Apicoectomy
Even with the most careful root canal treatment, bacteria can still remain in the branches of the root canal at its tip. This can then lead to a suppurative focus at the tip of the root, which is surrounded by a protective wall of connective tissue. However, since this is a latent source of danger, it should be eliminated by means of a surgical procedure called apicoectomy.
For this purpose, the mucous membrane is cut through under local anesthesia and the bone above the suppurative focus is removed. The suppurative focus is removed and with it the root tip.Then the root canal is closed from the tip with amalgam or cement, so that no germs can escape. The mucosa is sutured again and the resection is completed. The execution of a root tip resection is relatively easy for teeth with one root, but it is very difficult for teeth with several roots.
Root canal treatment for milk teeth
The treatment of milk teeth with pulpitis or gangrene is more difficult. Since milk teeth are smaller and enamel and dentin are thinner, the pulp is reached faster than in adult teeth. Of course, one must try to preserve the tooth, as it serves as a placeholder for the permanent teeth.
On the other hand, it must be remembered that immediately behind the milk tooth there is the permanent tooth and the roots of the milk tooth resorb. Therefore, a normal root filling or root canal treatment cannot be performed. In any case, the decayed tissue will be removed, then we have to decide what the further procedure is.
One possibility is to grind the tooth so that there is no congestion and no toothache. It remains open or is provided with an antibacterial insert. If the tooth is open, one should make sure that no food remains on it.
However, if the pulp chamber is wide open, this should not cause any problems. The alternative is to remove the tooth. This means that the important placeholder function is lost. This can be remedied by a placeholder that keeps the gap open so that the permanent tooth can literally break through.
