ​​the root apex. If there is swelling of the gums or pain when pressing on the tooth, you must first remove the active inflammatory process.

If the cyst was large, then bone healing can be stimulated with special osteoplastic materials based on synthetic hydroxyapatite - the preparations "Kolapol" or "Kollapan". In some cases, a retrograde root canal filling may also be used during the resection operation (see below).

Tooth resection: operation video

In the videos below, you can see how the gum is incised, the bone tissue is exposed in the projection of the tooth root, and the surgeon drills a window in the bone tissue, after which the top of the tooth root is cut off with a drill. Please note that together with the apex of the root, the doctor also scrapes out the focus of inflammation (granuloma / cyst) formed at the apex of the tooth root.

Resection of the apex of the tooth root: price 2020

How much does resection of the apex of the tooth root cost - the price in economy class clinics and the average price category for 2020 will be from 4,500 to 10,000 rubles.

Such a difference in price will primarily depend on the position of the tooth - access to the roots of the front teeth is quite simple, and therefore the operation is carried out quickly enough. However, surgical access to the tops of the roots of the lateral teeth (especially 6-7 molars) is very difficult, so the operation requires much more time and effort of the doctor.

Important : the above cost already takes into account anesthesia, surgery, and repeated examinations. Whether the price includes drugs for quick bone restoration (“Colapol” or “Kollapan”) - you need to specify in advance. Also, the above price does not take into account the cost of retrograde root canal filling, the need for which, however, is not always the case.

Retrograde filling of the root canal during resection -

The very name of the technique “retrograde root canal filling” implies that after cutting off the top of the tooth root with a drill, the upper part of the root canal will also be additionally sealed from the side of the cut off top.

The essence of the technique (see video below) -
using an ultrasonic nozzle, the upper part of the root canal is unsealed (2 mm deeper than the cut). After that, the unsealed part of the root canal is sealed with a special material of the ProRoot type (ProRoot-MTA). This guarantees a tight obturation of the root canal with the filling substance and will not allow infection to multiply in the root canal, which will cause the cyst to re-form.

Retrograde filling is the gold standard for resection throughout the civilized world, because almost completely eliminates the risk of re-formation of cysts. In Russia, it is rarely used due to the poor qualifications of most dental surgeons (some have not done a single such operation in their entire lives, and do not see the point in it), and also because of the need to use expensive materials.

Retrograde filling: video

This method is especially necessary when resection is performed on teeth whose root canals have been sealed for a long time, and the doctor has decided that there is no need to additionally refill them before the operation. The latter sometimes happens when there is an artificial crown on the tooth, and retreatment of the tooth will lead to the need, among other things, for repeated prosthetics.

Root apex resection: patient reviews

All patients note that the operation is absolutely painless. However, postoperative pain will occur immediately after the passage of anesthesia (severe pain after resection is not typical). The next morning, you can see swelling of the soft tissues of the face in the projection of the operation, sometimes a hematoma. In rare cases, there is suppuration of the surgical wound, but this does not happen often. Prophylactic antibiotics can help prevent this complication.

After surgery, usually –

Relapse and reoperation –
The percentage of relapses according to official statistics is about 1-3%. If the operation is done according to all the rules, then there should not be any complications. There are 2 main points that determine the quality of the operation. Firstly, the cyst shell must be completely removed (since even a small fragment of the cyst shell remains, it will appear again).

Secondly, it is the quality of root canal filling. If the root canal was poorly prepared, for example, loosely sealed, this will lead to the multiplication of infection along the walls of the canal and a new formation of a cyst. And here, too, retrograde root canal filling, which we described above, can help.

Alternatives to tooth resection -

Resection in most cases is not a mandatory and non-alternative method for the treatment of granulomas and cysts. Mandatory resection is required only in the presence of large cysts (for example, 1.5-2 cm or more). The latter is due to the fact that the shell of large cysts is very dense and thick, and does not completely disappear even with good conservative treatment (although the cyst itself decreases in size).

Sources:

1. Higher prof. the author's education in surgical dentistry,
2. Based on personal experience as a dental surgeon,
3. National Library of Medicine (USA),
4. "Outpatient surgical dentistry" (Bezrukov V.),
5. "Surgical dentistry and maxillofacial surgery" (Kulakov A.).

To date, to get rid of the cyst on the root of the tooth and eliminate the inflammatory process in the gums, dentists opt for tooth-preserving surgical procedures. One of them is resection of the apex of the tooth root: it has practically no contraindications, the postoperative period is minimal, and complications are quite rare.

Indications for resection of the apex of the tooth root - who needs the operation and when?

The considered type of surgical intervention is indicated in the following cases:

• Loose fit of the filling material to the root canal . This phenomenon favors the development of infection, which, in turn, leads to the formation of a cyst. If the canal is not filled in the root area, and / or the size of the cyst exceeds 10 mm, it is more expedient to eliminate the top of the tooth root with a drill and remove the cyst. With a significant destruction of the crown, this operation does not make sense to carry out.
• Poor filling of the tooth at the root apex in the presence of a pin / stump inlay in the dental canal . If the seal does not fit snugly along the entire length of the root canal, it is necessary to carry out the sealing through the crown, which does not always reflect well on the safety of the tooth, especially with curved canals.
• Inflammatory phenomena under the crown, when the root of the tooth is not available for therapeutic measures. Removing the prosthesis and completely unsealing the canals will cost more: after the end of the treatment, a new crown will be required.
• The presence, the dimensions of which exceed 10 mm. Ignoring this pathology can provoke frequent suppuration, inflammation in the future, which requires a gum incision. In addition, this negatively affects the protective reactions of the body: doctors recommend resection of the top of the tooth root. If the cyst is inflamed and there are signs of acute periodontitis, the manipulation in question is not carried out.

Preparation for resection of the apex of the tooth root - is anesthesia necessary?

The primary measure in preoperative preparation is root canals. This procedure is done in a maximum of two days: otherwise there is a risk of an inflammatory reaction.

The ideal material for filling a cavity in the body of a tooth is phosphate cement . Before its introduction, the doctor expands the root canal, performs disinfection, and the substance itself is introduced in such a way that it goes beyond the root apex.

For better filling use a pin : before the cement begins to harden, it is injected into the root canal.

Before carrying out the manipulation in question, the operator performs one of the following types of anesthesia:

• Infiltration anesthesia . It is relevant when performing a surgical procedure on the upper jaw, which is associated with the porous structure of its bone tissue. The doctor, through a needle, injects an anesthetic (often ultracaine) under the mucous membrane. In this case, the gum begins to turn white, which indicates that blood does not enter the periodontium.
• Conduction anesthesia . An anesthetic drug is injected into the area near the trigeminal nerve. The desired effect is achieved by impregnating the nerve fiber and the area around it with the specified drug. This type of anesthesia is indicated in the treatment of the lower jaw.
• . It is used very rarely, in the absence of contraindications. In this case, the patient should refrain from eating food and liquids 8 hours before the operation.

To minimize the anxiety caused by the upcoming surgical intervention, sedatives will help: valerian, motherwort tincture.

Stages of tooth root resection, dental instruments and equipment

The algorithm for carrying out the considered manipulation is as follows:

1. Creation of a mucoperiosteal flap by cutting the gums. The operator uses a scalpel (in the presence of scars) or thrust.
2. Formation of a hole in the area of ​​the apex of the tooth root using special burs with ball-shaped tips. This procedure is minimally invasive and painless.
3. Cleaning the bone from granulomas, foreign bodies (if any), filling material.
4. Turning sharp corners of the bone with a medical cutter.
5. Cutting off the apex from the root of the tooth. For these purposes, the surgeon uses a drill. Access is through the opening.
6. Removal of the apex of the root and cyst with tweezers. If necessary, the canals are filled. If the cystic formation is large, the cavity is filled with a synthetic bone substance (chips of the cortical plate or granules soaked in a special solution).
7. Suturing the wound surface; installation of drainage for several days.
8. Apply pressure bandage for 10 hours.
9. Applying an ice pack to the area to be operated on to reduce swelling.

Recommendations for patients after resection of the tooth root - can there be complications?

After this manipulation, to minimize the risk of complications, the patient should adhere to the following recommendations:

• Antibiotic therapy (lincomycin, sumamed, azitral), regular rinsing of the oral cavity with antiseptic drugs (furacillin, iodinol, chlorhexidine). Such activities will save the wound surface from infection, help relieve inflammation and swelling.
• Taking drugs that stop pain (Voltaren, Ketonal, Ketorol).
• Abstinence from sports, heavy physical activity for 24 hours after the operation in question.
• Exclusion from the diet for a day of cold, hot, spicy, salty foods and liquids (including garlic). During the first three months, the consumption of solid foods should be minimized. Those who are accustomed to chewing nuts with their teeth should give up their bad habit.
• X-ray examination of the operated area a couple of months after resection of the apex of the tooth root.

This procedure may be fraught with the following exacerbations:

• Bleeding, as a result of violation of the integrity of the walls of blood vessels. A similar phenomenon occurs during this operation rarely, but it can provoke posthemorrhagic anemia.
• Damage to the nasal cavity, maxillary sinuses. This exacerbation is associated with the proximity of the teeth to the maxillary sinuses. Incisions during the operation in this case should be small, and all actions must be done very carefully.
• Reappearance of the cyst. It is diagnosed with poor-quality cleaning of the wound surface or with poor drainage. This defect can be eliminated only through repeated manipulation.
• Injury to the trigeminal nerve, which leads to severe and regular pain. Sometimes there may be a decrease in sensitivity on the skin, mucous membrane. Such a defect is eliminated by a course of physiotherapeutic procedures, vitamin therapy.
• Exacerbations of a purulent nature that appear against the background of ignoring the rules of asepsis during or after surgery.

Resection (cutting off, removal) of the root apex is a surgical operation, the purpose of which is to eliminate the source of infection in the tooth root. This procedure allows you to save a diseased tooth with granuloma, periodontitis and other serious diseases. It is prescribed in the case when conservative treatment has not given positive results.

The main indication for surgery is the formation of a cyst near the top of the tooth root. A cyst is a cavity with a dense membrane filled with purulent fluid inside. In order to completely eliminate it, a cystectomy is first performed, that is, the doctor cleans out all infected tissues (the capsule itself along with the shell).

The second stage is resection, which means excision of the root area affected by inflammation. Thus, the focus of infection is completely eliminated, which saves the tooth from extraction.

Other indications for root resection:

Operation steps

• Tooth preparation - consists in filling the root canal for 2/3 of its length, carried out 1-2 days before surgery;
• local anesthesia;
• the gum is cut to create access to the root apex;
• with the help of a special spacer, a mucosal flap is opened and exfoliated;
• a section of bone is sawn out with a cylindrical nozzle of a drill;
• through the hole formed, the doctor cuts off the top of the root to the level of filling with filling material;
• the empty space in place of the bone is filled with osteoplastic material (synthetic bone tissue);
• At the end of the procedure, the wound is sutured and a medical dressing is applied.

The procedure lasts 40-60 minutes, it all depends on the location of the diseased tooth. As a rule, it is much easier on incisors and canines.

Anesthesia during resection of dental roots

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.

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

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

Contraindications for resection of the root apex

The operation is not performed in such cases:

• tooth mobility II-IV degree;
• exacerbation of periodontitis;
• the crown part of the tooth is destroyed by more than 50%;
• the tooth root is too curved and cannot be filled;
• viral and cardiovascular diseases.

If the cyst has damaged most of the root, then it is no longer advisable to do a resection. Most likely, the doctor will remove the entire tooth and prescribe an implant. The decision is always made after evaluating the x-ray. On it, the cyst is depicted as a dark spot.

In the first 2-3 days after surgery, mucosal edema and slight pain are possible. To prevent the inflammatory process and suppuration, the patient is prescribed antibiotics and rinsing the mouth with Chlorhexidine.

Doctor's mistakes during the operation can lead to more dangerous consequences:

Therefore, each patient should undergo a second X-ray to make sure that the operation was successful.

Refer only to proven surgeons. We have compiled a list of specialized specialists on our website, you just have to choose the best of them.

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What is a resection of the apex of a tooth?

Resection of the root apex is a surgical intervention designed to preserve the functional and aesthetic functions of the tooth by cutting off the edge of the tip of its root canal. In dentistry, the operation is also known as an apicectomy or apicotomy.

The procedure is considered to be preserving, since it is the only alternative to the complete extraction of a tooth whose roots are affected by a cyst or other purulent formation. The specificity of the operation is that access to the root is provided not in the traditional way (that is, not from the crown), but by cutting the mucosa and drilling a fragment of spongy bone from the vestibular side of the jaw row.

Dentists offer the patient to cut off the top of the root if it is affected by an inflammatory process that threatens to further destroy the tooth and infect neighboring organs. In such a situation, leaving everything “as is” is unreasonable, and removal will necessarily require the installation of an implant or resignation to the unpleasant prospect of wearing a removable prosthesis.

Most often, tooth resection is indicated for:

• chronic periodontitis, accompanied by a purulent formation at the top of the root of one of the teeth. Most often, this situation is a consequence of previously launched pulpitis, which was preceded by a banal deep caries. If the size of the cyst or granuloma is up to 0.9 cm in diameter, it can still be treated with conservative methods. But after crossing the line of 1 cm, there are only two exits: cutting off the top or complete removal;


• not completely sealed root canal after depulpation. This is mainly found in pulpitis or before prosthetics. It is impossible to leave the channel empty, as an infection forms in it. Of course, you can try to unfill the entire tooth from the crown to the root and re-fill, but this procedure has a high risk of perforation, that is, creating a through hole in the canal walls;
• incorrectly or incompletely sealed root under the crown. As in the previous case, the permanent prosthesis can be removed and the filling can be performed. But in this case, in addition to the risk of perforation, financial and time costs will increase significantly. The laboratory will have to make a new crown, and this is by no means fast or cheap;
• fracture of the root apex as a result of an attempt to extract the pin or old filling. Even if the fracture is very minor and manifests itself in the form of a crack, the only alternative to cutting off the defective tip may be the complete extraction of the tooth;
• the withdrawal of the filling material beyond the root into the periodontal tissue. If the cement is not removed surgically, it is guaranteed to cause an allergic reaction not only in the area of ​​​​the sealed tooth, but also near the tissues adjacent to it;


• perforation of the root apex during filling. This happens when the dentist cleans the inner walls of the canal from the remnants of the dead pulp. A through hole is guaranteed to lead to the exit of the material outside the tooth with all the ensuing consequences;
• fracture of the dental instrument in the apical part of the root and the inability to get it in another way. This is a clear medical error, and quite a gross one, because it is associated with the wrong choice of instrument and negligence. Fortunately, such cases are rare.

A relative contraindication is the presence in the body of any viral or infectious disease. Even with banal sore throat, immunity is weakened, which will significantly slow down the period of postoperative healing. In such cases, the operation is postponed until the patient has cured a cold or other disease.

In addition, resection of the apex of the tooth is inappropriate if it:

• highly mobile;
• affected by caries along the entire length;
• has a too short root, and removing part of it will lead to instability;
• too close to the roots of neighboring teeth (there is a risk of damage);
• has multiple twisted roots (because of this, the operation is never performed on the second and third molars);
• for any other reason, after cutting off the top of the root, it will not be able to fully perform chewing and other functions.

Preparation for the resection operation

First of all, the dentist must make sure that the patient has no contraindications for resection of the root apex. For this, a number of laboratory tests are carried out:

• on blood clotting;
• for the presence of infectious agents in urine and blood.

If the root canals, neck or crown of the tooth need filling, it is carried out strictly 1-2 days before the operation. If you fill the tooth with filling material at least a little earlier (say, a week), this is fraught with an allergic reaction to the filling in the form of purulent inflammation.

Anesthesia during resection of the apex of the tooth

Cutting off the root tip is equivalent to a full-fledged surgical intervention, and therefore requires anesthesia without fail. When removing a tooth, local anesthesia is most often used:

• conductive, if the tooth is located on the lower jaw. The injection is made in close proximity to the branching of the trigeminal nerve and provides a complete "freeze" of a large fragment of the dentition for 1.5-2 hours;
• infiltration, if the operation will be performed on the upper jaw. In this segment, cancellous bone is the most porous, and therefore allows for a high-quality and long-term effect when using the simplest anesthesia technique.

In exceptional cases, cutting off the root apex can be performed under general anesthesia. This is highly undesirable, because it significantly increases the period of further healing.

The technique of the operation for resection of the tooth

Depending on the size of the purulent formation and the location of the tooth in a certain area of ​​the upper or lower jaw, the operation can last approximately 30-60 minutes. So, if we are talking about the upper incisor, the dentist can manage in 20 minutes. But operating on the first lower molar is much more difficult, because the intervention can take up to an hour.

Step by step resection of the root of the tooth looks like this:

• the anesthesiologist or the dentist directly administers an anesthetic injection to the patient;
• until complete numbness occurs (5-10 minutes), the surgeon prepares and sterilizes the instruments;
• a specialist cuts the gum with a scalpel and turns the edges of the mucosa to the sides in order to organize a working area for himself;
• the surgeon, using a drill nozzle, makes a round hole in the bone tissue so that its diameter is not less than the size of the purulent formation;
• with another nozzle of the drill, the specialist carefully cuts off the tip of the root (the length of the removed part should be no more than a third of the entire length of the root);


• the dentist very carefully takes out the cut-off tip and the granuloma attached to it through the drilled hole with tweezers (it is important to do this so that the walls of the formation do not burst and pus does not get into the wound);
• the specialist processes the resulting recess with healing preparations and antiseptics;
• if the cavity turned out to be sufficiently voluminous, synthetic bone tissue is laid into it (it will completely grow together with natural tissues in 3-12 months);
• the edges of the mucosa are connected and sutured using drainage (so that the ichor can go outside without obstructions);
• ice is applied to the outside of the lip or cheek for 15-20 minutes to avoid hematoma.

On this, the actual resection of the apex of the tooth is completed. The dentist instructs the patient on further wound care and coordinates with him the schedule of subsequent visits. Over the next year, you will have to visit the clinic at least 5 times:

• about a week after the operation - to remove the sutures;
• four more times every quarter for x-rays (to make sure healing is going well).

How much does a tooth resection cost in Moscow

Considering that the intervention is not too long and complicated, the cost of the operation is acceptable. The price for a tooth resection in Moscow varies from 4,000 to 7,000 rubles.

Please note that anesthesia is paid separately. Local infiltration or conduction anesthesia will cost only 200-400 rubles, but in the case of general anesthesia, you will have to pay from 1,200 rubles.

Postoperative care of the tooth after root resection

To avoid complications after resection, you must adhere to the following recommendations:

• 3-4 hours after the operation, do not eat or drink;
• the next day, completely abandon physical activity, brushing your teeth, smoking and alcohol;
• for about a week do not eat hot, sour, sweet, spicy and too hard foods;
• 2-3 weeks in no case do not take hot baths, do not soar legs, do not visit solariums and saunas;
• 2-3 months to use a soft brush and paste without abrasive particles.

In addition, the dentist will definitely prescribe regular rinses. These are mainly pharmacy solutions (chlorhexidine, miramistin), irreplaceable soda-salt liquid and decoctions of some medicinal plants (sage, chamomile, St. John's wort, calendula).

Under the condition of a well-performed operation and conscientious postoperative care, the likelihood of complications after resection of the root apex is minimal.

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How is a root resection performed?

The meaning of the resection operation is to cut off the top of the tooth root along with the “purulent sac” with a drill. And many patients are therefore immediately interested in the question - how long will the tooth last after resection. It must be said that the operation does not affect the life of the tooth in any way, because. the size of the removed part of the root is very small.

Resection of the tooth root is a fairly simple operation, and it usually lasts from 20 to 40 minutes. The anterior teeth are operated on faster, which is associated with the convenience of visual control of the operation, but the lateral teeth (6-7 molars) require more effort and time from the doctor. On the animation below you can see all the main stages of the operation.

Tooth resection: animation

1. Preparation for the operation -

Tooth resection can be performed only if there is no active purulent inflammation in the area of ​​the root apex. If there is swelling of the gums or pain when pressing on the tooth, you must first remove the active inflammatory process.

The essence of the preparation for the operation is a high-quality filling of the root canal (Fig. 4). If resection is planned as the final stage of therapeutic treatment of chronic periodontitis, then the root canal is sealed no more than 1 day before surgery. It is important that the canal is filled very tightly with a filling agent (eg gutta-percha), as if the obturation of the canal is not dense, the granuloma / cyst will then appear again.

If the operation is planned in the tooth, the root canals have already been sealed, then the strategy here may be different. For example, if the canal of this tooth is well sealed throughout (except at the very top of the root), it is not necessary to unfill such a canal, because the top will still be sawn off. In all other cases, root canal refilling will be required.

2. Method of operation -

The operation is performed under local anesthesia and is completely painless. Moderate pain occurs only at the end of the operation, which will require the use of painkillers. Below you can see the progress of the operation in detail on schematic images and videos, but first we will draw your attention to the main points during the operation.

The main stages of the operation –

Operation scheme(Fig.5-10) –

If the cyst was large, then bone healing can be stimulated with special osteoplastic materials based on synthetic hydroxyapatite - the preparations "Kolapol" or "Kollapan". In some cases, a retrograde root canal filling may also be used during the resection operation (see below).

Tooth resection: operation video

In the videos below, you can see how the gum is incised, the bone tissue is exposed in the projection of the tooth root, and the surgeon drills a window in the bone tissue, after which the top of the tooth root is cut off with a drill. Please note that together with the apex of the root, the doctor also scrapes out the focus of inflammation (granuloma / cyst) formed at the apex of the tooth root.

Resection of the apex of the tooth root: price 2017

How much does resection of the apex of the tooth root cost - the price in economy class clinics and the average price category for 2017 will be from 4,500 to 10,000 rubles.

Such a difference in price will primarily depend on the position of the tooth - access to the roots of the front teeth is quite simple, and therefore the operation is carried out quickly enough. However, surgical access to the tops of the roots of the lateral teeth (especially 6-7 molars) is very difficult, so the operation requires much more time and effort of the doctor.

Important: the above cost already takes into account anesthesia, surgery, and repeated examinations. Whether the price includes drugs for quick bone restoration (“Colapol” or “Kollapan”) - you need to specify in advance. Also, the above price does not take into account the cost of retrograde root canal filling, the need for which, however, is not always the case.

Retrograde filling of the root canal during resection -

The very name of the technique “retrograde root canal filling” implies that after cutting off the top of the tooth root with a drill, the upper part of the root canal will also be additionally sealed from the side of the cut off top.

The essence of the technique (see video below) -
using an ultrasonic nozzle, the upper part of the root canal is unsealed (2 mm deeper than the cut). After that, the unsealed part of the root canal is sealed with a special material of the ProRoot type (ProRoot-MTA). This guarantees a tight obturation of the root canal with the filling substance and will not allow infection to multiply in the root canal, which will cause the cyst to re-form.

Retrograde filling is the gold standard for resection throughout the civilized world, because almost completely eliminates the risk of re-formation of cysts. In Russia, it is rarely used due to the poor qualifications of most dental surgeons (some have not done a single such operation in their entire lives, and do not see the point in it), and also because of the need to use expensive materials.

Retrograde filling: video

This method is especially necessary when resection is performed on teeth whose root canals have been sealed for a long time, and the doctor has decided that there is no need to additionally refill them before the operation. The latter sometimes happens when there is an artificial crown on the tooth, and retreatment of the tooth will lead to the need, among other things, for repeated prosthetics.

Root apex resection: patient reviews

All patients note that the operation is absolutely painless. However, postoperative pain will occur immediately after the passage of anesthesia (severe pain after resection is not typical). The next morning, you can see swelling of the soft tissues of the face in the projection of the operation, sometimes a hematoma. In rare cases, there is suppuration of the surgical wound, but this does not happen often. Prophylactic antibiotics can help prevent this complication.

After surgery, usually –

Relapse and reoperation –
The percentage of relapses according to official statistics is about 1-3%. If the operation is done according to all the rules, then there should not be any complications. There are 2 main points that determine the quality of the operation. Firstly, the cyst shell must be completely removed (since even a small fragment of the cyst shell remains, it will appear again).

Secondly, it is the quality of root canal filling. If the root canal was poorly prepared, for example, loosely sealed, this will lead to the multiplication of infection along the walls of the canal and a new formation of a cyst. And here, too, retrograde root canal filling, which we described above, can help.

Alternatives to tooth resection -

Resection in most cases is not a mandatory and non-alternative method for the treatment of granulomas and cysts. Mandatory resection is required only in the presence of large cysts (for example, 1.5-2 cm or more). The latter is due to the fact that the shell of large cysts is very dense and thick, and does not completely disappear even with good conservative treatment (although the cyst itself decreases in size).

The therapeutic treatment of cysts is carried out by a dentist, and the only drawback of this method is the duration of therapy and a slightly larger number of visits to the doctor. In order for the granuloma/cyst to begin to decrease and disappear, it is necessary to completely neutralize the source of infection in the root canals, and then fill the root canals with a calcium hydroxide-based therapeutic paste for a period of several months.

After a few months, the doctor will take an x-ray to see how much the cyst has decreased, and if everything is fine, he will appoint you for a permanent root canal filling. Until that moment, you will walk with a temporary filling. It should be noted that conservative treatment is not always effective, and the tooth becomes inflamed over and over again. Therefore, it is sometimes easier to immediately seal the root canal on an ongoing basis, and the next day to perform an operation and remove the cyst.

Tooth Resection: Benefits

We have already said that resection of the root of the tooth is usually done in the presence of cysts and granulomas, the occurrence of which is associated with an infection in the root canal. If the root canals in the causative tooth have not previously been sealed, then in most cases therapeutic treatment is applied first.

But in most cases, granulomas / cysts occur due to poor-quality root canal filling (Fig. 12). Often, in such situations, it is possible to perform a resection immediately - without retreatment of the canals in the tooth, but a prerequisite for this is that the root canal must be poorly sealed only at the very top of the root, and the rest of the length is good.

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The operation is called resection of the root apex because one of the moments of this intervention is the removal of the root apex. In fact, the main goal of such an operation is to eliminate the periapical granulation focus that occurs in chronic periodontitis. Therefore, this operation is more correctly called a granulomectomy.

Indications for granulomectomy for chronic periodontitis and its consequences have been greatly narrowed due to the method of treating chronic inflammatory periapical processes by obturating the root canal with filling material and introducing it for therapeutic purposes into the periapical region. In rare cases, granulomectomy is also performed in acute periodontitis, when it is necessary to avoid tooth extraction at all costs, and the possibility of treatment through the root canal is excluded due to the presence of a solid filling material in the canal, an artificial tooth pin, or a foreign body like a broken pulp extractor. This also includes cases of obstruction of the root canals due to their curvature. The tops of the teeth roots located in the cavity of the cyst are also resected.

Granulomectomy is an operation that allows you to save the tooth in the absence of large destruction by the pathological process of the near-apical section of the alveolus and its edge in the area of ​​the resected tooth. The size of these destructions is established by means of an x-ray. When the alveolus is destroyed by the near-apical process by more than one third of the root length, resection of the root apex is contraindicated, since the resected tooth in these cases is not well-fixed in the alveolus. If the edges of the alveolus are destroyed as a result of periodontal disease, resection of the root apex is indicated only for grade I atrophy of the alveolar edge.

With a combination of near-apex and marginal processes, it is necessary to carefully consider the indications for resection of the root apex. Much wider, despite the extensive destruction of the bone, it is possible to resect the root apex when preparing the tooth for fixed prosthetics. In these cases, a fixed prosthesis, fixed on adjacent teeth firmly seated in the alveolus, plays the role of a fixing splint for the resected tooth.

Before the operation, the tooth is processed and sealed. In some cases, the tooth has to be filled during the operation through the crown, or from the side of the surgical wound through the root stump.

Phosphate cement is the best filling material. After expansion and thorough disinfection of the canal, liquid cement is introduced into it so that it penetrates as far as possible beyond the root apex. To obtain the best filling results, a metal pin is sometimes inserted into the root canal until the cement hardens. In some cases, it is convenient to fill the canal between the injection of anesthetic liquid and the onset of anesthesia.

Filling the canal during the operation through the crown of the tooth provides control over the pushing of the filling material beyond the root apex, but lengthens the operation. When filling the root stump with an amalgam, after removing the apex, the root canal is expanded from the side of the wound with a small bur in the form of an inverse cone approximately 2-3 mm deep, after which the formed cavity is sealed with an amalgam. The wound at this time is carefully drained with gauze napkins. Technically, this filling method is quite complicated, since the surgical field is filled with blood. The results with this method are the worst: the amalgam often falls out of the cavity prepared in the root, as a result of which a gingival fistula appears after the operation.

On the radiograph, such a metal filling that has fallen into the operating cavity resembles a pellet or a small fragment of a bullet. In some cases, filling the root with an amalgam through the wound is the only way to isolate the canal, for example, if there is a solid filling material at the mouth of the canal, an artificial tooth pin, etc.

The operation consists of a number of successive steps: 1) gum incision and formation of a mucoperiosteal flap; 2) trepanation of the wall of the alveolar process to expose the apex of the root; 3) root resection and curettage of the granulation focus; 4) suturing.

After the patient is properly prepared for the operation, the lip or cheek is retracted with blunt hooks and anesthesia is started. When resection of the root apex in the upper jaw, conduction anesthesia is recommended at the infraorbital foramen or tubercle of the upper jaw in combination with infiltration anesthesia to bleed the surgical field. In some cases, anesthesia of the dental plexus is sufficient. For resection of the root apex in the lower jaw, mandibular anesthesia should be used in combination with infiltration anesthesia. In order to form a mucoperiosteal flap, several types of incisions have been proposed. The most common and convenient is the arcuate incision according to Brocade (Fig. 36).

When resecting the tops of the roots of the lower premolars, an incision should be made at the level of the middle part of the root in order to avoid injury to the neurovascular bundle emerging from the mental foramen. When resecting the tops of the roots of the upper and lower canines, an incision should be made, slightly retreating from the transitional fold to the edge of the gum, so as not to injure the rich arterial and venous network in the area of ​​the transitional fold.

The formation of a trapezoidal flap is indicated in cases where, in addition to resection of the root apex, intervention is required in the region of the edge of the alveolus (Fig. 37).

The formed mucoperiosteal flap should be wide enough and partially capture the area of ​​adjacent teeth. After the incision, the mucous membrane with the periosteum is separated from the bone and the flap is pulled up with a hook.

The next stage of the operation - trepanation of the anterior wall of the alveolar process of the jaw to expose the root apex - is greatly facilitated if there is already an usura in this wall in the region of the root apex. In this case, it is sufficient to expand the bone defect with a grooved chisel, a large round bur or a cutter so that the root apex is completely exposed. If the anterior wall of the alveolar process does not yet have a usura, then it is necessary to establish the place where the bone trepanation will be performed. This moment of the operation is perhaps the most difficult for novice doctors: they do not immediately find the desired area to be trepanated, and therefore cause unnecessary trauma. Bone trepanation should be started 3-5 mm below the projection of the root apex along the borders of the alveolar eminence of the tooth to be operated on. A flat chisel removes the bone layer by layer along the boundaries of the alveolar eminence until a granulation tissue or root appears, which has a different color and density than the bone. After that, the formed bone defect is increased with a grooved chisel until the root apex is completely exposed and the inflammatory focus is wide opened. Usually, granulations surround the apex, therefore, in order to completely scrape them, it is more convenient to first resect the root. To do this, the top of the root is sawn off using a fissure bur. It is possible to start this removal of the tip by sawing the root with a fissure bur and finish with a light blow on the chisel inserted into the formed cut. Resection of the root apex using only a chisel and a hammer should not be done, as this can lead to crushing of the root or dislocation of it from the alveolus (Fig. 38). As a rule, it is necessary to resect the apex of the root at the level of the bottom of the granulation cavity, but still remove no more than a quarter of the length of the root. In some cases, experienced surgeons resect one third of the length of the root. After cutting off the top, it is removed from the wound with tweezers or a spoon and proceed to remove the granulations. They are scraped out with sharp spoons of various sizes, after which the bone edges of the wound and the amputation surface of the root are smoothed with a cutter. It is desirable that the amputation surface of the root has an inclination towards the vestibule of the mouth: this allows more careful control of the correct filling of the canal (Fig. 39). After that, the wound is again carefully scraped out with a spoon so that no fragments of bone or root remain in it. To do this, you can also wash the wound with hydrogen peroxide. The last act of the operation is suturing. The sutures are removed on the 6-7th day (Fig. 40).

The technique of resection of the root apex of individual teeth differs in some features. The upper first premolars have two roots in approximately 50% of cases. Therefore, when resecting the apex of a tooth that has two roots, it is necessary to check the number of canals. If during the operation a lumen of only one canal is detected, it is necessary to resect the existing interradicular septum between the buccal and palatine roots (about 2-3 mm thick). Only then is the palatine root exposed.

When resecting the tip of the second upper premolars, one should keep in mind the proximity of the tips of these teeth to the maxillary sinus. The latter can sometimes be preliminarily established using an x-ray. Sometimes the connection of the root apex with the maxillary sinus is established only during the operation. In these cases, the resection of the apex must be done with particular care so as not to push the resected root segment into the maxillary sinus. A healthy maxillary sinus opened during resection of the root apex is not probed or washed. In this case, the wound must be sewn up tightly.

Resection of the top of the roots of the first upper molars is rarely done, at least when the periapical process is present only in the buccal roots or only in the palatine root. Resection of the buccal roots of the first upper molars is not difficult, since the roots of these teeth are located very close to the anterior wall of the alveolar process; resection of the apex of the palatine root, performed from the palatal side, is much more difficult. It is rarely necessary to resort to it, since the width of the canal of this root usually ensures the success of conservative methods of treatment. Root apex resection of second molars is rare.

When resecting the top of the roots of the lower premolars, one must remember the proximity of the neurovascular bundle emerging from the mental foramen.

Resection of the apex of the roots of the lower first molars is difficult due to the massiveness of the jaw and the proximity of the mandibular canal.

On the lower second and third molars, resection of the root apex is not performed.

Complications that occur after root resection: postoperative pain, bleeding, wound suppuration - are treated in the usual way. Some authors recommend applying a pressure bandage for 12 hours to the soft tissues of the face in the surgical area to reduce postoperative edema and hemorrhage. The best effect is cold (ice) during the first day after the operation.

In general, with proper consideration of indications and contraindications for resection of the root apex, with proper filling of the canal, with the correct technique of the operation and normal healing of the surgical wound, resection of the apex of the tooth is an operation that allows you to save the tooth for a long time.

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Indications for resection of the apex of the tooth root:

• The presence of a granuloma or cyst in the apical part of the root of the tooth;
• Poor quality root canal treatment.

Contraindications for resection of the root of the tooth:

• Exacerbation of periodontitis is the main contraindication to resection. Acute symptoms should be removed - only then the operation will be possible;
• Mobility of teeth;
• Severe destruction of the crown part of the tooth;
• Cracks in the area of ​​the root of the tooth;
• Cardiovascular and infectious diseases in the acute stage.

Stages of resection of the apex of the tooth root

The procedure for resection of the apex of the tooth root lasts from half an hour to an hour. It directly depends on where the diseased tooth is located. If you need to perform a resection on the front teeth, then the operation is unlikely to take more than half an hour, but if you need to operate on distant teeth located in places that are hard to reach for the dentist, then it may take up to an hour.

Canal filling

Before performing a resection of the root of a tooth with unsealed canals, these canals must be sealed. This is done one or two days before the actual resection - if the filling is done earlier, then serious inflammation may occur.

Usually, phosphate cement is used for filling. First, the channels are expanded and thoroughly disinfected, and then a filling is performed, with the expectation that the liquid cement will fall behind the top of the root. Sometimes, for a more durable filling, a metal pin is inserted into the canal.

Anesthesia

The resection is performed under local anesthesia.

• If the resection of the apex of the tooth root is carried out on the tooth of the upper jaw, then infiltration anesthesia is used. It provides a sufficiently long anesthesia and a large depth of penetration into the tissue. Infiltration anesthesia is the introduction of an anesthetic with a needle into the jaw tissue. In order for the drug to penetrate deep enough, the structure of the bone tissue must be porous - which is why this anesthesia is used mainly for the upper jaw;
• If resection of the apex of the tooth root is necessary in the lower jaw, conduction anesthesia is performed. In this case, an anesthetic is injected with a needle into the area next to the nerve. The nerve fiber is impregnated and blocked, due to which pain sensations disappear.

Creating access to the apex of the tooth root

After anesthesia, an arcuate incision is made in the gum. The gingival mucosa is then peeled off to expose the bone tissue. Then the periosteum exfoliates, and already in the bone, opposite the top of the tooth root, the dentist cuts a small hole with a special tool.

Direct resection of the apex of the tooth root

Resection is carried out through the hole that the dentist sawed out with a special bur. It is through it that the dentist finds the top of the tooth root and cuts it off from the rest of the root, perpendicular to the upper axis of the tooth. With a special spoon or tweezers, the cut off part is removed from the hole along with the focus of inflammation and the cyst.

If after the extraction of the cyst in the periodontal tissues there is a vast empty space, then it is filled with synthetic bone tissue. This tissue accelerates regenerating processes so that the empty cavity is filled with natural bone tissue as soon as possible.

Wound closure after resection

After removal of the root and cyst, the mucous membrane is returned to its place and sutured with surgical suture material. Drainage is installed between the sutures, which in the first two days after resection ensures the outflow of sanious secretions from the wound.

A bandage is applied to the upper lip and chin for 10-12 hours, and an ice pack is applied to the side of the face on which the operation was performed to prevent hematoma.

Possible complications after resection of the root of the tooth

Resection of the root of a tooth is a very complex operation that requires a sufficiently large experience and extensive knowledge in the field of surgical dentistry from the dentist performing it. Due to the complexity of the operation, certain complications may occur after it, most often associated with dental errors:

• Perforation of the nasal cavity;
• Damage to blood vessels in the jaw;
• Injuries of the alveolar nerves;
• paresthesia of the face;
• Damage to the maxillary sinus;
• Suppuration or inflammation of the surface of the wound;
• Re-formation of cysts - can happen if the wound cavity was not cleaned well enough.

These complications can also occur due to not too favorable anatomical and topographic conditions, that is, when the upper teeth are very close to the maxillary sinus. However, even in this case, complications can be avoided if incisions are made with high quality.

Postoperative period

Despite the fact that the operation itself does not last very long, it is quite difficult and requires a long recovery period.

1. On the first day after the operation, it is better to abandon any heavy physical exertion. You can eat three hours after the operation. For some time, you should limit spicy, salty, hot and cold, and also do not use too “aggressive” toothpastes and mouthwashes;
2. In the first couple of days after the operation, edema may develop, and moderate soreness often occurs. To prevent inflammation or suppuration, you should take antibacterial drugs prescribed by your doctor, as well as use special mouthwash solutions - most often herbal decoctions and chlorhexidine;
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Modern dentists in the treatment of teeth try to save them to the last in order to leave the physiological functioning of the dentition and prevent the resorption of the tissues of the alveolar ridge. Tooth extraction is a last resort.

To save teeth in situations where conservative therapy is powerless, specific operations help. Surgical interventions that do not involve the extraction of teeth are the excision and sterilization of infected tissue areas, for which sometimes it is necessary to correct the inflamed tooth root itself.

The advantages of such operational manipulations:

• Minimal traumatism of the oral cavity;
• Saving money on the installation of implants;
• Full, but temporary preservation of the function of the dentition for an indefinite period. There are cases when saved teeth serve for decades;
• Bringing the infectious process to the stage of remission by removing the affected tissues, adding a lifetime to the tooth;
• Preservation of an aesthetic, healthy smile.

One of the tooth-saving operations is microsurgical manipulation of partial root excision. Such a surgical intervention allows you to get rid of various formations and save the tooth from the spread of inflammation. The main condition for the successful implementation of such an operation is the timely appeal of the patient to the dentist, in advanced cases, when the bone damage is several centimeters in diameter, these operations are not successful. People should be aware that an annual screening visit with a picture immediately detects the presence of cysts. And long-term ignoring the signs of a pathological process in the oral cavity leads to the fact that the implementation of a tooth-preserving operation becomes impossible and the dentist has nothing left but the removal, complete amputation of the tooth, followed by prosthetics on the implant.

The essence of the operation for resection of the root apex

The operation for resection of the root apex is a procedure for excision of pathological foci of inflammation in the root area or near it, if the patency of the canals is blocked by foreign bodies or if conservative treatment fails.

This type of surgical intervention was previously considered minimally traumatic and requiring little time. The function of the tooth is not fully preserved as the length of the tooth decreases. The surgical procedure in the vast majority of cases is carried out on canines and incisors, but much less often on multi-rooted teeth, since it is easier to remove the root completely there. In dentistry, the operation is called an apicoectomy, which literally means the removal of the top.

Modern dentistry allows for forced resection without any risks to the patient. The recovery period will take a little time and will not cause much discomfort to the patient. The main advantage of this procedure is the complete cure of the dentoalveolar apparatus from the infectious process, which is steadily progressing and affecting more and more structures of the oral cavity.

We have not performed classical tooth root resection in our Center for many years. We have developed an ultrasonic protocol for tooth-preserving surgery without root resection.

Indications for root resection

Excision of the root apex is required in the following situations:

The cyst is the main problem requiring cystectomy and apex resection. It is a delimited area of ​​inflammation that looks like a sac with a cavity filled with liquid contents, usually pus. The cyst can aggravate and cause serious changes in the patient's condition: headache, swollen lymph nodes, discomfort in the area of ​​the tooth itself, and others. It can also be the main cause of the spread of inflammation to the surrounding structures: sinuses, ears, tonsils.

Treatment of a tooth cyst in modern conditions is reduced to cystectomy with resection of the root apex, but it is better with root polishing and its preservation.

If the tooth was filled with cement in the USSR, then repeating this process is not recommended due to the high risks of perforation and other complications. As a rule, conservative therapy is useless, and the cyst continues to grow instead of resolving. Surgical intervention is better not to delay, since the involvement of new tissues in the pathological process may become a contraindication for apicoectomy.

In the process of preparing for root resection, a full-fledged X-ray examination is important, since surgical intervention is possible if there is at least 5 mm of healthy bone tissue of the alveolar ridge. Otherwise, the risk of bone fracture during the surgical approach is too great. Since the situation of each patient is special, the doctor decides on a resection on an individual basis. He independently assesses the risk of a surgical procedure, thinks through alternative options and tends to the most optimal one.

To whom is the operation contraindicated?

Patients should understand that, as in any surgical intervention, there are pros and cons of root resection, the ratio of which is evaluated by the dentist. The disadvantages of treatment by excision of the apex appear, most often, in the case of performing surgery in the presence of the usual general clinical contraindications. Therefore, the initial stage of the examination should be aimed at excluding conditions that do not allow resection.

These include:

• Excessive tooth mobility;
• Involvement in the pathological process of more than a third of the tooth;
• Too tight contact of adjacent tooth roots with the affected ones;
• Destruction of the top of the tooth without the possibility of its restoration;
• Cracks in the affected tooth root;
• Exacerbations or decompensation of severe chronic diseases of the body (diabetes mellitus, coronary artery disease, hypertension, asthma, and so on);
• Violation in the blood coagulation system;
• Immunodeficiencies in severe stages;
• Mental pathologies in the acute stage;
• The presence of an oncological process of any localization.

Some of the contraindications for apex resection are direct indications for complete tooth extraction. Another part of the conditions are general contraindications to surgical procedures in principle. Risk assessment occurs for each patient individually.

In our Center there is no goal to save a compromised tooth at any cost, prolonging its agony, I ask you to be understanding that in some situations we do not undertake the removal of a cyst and root resection, offering removal.

Preparation for resection and the course of the operation

Excision of the apical part of the root is carried out quickly, but the overall complexity depends on the location of the affected tooth. It is easiest to work with fangs and incisors, and it is more difficult to get to the areas of inflammation in the roots of chewing teeth. The surgery is simple and is performed under local anesthesia.

Preparation for the operation consists in preliminary filling of the tooth canals with special antiseptics, and then with BeeFill sealant. First, they are thoroughly cleaned, and then sealed with a special material. If such manipulation is not possible, then retrograde filling is performed. The procedure is carried out no later than 2 days before resection, so that an inflammatory reaction does not occur.

Anesthesia

Anesthesia for resection is always local, but it can be of two types:

• Infiltration. It is performed during operations on the upper jaw and consists in injecting lidocaine or ultracaine derivatives into the submucosa of the gums. Gradually, the drug spreads deep into the tissues and completely disables the nerve endings.
• Conductor. For the lower jaw, anesthesia is used, the essence of which is the introduction of the drug into the area near the nerve. As a rule, the areas of the branches of the trigeminal nerve are used for this.

Operation steps

• Access. The dentist gets to the root of the tooth through all the infected layers. First, an arcuate micro-incision of the gums is made with an exposure of the periosteum of about 5 mm. Then, the periosteum is detached and the affected alveolar crest of the jaw is exposed. Usually, the bone in the projection of the cyst has already died, dissolved, and sawing is not required. The doctor prepares a small hole through which access to the affected area is opened.
• Removal of the cyst and correction of the root apex with a focus of inflammation. The dead root is cut off perpendicular to the upper axis of the tooth. It is carefully removed through the hole along with the cyst and tissues affected by the inflammatory process. The empty space that remains after removal can be filled with osteoplastic material. If possible, resection is best avoided, weakening the root can shorten the life of the tooth.
• Suturing the wound area. The closure of the wound is sometimes carried out with the installation of a microdrainage for the outflow of the sanious discharge. It remains between the stitches for two days after the operation. Also, an ice pack is applied on the side of the lesion to prevent swelling and bruising.

Recovery period

Surgery to remove the top lasts no more than an hour, and the recovery period lasts much longer, about three days. Soft tissues recover within the first week, but the bone heals for several months. On the first day after surgery, the patient may experience swelling and moderate pain. They should gradually decrease and disappear during the first week after the operation.

The patient and the doctor should not forget about the possible complications of surgery. The task of the dentist is not only to prevent their occurrence, but also to notice the development of an unfavorable outcome in time for its effective relief. Usually, in a skilled surgeon, the risk of complications is minimal, but the following complications sometimes occur:

• Damage to nearby blood vessels with the development of bleeding;
• Infection of postoperative wound;
• Recurrence of cystic formations (occurs due to inadequate cleaning of the cavity);
• Perforation of the maxillary sinus;
• Perforation of the nasal passages;
• Damage to nerve fibers in the region of the alveolar crest;
• Formation of facial paresthesia.

!Important: Apex resection is an extreme high-precision surgical procedure that requires a highly qualified surgeon and extensive experience in performing such interventions, since during the operation it is necessary to quickly decide on the extent of resection, and it is better to only remove the cyst and polish the root without resection!

Otherwise, the risk of complications becomes very high. In addition, the congenital anatomical features of the structure of the dentoalveolar apparatus can become the cause of the development of complications, so the doctor, in preparation for the operation, must carefully study the shape and structure of the affected area in order to take into account all the nuances found. A detailed diagnosis on a surgical computed tomography is required.

Tamara Vladimirovna

I have been contacting Vladimir Igorevich Strigin since 2016 regarding the installation of bridges. The doctor works highly professionally, with minimal adjustments. Often one fitting is enough and new bridges are felt in the oral cavity almost like natural teeth, no discomfort, no inconvenience! I am very satisfied with the quality of Vladimir Igorevich's work!

Anastasia

I had veneers done by Strigin Vladimir Igorevich. The doctor is polite and attentive. Aimed at the perfect result and always listens to the wishes of the client. The result is very satisfied. special thanks to the polite staff of the clinic.

Root resection cost

Prices for apical resection are set according to the volume of surgery, usually up to 15.000 rub. per tooth(the number of operated teeth), additional expenses for consumables (Bio-Oss Spongiosa (granules) - 10.000 or 12.000 rubles for container and anesthesia. The pricing of different clinics is explained by the qualifications and experience of the dentist, the use of specific equipment and other manipulations performed as needed. The patient should carefully choose a clinic for treatment so that he does not have to visit the dentist additionally and spend extra money twice when the cyst recurs.

Excision of the root apex is one of the operations that, for the most part, positive feedback from patients. It allows you to avoid more serious manipulations and financial costs, as it is cheaper than an operation to remove the entire tooth with subsequent prosthetics. Unfortunately, not all people can afford the recently appeared implantation technique, and therefore partial root excision becomes a real salvation for them.

!Important: The most unpleasant thing in the treatment of cysts is that often such chronic inflammatory processes go without any symptoms, without pain and swelling. Most of the situations I deal with on a daily basis are randomly discovered huge, neglected cysts, with no symptoms of inflammation in the mouth.
And after what I saw, I am very grateful to patients who understand that it is not a doctor who needs an annual dental Check-Up. Spend it on insurance anywhere, it is important that the tomograph on which the diagnosis is carried out is specialized in the search for small neoplasms, for example, Galileos.
Now there are patients who are ready for preventive dentistry and have an annual check-up without persuasion and with gratitude for the attention to their dental health.|

Some patients, having heard from the doctor that they will have a resection of the top of the tooth root, begin to panic. But are these premature experiences justified? Resection or medically apicoectomy is understood as a surgical intervention, the purpose of which is to eliminate the focus of infection in the root of the tooth by partially cutting off the affected area. Thanks to this operation, it is possible to restore the basic functions of a diseased tooth, which means saving its life.

What is the essence of the procedure, when is it necessary and whether there are alternative options - we will consider in detail in the article below.

When is resection performed?

The dentist, more precisely, the dentist-surgeon or maxillofacial surgeon, will decide on the advisability of such surgical treatment. As a rule, this operation is prescribed when conservative methods are powerless or simply impossible to use.

The main prerequisite for resection is a cyst or a so-called peculiar "pouch" covered with fibrous tissue and filled with pus. Diagnosis of pathology at an early stage allows you to do without surgery. But the most dangerous thing is that it can be quite difficult to identify a problem in the early stages - this cannot be done without an x-ray and a professional examination.

Another reason why such an operation is carried out is this. The disease occurs due to inflammation of the tissues of the tooth and is in most cases a consequence of untreated caries, pulpitis, neglected diseases of the oral cavity. It is a kind of precursor to the formation of a cyst.

Important! In the case when the diameter of the cyst is more than a centimeter, resection is the only option to save the tooth, as well as overall health. It is worth remembering that a cyst can cause intoxication of the whole organism and other serious consequences.

The following indications for resection are also distinguished (mainly inflammation or neoplasm on the root, which arose as a result of various circumstances):

• dental errors made at the stage of root canal filling: for example, before filling, the doctor must carefully remove the pulp if necessary, clean the canals and fill them with filling material along the entire length, because an infection can penetrate into the remaining voids and cause inflammation. But medical errors sometimes lead either to the fact that the root canal is not completely filled, partially, or the filling material, on the contrary, goes beyond the top of the root, which leads to the formation of inflammation,
• resection is effective when there is an inflammatory process, and the channels are strongly curved: they can be severely damaged by other manipulations,
• the presence of an intracanal metal pin: the pin is fixed inside the canal with very strong dental cement. Trying to extract it, you can injure the tooth, which will cause it to be partially removed,
• if the tooth is inflamed under an artificial crown: therapeutic treatment will require a lot of time and money. To get to the focus of inflammation, you need to remove the crown, remove the filling, eliminate the cause of the disease, and then install a new crown. Under such circumstances, it is easier to perform a resection operation by removing the inflamed area.

To whom the operation is contraindicated

Like other surgical interventions, resection has contraindications. It is not carried out if the patient's history contains the following cases:

• advanced periodontal disease: treatment cannot be carried out in the presence of loose and mobile teeth - it will simply be ineffective,
• the crown of the tooth is seriously damaged and cannot be restored with a filling or,
• the root of the tooth is seriously destroyed or it is impossible to get to the source of infection. The latter concerns a multi-rooted tooth,
• the presence of viral and exacerbation of chronic diseases, pathologies of the cardiovascular system,
• the cyst has grown more than half of the root.

In all of the above cases, resection is useless. As a rule, the doctor decides to remove the affected tooth and prescribes or prosthetics.

Features of the procedure and its stages

1. Preparatory stage of the operation

The procedure is considered not traumatic, but requires preliminary preparation. So, X-ray diagnostics is first carried out to clarify the scale and features of the problem.

Next, the specialist performs the removal of the nerve of the tooth, if it is still available. All dental canals are filled. If the slightest signs of an inflammatory process appear, you should once again carefully check whether there are voids in the dental canal. If inflammation is detected, the canal is well cleaned, suppuration is removed and re-filled.

Important! In most cases, patients are faced with a cyst, granuloma and other inflammatory processes already when the tooth was previously treated, so there is no need for depulpation and filling at the preparatory stage.

2. Anesthesia for pain-free treatment

The patient may not worry - he will not feel pain at the time of the surgical intervention. After all, the procedure is carried out under anesthesia. Two options are used: infiltration and conduction.

Infiltration doctors are more often used in the case when the operation will take place on the upper jaw - the anesthetic drug will easily spread over the tissues adjacent to the focus of inflammation. In this case, an injection is made in the area of ​​\u200b\u200bthe submucosal gum.

If the area to be operated is on the lower jaw, conduction anesthesia is used. The injection is made in the part of the jaw where the nerve is located. The medicine quickly enough covers nearby tissues - you can start the procedure.

3. The operation itself

Let's take a closer look at how the operation will go. As a rule, all manipulations take 20-40 minutes and suggest the following:

1. one small incision is made on the mucous membrane of the gums: the mucous flap is peeled off from the bone, opening access to the top of the tooth root,
2. a small hole is drilled in the bone tissue of the gums, through which all purulent formations are completely cleaned out, the tumor is removed,
3. then the wall of the tooth is knocked out with a chisel or hammer: this is necessary to completely expose the diseased root, which will allow the dentist to carry out high-quality canal filling in the future,
4. then the doctor finds the top of the root, carefully cuts off this area and takes it out with tweezers,
5. a synthetic material is placed in the resulting wound to restore damaged bone tissue,
6. at the last stage, the incision on the gum is sutured and a bandage is installed. This device will protect the operating area from any external influence and accelerate the healing process of tissues.

In the future, the dentist may prescribe additional medication to avoid re-inflammation and speed up tissue repair.

Technique using a laser

Laser resection is a more gentle procedure, but also more expensive. The operation is faster, the oral cavity is practically not injured, and the postoperative period is easier. What is this method? To begin with, a small incision about 10 millimeters deep is made on the gum. Through it, with special ultrasonic equipment, the root tip is cut off, as well as directly the neoplasm, which caused the operation - for example, a cyst.

After the area is treated with a laser, the wound is filled with synthetic bone tissue, closed with a biomembrane. By the way, laser treatment allows you to minimize possible complications, shorten and facilitate the rehabilitation period.

rehabilitation period

In order for tissue restoration to go smoothly and without deviations, it is important to follow all the recommendations of the dentist. The very first thing to do is to apply cold to the operated area for half an hour. This is necessary so that edema does not develop after resection. You can eat only 3 hours after the completion of all surgical procedures.

Also, for a while, you need to give up dishes and drinks that will cause discomfort and can provoke complications: you need to exclude cold, hot, sweet, spicy, salty from the diet. These products can further injure the mucous tissues of the oral cavity. It is equally important to choose a gentle toothpaste, rinses and a brush of soft hardness. Hygiene procedures must be carried out carefully.

On a note! If the doctor has prescribed drugs with anti-inflammatory, antiseptic or immunostimulating effects, they must be taken. Medications will help tissues recover faster. You can also rinse your mouth with decoctions of chamomile, sage, oak bark. Once every 3 months you need to visit the dentist and do x-rays.

Are complications possible

To exclude undesirable consequences, resection should be carried out only by an experienced doctor. Swelling of the gums, slight pain for some time after the operation is a normal phenomenon. But if these symptoms do not go away and increase for 2-3 days, you need to consult a doctor.

For your information! Like other procedures, resection has its pros and cons. An undoubted plus is that the removed bone tissue will fully recover in 3-4 months and will be able to perform its functions. A tooth that has been saved can last for decades and even serve as a support for dentures. The possibility of recurrence is minimized, soft tissues will heal in 7-10 days. Among the minuses of this are possible complications and relatively high cost.

What other complications are possible: perforation in the maxillary sinus in the upper jaw and hypesthesia. Perforation is the formation of a hole, in our case, connecting the nasal sinuses and the upper jaw. Pathology can be fraught with the formation of a fistula, which will provoke purulent sinusitis. Hypesthesia is a violation of sensitivity. A so-called “numb” tongue or chin may indicate that a nerve was damaged during the operation. If this unpleasant sensation does not go away after a couple of hours after the procedure, you need to seek help from a doctor.

Alternative Treatment Options

An alternative to resection is therapeutic treatment. It is possible only in the early stages of development of cysts, granulomas, when they are still small in size. The treatment is performed by a dentist. The patient should immediately tune in to the duration of all manipulations and frequent visits to the doctor.

First you need to completely eliminate the focus of infection in the root canals. Only then can they be sealed with a material containing calcium hydroxide. After a couple of months, you need to go through and, if everything is fine, the doctor will remove the temporary filling and finally seal the canal.

It should be noted that therapeutic treatment does not always bring the desired results. After some time, the disease may return and recur. Resection is still often performed because therapy leads to frequent relapses of the disease.

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1 According to IDA - International Dental Association.