A root apex resection is the removal of the lowest part of the root of the tooth. It can be considered if a root canal treatment has been carried out but the hoped-for success, i.e. freedom from pain, has not been achieved. This procedure is already over 100 years old and leads to success in 75-90% of cases. Not every dentist has the necessary expertise to carry out such a treatment. Often one has to go to an oral surgeon or a specialist in this field to have a root tip resection performed.
Procedure of a root tip resection
After proper explanation of the costs and benefits by the practitioner, a local anaesthetic is administered first. Then the gums and periosteum are cut through and a flap is formed to cover the defect at the end. Now a hole is drilled into the bone in the area of the root tip with a bone milling machine until the inflamed tissue is discovered.
The root tip is then shortened by approx. 3 mm. Now the root canal may need to be treated – if this has not already been done before.
There are several possibilities, depending on whether the tooth had already received a root canal treatment before the apicoectomy or not. 1. the tooth has not had a root canal treatment yet: Now the canal is prepared and widened with small files, followed by disinfection, drying and filling with Gutta Percha pins (a rubber-like material. 2. the tooth has previously been treated at the root: The previous root canal filling is checked for tightness.
If the filling is tight, nothing else happens, if not the filling can be renewed or a retrograde root filling is made. Retrograde means that the filling is placed from the tip of the root and not, as is usually the case, through the crown. Furthermore, only about 1/3 of the canal is filled with the material MTA (Mineral Trioxide Aggregate).
Once the tooth is completely treated, the granulomatous, i.e. inflamed, tissue is removed from the bone cavity and then rinsed with sterile saline solution. The soft tissue can then be folded back into place and fixed in place with several sutures. The success of the operation can be checked by means of an X-ray.
Finally, the root canal treatment is condensed once again from the crown and the temporary closure of the dental crown is made. The sutures are removed after about 8-10 days. This temporary denture can be replaced by a definitive closure after the patient is free of pain.
Preparation for a root tip resection
The apicoectomy is only a last rescue attempt for the diseased tooth. Usually the tooth has already been treated at the root and the root canal filled. Often this filling has even been renewed, as there have been repeated complaints or an inflammation is still visible on the X-ray.
If the pain persists beyond this, a root tip resection is considered. Beforehand, it should be ensured that the root canal treatment carried out has no flaws whatsoever. An x-ray should also be taken.
In patients with blood coagulation disorders or if anticoagulant medication is being taken, a dressing plate must be prepared. This can very easily control bleeding after the procedure and prevent post-operative bleeding. A change in medication is then not necessary!
If a patient has an increased risk of endocarditis, an antibiotic must be taken beforehand for this type of procedure. Endocarditis is an inflammation of the inner skin of the heart. Diseases that cause an increased risk of this disease include a congenital or acquired heart defect or a mitral valve prolapse.