Follow-up treatment for a root tip resection

After apicoectomy, a few precautions must be taken to allow the wound to heal well. Even you should take care not to exert yourself too much in the first days after the procedure and not to drink coffee. Cooling of the region relieves discomfort and reduces swelling.

Controlled wound healing is very important for healing. – How often does inflammation occur after apicoectomy? – Swelling after apicoectomy

Cystectomy

A cystectomy is the surgical removal of a cyst in its entirety. It can, but does not have to be accompanied by an apicoectomy. A cyst is a capsule lined with epithelium, i.e. “surface tissue”, within the tissue – often bone on the tooth.

The capsule can have one or more chambers and may be filled with a secretion. The cyst must be removed as soon as it is detected, otherwise it will continue to grow and the bone may be severely affected. In a cystectomy, the cyst including the cyst bellows is removed completely and then a tight wound closure is applied.

Afterwards, the resulting cavity can heal via a blood coagulum (blood clot). This works without any problems with cavities up to 1 cm. However, if the cavity is larger than 1 cm, the defect must also be filled.

This can be done with a collagen sponge or an autologous bone transplant. Blood filling alone would not be sufficient here. Finally, the bone defect is covered with the gum flap to ensure adequate wound healing.

Depending on which tooth is treated, the correct access to the cyst must be decided. If the cyst is present on the tooth where the apicoectomy is to be performed at the same time, both can be performed in one procedure. A further visit to the dentist after approximately one week is mandatory.

The stitches must be removed by the dentist to prevent them from growing into the gum. Furthermore the wound must be checked. In some cases there may be heavy bleeding on the same day after the treatment.

This can usually not be stopped at home without help from others. At risk here are especially patients with a blood clotting disorder or patients who use blood-thinning medication. Furthermore, it is important to prepare a bandage plate beforehand in order to be able to compress the area well. This can prevent the patient from having to return to the practice or even to the emergency service on the same day.

Instruments

There are various instruments that are used for apicoectomy. These are listed below together with their tasks. The scalpel is used to form the gum flap required for the wound treatment, for which the gum and periosteum are cut through.

With a rasparatory device, the resulting flap can be detached from the bone and folded to the side. With a Lindemann or bone miller the bone is cut through to the root of the tooth to make the root visible. A dental drill is then used to remove the tip of the root.

So-called root canal files are needed to widen the root canal and remove the damaged tooth material. Various irrigations are necessary to rinse away the ablated tissue and disinfect it there. The widened canal is then filled with Gutta Percha or retrograde with MTA.

Furthermore, there are special curved and angled spatulas and root canal instruments so that the root can also be palpated and treated from the lower side. This shape is necessary because the hole that is drilled is very small and does not have enough space to use normal dental instruments. Finally, the flap can be fixed with needle and thread to cover the defect that has developed.