Diagnosis

Since the inflammatory process is largely painless, only an x-ray provides certainty that an inflammatory reaction has formed in the bone due to the spread of bacteria. In some cases the pus makes its way out and forms a fistula on the tooth, through which the contents of the cavity are emptied.

Operative procedure

Under local anesthesia, the mucosa together with the periosteum above the relevant root tip is opened with an arch incision and the bone is opened until the root tip is exposed. Then the root tip is removed and the entire focus with the granulation tissue is cleared out. The filling of the root canal can be performed shortly before the procedure or during the surgical intervention.

During this procedure the wound cavity is tamponed out, the canal is cleaned and dried and after the filling material has been introduced, the canal is closed with a pin which protrudes over the opening of the root canal. The pin is wedged in the canal by pulling so that no germs can escape from the canal. Then it is cut off flat with the root.

Another method is to close the root canal from the operated side (retrograde root filling). In both cases, the bone cavity is then rinsed out with physiological saline solution or hydrogen peroxide, and the mucous membrane flap is closed with a few sutures. Care must be taken during the incision to ensure that the suture is underlaid by the bone and does not lie on the wound cavity. In the normal course of healing, new bone is formed again within a year and fills the wound cavity.

General or local anesthesia?

Two types of anaesthesia are used for apicoectomy. Most treatments are performed with local anesthesia (local anesthesia), but general anesthesia is also possible, especially in clinics for anxiety patients, or patients with disabilities. But which form can be preferred?In general, general anesthesia carries much more risks than local anesthesia, as the drug acts throughout the body and not only in the area to be operated on.

General anesthesia is performed by a separate anesthetist who monitors the patient during the operation. This service is not covered by health insurance companies, as the standard is local anesthesia and must be paid for completely privately. Furthermore, after the general anesthesia, an inpatient admission is often necessary, the patient does not leave the clinic until the next day.

With local anesthesia, only the area to be operated on is anesthetized and the patient is conscious. This form of anesthesia leads to far fewer side effects, possible risks and complications than general anesthesia and is completely covered by the health insurance. The anesthetized state is no longer noticeable after a few hours after the apicoectomy and the patient is fully sane again.

With general anesthesia, it takes several hours until the patient wakes up and is usually still dazed all day long. In general, it can be said that local anesthesia is the standard anesthesia for apicoectomy.

Advantages General anesthesia is mainly indicated for anxiety patients and people with disabilities, whose limitation would hinder a regular form of therapy.
With general anesthesia, the patient does not notice the apicoectomy due to the blockage of consciousness and therefore cannot be influenced by negative experiences.
Disadvantages Nevertheless, general anesthesia generally has significant drawbacks, since the drug acts throughout the body and not just locally. How high the risk of complications from general anesthesia is depends on the general health condition and systemic diseases. Furthermore, after the general anesthesia an inpatient admission is often necessary, the patient usually leaves the clinic the next day.
General anesthesia is not covered by health insurance and is a private service, which is charged at about three hundred Euros. After awakening, the patient is dazed and not legally competent. Complications such as nausea and vomiting are to be expected on average with a 10% probability. Worse complications are very rare and that a general anesthesia can be fatal is with a probability of 0.009%. Therefore, the patient should consider beforehand whether the time, money and risk are worth it to prefer general anesthesia over local anesthesia.