Tooth resection: indications and essence of the operation. Apex resection operation Pictures before and after root apex resection

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 cut 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 burr 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;
Medical filling What fillings are better to put

Resection of the root apex is an operation in which part of the root of the tooth is removed simultaneously with the elimination of the focus of inflammation in the canal. Such manipulation is used in cases where endodontic treatment does not give positive results. The operation is quite complicated, but it allows you to save the problem tooth and the integrity of the entire dentition, as well as eliminate the focus of infection, preventing the development of complications.

Indications for resection of the root apex

• Periodontitis.
• Granulomas.
• Cysts, fibroids.
• Poor-quality filling of dental canals.
• Perforation of the root of the tooth.
• Curvature of the root canals.
• The presence of a foreign body.
• The focus of inflammation in the area of ​​​​the installation of a denture.
• Inflammation of single-rooted teeth with a preserved crown.
• The presence of a fragment of a dental instrument in the canal.
• Curvature of the apex of the tooth root.
• Fracture of the root of the tooth or its apex.

Contraindications

• Periodontal disease with a significant degree of exposure of the tooth necks.
• Periodontitis accompanied by tooth mobility.
• Swelling at the site of the tooth.

The order of the operation

• Tooth preparation. The root canal is sealed by at least two thirds. If this is not possible, an intraoperative retrograde filling is performed.
• Anesthesia. The operation is performed under local anesthesia.
• On the jaw at the location of the transitional fold, an incision is made to the bone. The mucosal flap is opened and exfoliated with a special spread.
• Using a cylindrical or spherical nozzle, the outer bone wall is removed.
• Having exposed the top of the root, it is opened to the level of filling with filling material, which is easy to determine by the white dot in the center of the cut.
• The bone cavity is carefully cleaned from granulomas, granulations, foreign bodies, filling material.
• The sharp edges of the bones are turned with a cutter.
• Resection of the tooth root is carried out at the level of the bottom of the cavity. This is necessary so that the root section does not protrude. If necessary, retrograde canal filling is performed.
• The cavity is filled with a bone substitute and covered with a special membrane.
• The cut off mucosal flap is returned to its place, the wound is sutured.
• A pressure bandage is applied to the operated site for half an hour and cold is applied to minimize the manifestations of edema and hematoma.
• After three to four months, the operation site is overgrown with full-fledged bone tissue.

Rehabilitation after surgery

During the recovery period after surgery, it is necessary to observe the rules of oral hygiene and take measures to prevent inflammation. You can eat no earlier than three hours after the operation, while the food should be liquid. According to the doctor's prescription, it is necessary to use anti-inflammatory, antimicrobial and immunostimulating agents.

The operation is performed under local anesthesia. An incision is made in the region of the root apex on the gum and the mucous flap is lifted. Then the boron is cut off and the infected area of ​​the root apex is removed. The open root canal is sealed, the wound is filled with a bone substitute and then sutured. After 3-4 months, bone tissue is formed at the site of the operation.

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.).

The surgical removal of the top of a tooth root is called an apicoectomy. This method helps to get rid of a variety of inflammations and infections that penetrate into the tissues around the root tip from the canals.

As a rule, roots of canines and incisors are subject to resection, in rare cases - multi-rooted. It is believed that chronic sinusitis can be a possible provocateur.

What it is?

Symptoms are poor: at first spontaneous pain intensifies when something gets on the tooth, including the other jaw. This is due to swelling. Palpation and X-ray do not give the desired result - nothing is felt or seen.

In parallel, inside the neoplasm, the pressure of the pus increases, which can ultimately lead to rupture of the membrane. The infection will come out, and the inflammatory processes will worsen.

Previously, in order to save a tooth from a cyst, it was completely removed. No reason, no problem. However, this decision led to aesthetic discomfort. However, this radical method is still found today.

Causes of cyst formation

Although the cyst occurs from infection, the latter is provoked by 2 cases:

• Firstly, untreated or untreated caries, the provocateur of which is not bacteria, as is commonly thought, but acids. After it develops into pulpitis - this is caries that has penetrated to the nerve or, as they are otherwise called, the pulp.

  By the way, it can be triggered by microbes and their toxins, dental trauma, alkali or acid, high temperature. Pulpitis then develops into a periodontal abscess, which should be recognized and stopped as early as possible;

• Secondly, improper filling.

The latter means the following:

• if not the entire segment of the root canal was sealed, but an empty piece remained;
• if it was sealed instead of the entire length of the canal, only its tip;
• if the canal was sealed only up to the top, and the crown filled the void;
• if debris remains after a dental failure;

In all these cases, the development of infection is a matter of course.

Conservative treatment

As one of the ways to treat a cyst (with a diameter not exceeding 1 centimeter), a special preparation is introduced into it, after the treatment of the root canals, due to which infectious and inflammatory processes disappear.

However, the process lasts a couple of months, does not always bring the expected results, even in the case when the tooth has not been sealed. And if not? Then the process of refilling follows.

Although it cannot be called effective and ideal in this case, sometimes it is easier to just perform an apicoectomy than to first remove the filling substance, then put it back.

Indications

Resection of the apex of the tooth root is reasonable to apply in the following cases:

• there is a pin - a special design that is fixed in the root canal and prevents its destruction;
• when is the crown;
• under-sealing or lack of the possibility of re-sealing;
• pain and swelling;
• large neoplasm;
• excessive tortuosity of the channels;
• a broken tooth just in the upper third.

Contraindications

As contraindications for surgical intervention, the following are distinguished:

• very high tooth mobility;
• exacerbation of any cardiovascular diseases and SARS;
• acute stage of periodontitis. Symptoms, for example, purulent: the pain becomes pulsating, and the tooth becomes mobile.

  First, pus accumulates in the tooth gap (microabscess), then it impregnates the bone tissue, then it gets under the periosteum, which eventually destroys. When the process is completed and the pus has entered the soft tissues, the pain subsides in proportion to the increasing swelling of the face;

• numerous cracks at the root;
• destruction of the outer coronal part of the dentin - tooth tissue.

Holding

Like any operation, apicoectomy is divided into stages: preparation, anesthesia, access, the operation itself, wound closure. But more about everything.

Preoperative preparation

Not earlier than 2 days, so that the inflammatory process does not begin, root canals are filled with phosphate cement.

The channel is expanded, disinfected, a significant amount of cement fluid is injected to penetrate the top of the diseased tooth, and then the channel is checked for fullness with a special device.

Anesthesia

If the operation is performed maxillary, then infiltration painkillers are used., which act for a long time and penetrate deep enough. They are introduced into the submucosa of the gums, "freezing" the bone and soft tissues of the nerve endings, bleeding the periodontium. The gums turn white from the injection.

Moreover, it has been proven that the injection between the second small molars and the first upper teeth is the least effective than between the upper central and lateral. Vascular injury and hematoma formation are possible.

If the operation is mandibular, then conduction anesthesia or local anesthesia is used.. Its essence lies in the introduction of the drug into the region of the trigeminal nerve, where the tissue around the nerve fibers and they themselves are impregnated and blocked. It works a little faster and does not penetrate so deeply.

Availability

The doctor, at the location of the cyst, cuts the gum in an arcuate manner, and cuts a hole using a drill, exfoliating the mucous membrane, followed by the periosteum, exposing the bone tissue.

Apex resection

The previously sawn hole will serve as the channel, thanks to which the dentist will first find the top of the root, cut it off from the entire tooth, and extract it together with the focus and cavity, using a special spoon or tweezers.

Bone tissue of synthetic origin fills a huge empty space, which can form after the extraction of infected neoplasms. It, in turn, contributes to the speedy restoration of natural bone tissue.

We sew up the wound

Suturing the mucous membrane, the specialist lays drainage between each suture. It helps not to accumulate sanious secretions, which are possible during the first two days, but to come out naturally.

For the first 10-12 hours after the operation, a special dressing is applied to the upper lip and chin, and ice is applied to the side of the face where the resection was performed.

Possible complications

Although the resection lasts literally half an hour, it is still a complex process that requires the dentist to be qualified for this.. Otherwise, complications are possible:

• suppuration of the wound;
• secondary cyst formation;
• paresthesia - a violation of sensitivity due to nerve damage;
• rupture of the sinus mucosa or a hole in the nasal cavity;
• damage to the trigeminal nerve;
• vascular injury.

However, the anatomy of the structure of the jaws can also be the cause of the development of adverse postoperative factors. But this is overcome by a wider cut and delicate handling.

Postoperative period

Approximately a day after the operation is required to refrain from any factors that irritate the tooth: hard physical labor, toothpaste, mouthwash, carbonated drinks, salty and spicy.

The fact that the first two days will be accompanied by soreness (quite moderate) and swelling is normal. If the disease is very strong or even pulsating, go to the dentist immediately, otherwise the consequences can be very unpleasant.

Three months later, an x-ray should be taken to ensure a good outcome of the operation. And during these three months, you should give up any solid foods, including nuts.

Issue price

Dentistry is one of the most expensive medical industries. And it is impossible to name a certain amount of an apicoectomy, since it is selected taking into account the complexity of the task and is calculated for each absolutely individually. Approximate frames - from 4,500 rubles to 15,000 rubles.

What forms the price?

Perhaps for some, this cost will turn out to be unreasonably high, but if we compare a timely treated tooth and its removal with subsequent prosthetics, the amount turns out to be ridiculous.