If the tooth is mobile after root resection. Method of resection of the tops of the roots of the teeth: description and essence of the operation. Indications and contraindications for resection

The pathological fear of the dentist is inherent in every person since childhood. Especially if he hears scary names. For example, resection of the apex of the tooth root. What is it, and is it worth it to be so afraid? However, a terrible toothache, which is familiar to everyone, leads us to the dentist's office, where they make a diagnosis: pulpitis, granuloma, cyst. After that, they say that a tooth resection will be required.

A terrible toothache that is familiar to everyone leads us to the dentist's office, where they make a diagnosis.

What is root resection

In dentistry, this procedure is considered complex, therefore, it is carried out under local anesthesia. If the attending physician recommends its implementation, then it is the only way get rid of complex disease and save the tooth. The doctor will not suggest such a method until more and more sparing treatments have been carried out. If a serious inflammatory process progresses in the root area, then it must be stopped, otherwise serious consequences are possible.

Usually the dentist tries to localize the disease using endodontic treatment to stop the gingival and root inflammation. And if this does not help, they resort to the resection method. This must be done and as quickly as possible. Typically, such an operation is prescribed for the following diseases:

granuloma;
cyst;
fibroma;
periodontitis;
pulpitis;
the case when a piece of a tool remained at the root;
poor-quality canal filling;
root break;
root curvature.

Sometimes a tooth is really easier to remove, especially if the issue of a wisdom tooth is being decided.

Losing a tooth is only a small part of the consequences. More sadly, if the inflammatory process affects neighboring teeth, gum inflammation begins, it is affected lymphatic system, and with the flow of lymph, inflammation can affect other human organs.

Important! If a resection of the tooth root is scheduled, it means that severe inflammation which needs to be removed immediately. Delay is fraught with serious consequences.

In such a situation, there is no question: to do or not? Do it, definitely! The situation is dangerous to health in general. And since it surgical intervention you need to know how to prepare yourself for this.

What a person needs to know before the upcoming resection

It is already clear that the operation cannot be avoided. This is a complex procedure, but it will help prevent extraction, relieve gum inflammation and avoid serious consequences. Some patients prefer to extract a tooth, simply not fully understanding what an apex resection is. But there are teeth in the dentition that are important to keep. Especially if the incisors and fangs are at risk.

In dentistry, this procedure is considered difficult, therefore it is performed under local anesthesia.

Sometimes a tooth is really easier to remove, especially if the question of a wisdom tooth is being decided. But sometimes uninstalling won't solve the problem. The word resection itself in translation means removal. But in this case, this is not a tooth extraction, but its salvation and elimination of the disease. With such an operation, the doctor manages to penetrate directly into the site of infection and quickly stop the inflammatory process, preventing the further spread of gum infection, which is dangerous not only for neighboring roots. O possible consequences already mentioned.

Despite the complexity of the procedure, the patient will not feel anything, as it is performed under local anesthesia. There is some discomfort and slight pain in the gum area after anesthesia. Most often, an operation of this nature is performed when the anterior dentition is at risk. The front teeth have one straight root, which greatly facilitates the course of the operation.

Contraindications for resection

Despite the safety of the operation, there are still contraindications:

gum periodontal disease;
tooth mobility in the gums (periodontitis);
periadenitis (disease of bone ligaments);
cardiovascular or infectious diseases in the acute stage;
epilepsy;
poor blood clotting;
cracks in the root of the tooth;
crown destruction.

Despite the complexity of the procedure, the patient will not feel anything, as it is performed under local anesthesia.

The decision to prohibit or allow the operation is made solely by the attending physician in each individual case.

Important! Taking into account the seriousness of the upcoming operation, you should not trust your health to doctors with no great experience or doctors of dubious reputation. Choose dentists with extensive professional experience.

How is the operation

The entire operating process lasts from 30 minutes to one hour. It depends on the location of the tooth. The operation in the area of the front teeth is faster. On the eve of surgery, the doctor checks the teeth for caries, and if it is, the canal is sealed. This should be followed by at least two days. Otherwise, during the operation, it may occur backlash on the filling.

The tooth, in the area of which the operation will be performed, is sealed with gutta-percha or phosphate cement. The channel expands, it is thoroughly cleaned, disinfected, then the filling material is placed in liquid state injected into the channel. This is necessary so that the narrowest places of the root are closed.
On the day of the operation, the attending physician conducts a test for anesthetic drugs and positive reaction anesthetizes the injection site. It doesn't hurt, it's rather uncomfortable.
An incision is made in the gum so that it is visible bone. After that, on the basis of the projection, a small hole is made in the jaw bone using a drill.
Through this hole, the doctor determines the top of the root and separates it along with the cyst. After that, antibacterial, anti-infective drugs are injected into the location of the cyst.
If after resection formed large cavity, it is filled with artificial bone tissue. This is done for speedy recovery own bone tissue.
Sutures are applied, drainage is installed to drain the ichor from the site of the operation. Drainage is removed after a couple of days.

After the operation, a bandage is applied to the patient in the region of the upper lip, it can be removed after 12 hours. The doctor may advise applying ice. This is necessary in order to prevent the occurrence of hematomas.

The tooth, in the area of which the operation will be performed, is filled with gutta-percha or phosphate cement.

Postoperative complications

It is clear that swelling or bruising is a completely normal postoperative phenomenon. Especially if you remember that resection of the apex of the tooth root is considered complicated operation. There is an introduction into the bone tissue of the jaw, which can lead to the following consequences:

violation of the integrity of blood vessels;
nasal perforation;
alveolar injury;
perforation of the maxillary sinus;
paresthesia of the face.

This does not happen so often and only if a person has a difficult anatomical structure facial bones, or upper teeth close to the maxillary sinus. In such cases, surgery is carried out carefully, and the incisions themselves are made a little larger.

Paresthesia occurs if during the operation it was accidentally touched facial nerve. In this case, additional complex treatment and physiotherapy procedures. This is another one of important facts which requires extensive experience of the surgeon.

The pathological fear of the dentist is inherent in every person since childhood.

Leaving aside the negative, we can say that almost all operations are favorable, without consequences, and the patient goes home the same day, where he independently carries out postoperative measures.

Postoperative measures

The doctor recommends refraining from excessive activity and, if possible, spend a couple of days in bed, excluding any physical exercise. You can eat on the first day, but not earlier than after three hours. It should be soft food that does not require thorough chewing.

salty, spicy foods, hot or carbonated drinks should be avoided for now, as they are annoying factors. Do not use toothpaste and rinses.

At this time, it is better to rinse the mouth with decoctions of anti-inflammatory herbs. It can be:

chamomile;
St. John's wort;
sage;
plantain;
yarrow or collections of these herbs.

Decoctions are easy to prepare. It is necessary to pour one spoon of grass with a glass of boiling water, insist, cool to body temperature and rinse the mouth. There is a desire to brush your teeth - then it is better to use children's toothpaste or unscented tooth powder.

Nerves in the tooth

During the first two days, the patient may experience slight discomfort. The jawbone was opened, so pain are considered the norm. The use of anabolics is not contraindicated. Which ones, the dentist will recommend. Two months after the resection, the patient should X-ray to rule out relapse. solid food not recommended for the next two to three months. Apples, carrots are best grated.

Conclusion

Do not think that lotions and baths with medicinal herbs help to get rid of the inflammatory process. Herbs are only good after surgery. Heat can cause fast growth cysts. Do not forget that such neoplasms are filled with pus. Heat can provoke its spreading in the jaw bone tissues, provoking new inflammatory processes.

Photograph of a diseased tooth

Once in the lymph, pus spreads throughout the body. Patients notice swelling in the jaw area, inflammation lymph nodes. In such a situation, all human organs that can be affected by infected lymph are at risk. Therefore, you should not subject your body to such tests, hoping that everything will resolve itself. Such diseases do not resolve, it is necessary to decide on a resection, if the doctor strongly recommends it, spend a few minutes and get rid of the disease. Be healthy!

Any procedure in dental office becomes a real test for us. Perhaps there is no person who has not experienced toothache. Despite this, we still try to postpone the visit to the dentist. But most often, patients are faced with the procedure of canal filling or treatment of advanced pulpitis. In fact, these are fairly simple manipulations that are performed in most cases under local anesthesia. After their conduct, patients are not so often tormented by severe pain.

But the situation is completely different with such a procedure as resection of the apex of the tooth root. This operation is complex dental procedures. It is rather unpleasant for the patient. Of course, the doctor will perform it under local anesthesia, but since a wound remains in the mouth after resection, there will still be pain after the anesthesia has passed.

Indications and contraindications for resection

Indications for resection of the apex of the tooth root:

cysts and granulomas near the root of the tooth large sizes,
the impossibility of treating dental canals, for example, if they are in the wrong anatomical location.

An important condition for the operation is the presence of bone tissue of at least 0.5-1 cm in thickness, otherwise a bone fracture may occur during the removal of a cyst or granuloma.

In addition, resection of the tooth root will be ineffective in chronic periodontitis and periodontitis, especially with increased mobility tooth (in this case, it is better to remove the tooth completely along with a cyst or granuloma). The operation is not recommended if the tooth root is severely destroyed by the cyst itself or by the granuloma that has spread into it - the removal will also be more effective way treatment.

Contraindications for surgery:

tight contact of diseased tooth roots with healthy ones,
the spread of a cyst or granuloma to more than a third of the tooth - it is shown complete removal,
the tip of the tooth is destroyed - in this case it cannot be restored or used as a basis for fixing the prosthesis,
severe tooth mobility
common diseases body: cardiovascular disorders, immune systems, diabetes, mental disorders, diseases of the circulatory system.

Stages of surgery and rehabilitation

First, the tooth is prepared for surgery. The canal is filled with at least two-thirds of the root. If such preparation is not possible, then intraoperative retrograde filling is performed. Such filling is carried out using hardening materials that can rub against the canal walls.
Anesthesia is carried out with local conduction anesthesia. As soon as the anesthetic begins its action, an oval incision is made to the bone in the jaw at the location of the transitional fold, where the immovable mucous membrane passes into the gum, to make it convenient to sew up the wound later.
Having opened the mucosal flap, it is peeled off with a special spread to the level of the root apex. If the periosteum is linked to the bone by a scar, then it is cut with a scalpel. The base of the cut section of the mucosa should be turned towards the entrance to the oral cavity, this will give good food blood.
Then a spherical or cylindrical nozzle is used on the drill, with which the outer bone wall is removed.
After the root tip is exposed, it is opened to the level of filling with filling material. This place is easily identified by the white dot in the center of the cut.
Then the bone cavity is carefully cleaned from granulations, granulomas, filling material, foreign bodies.
Sharp bone edges are turned with a cutter.
Resection of the root of the tooth is carried out at the same level where the bottom of the cavity is located. This is done so that the root section does not protrude.
If necessary, then retrograde filling of the canal is done. Synthetic preparations are injected into the cavity. Sterile powder or granules must first be moistened with a solution, only after that they are introduced into the bone cavity by 80 percent. The drug moistened in this way swells and does not fall out of the bone cavity.
If synthetic materials are not available, chips from the cortical plate can be used. The bone cavity, which is filled with material, is covered with a special membrane.
After that, the cut flap is placed in place, sutured.
Cold is applied to the patient for 30 minutes and pressure bandage to the operation site to reduce severe swelling and hematoma.

Rehabilitation

During the recovery period after surgery, it is necessary to maintain oral hygiene and take preventive measures for inflammation. Immediately after the procedure, an ice pack is applied for half an hour. Food can only be taken no earlier than three hours after the operation. Food must be liquid.

It is prescribed to take antimicrobial, anti-inflammatory, immunostimulating agents. Until the moment the sutures are removed from the operation sites, patients should be released from work.

Consequences after resection

We have already mentioned that a lot depends on the skill of the doctor and compliance with safety precautions during the operation. If the doctor and the patient with all due responsibility approach the resection, then the likelihood of complications is reduced significantly. But sometimes they do happen. What are the consequences of resection.

The most common complications:

Perforation of the maxillary and nasal sinuses;
Bleeding;
Sometimes the resection may be insufficient, and it may also remain in the bone cavity;
The doctor may not carefully remove the filling material and granules;
Nerve fibers may be damaged. Most often this is due to the fact that the inflammatory process has developed. Therefore, both the doctor and the patient must make every effort to overcome the infection in oral cavity. If the nerve fibers were injured, then the patient is prescribed physiotherapeutic procedures.

Unfortunately, even if the operation was successful, without dangerous complications, no one is safe from possible relapses. Well, if the quality of the operation was not enough high level, then very often there is a re-infection of the tissues of the bone, gums and tooth.

If the procedure was carried out in violation of the methodology or the doctor did not adhere to the rules of hygiene too carefully, then after such an amateurish intervention, the patient has to resort to treatment again. Such treatment can be quite expensive and very long.

How to choose a doctor? You might think that the quality of the operation performed will directly depend only on how expensive the clinic has become a place for it. In part, this affects the quality of the operation. Modern clinics use latest equipment, more modern materials, better tools. But this is not a 100% guarantee of success.

First of all, you should pay attention to who will perform the operation. This should be a surgeon with extensive experience in performing resections.

If a doctor does not have enough experience and skill, none of the most advanced technologies will save him. There are many negative reviews about carrying out such operations in expensive clinics. At the same time, the operation performed even in the district dental clinic, but an experienced doctor brings excellent results. Therefore, do not rush to lay out a round sum in expensive private offices. Unfortunately, talented doctors do not always work in such clinics. Very often there are simply those specialists who have some capital for such a private practice.

Resection of the root of the tooth is a serious surgical intervention. It should be resorted to only when gentle methods of treatment have not given desired result. Choose an experienced and competent dentist to perform this procedure. Then the successful outcome of the operation will be almost inevitable.

Removal of the apex of the tooth root surgically 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 resections, in rare cases- multi-rooted. It's believed that possible provocateur may be chronic sinusitis.

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 was sealed root canal, and there was an empty piece;
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 was completed and the pus got into 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. Introduced into the submucosa of the gums, "freezing" bone and soft tissues nerve endings, exsanguinating the periodontium. The gums turn white from the injection.

Moreover, it is proved that the injection between the second small root and the first upper teeth less effective than between the top center and side. 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 area trigeminal nerve where the fabric is around 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, and naturally go out.

For the first 10-12 hours after the end of the operation, a special bandage is applied to upper lip and chin, and ice on 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 avoid any hard 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.

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 with therapeutic purpose in the periapical region. In rare cases, granulomectomy is performed with 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, a pin artificial tooth, or 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 major damage. pathological process near-apex area 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 fixed prosthesis, fortified on firmly seated in the alveolus neighboring teeth, 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. For getting best results sealing into the root canal until the cement hardens, sometimes a metal pin is inserted. 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 x-ray, such a fallen into the operating cavity metal seal resembles a pellet or a small fragment of a bullet. In some cases, root filling with amalgam through the wound represents the only possibility 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) wall trepanation alveolar process to expose the top 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. Resection of the root apex upper jaw, conduction anesthesia is recommended at the infraorbital foramen or tubercle of the upper jaw in combination with infiltration anesthesia for exsanguination operating field. In some cases, dental anesthesia is sufficient nerve plexus. For resection of the root apex mandible mandibular anesthesia should be used in combination with infiltration. 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).

Rice. 36. Arcuate section according to Brocade.
Rice. 37. Trapezoidal section according to Novak - Peter. With this incision, the edge of the gum is damaged.

The formed mucoperiosteal flap should be wide enough and partially capture the area 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. With a flat chisel, the bone is removed layer by layer along the boundaries of the alveolar eminence until it appears granulation tissue or a root that 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 a wide opening inflammatory focus. 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. You can start this removal of the top by sawing the root with a fissure burr and finish light blow along 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).

Rice. 38. Resection of the root apex with a chisel.
Rice. 39. Resection of the root apex with a bur.

Rice. 40. Successive stages of granulomectomy.

The technique of resection of the root apex of individual teeth differs in some features. Upper first premolars in approximately 50% of cases have two roots. 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, resection of the apex must be done with particular care so as not to push the resected root segment into 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.

Root apex resection upper molars 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 success. conservative methods 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. Best Action exerts cold (ice) during the first day after surgery.

In general, with proper consideration of indications and contraindications for resection of the root apex, with proper canal filling, with correct technique operation and normal healing of the surgical wound, resection of the apex of the tooth root is an operation that allows you to save the tooth for a long time.

it surgical intervention used in cases where the infection affects the root of the tooth or top part its channels, and it is not possible to get to the source of infection by conventional means. It is carried out in order to save the tooth, instead of extracting it.

Access to the tooth during resection of the root apex is made through the gum. Most often, this method is used on canines and incisors, since they are the easiest to operate on. On the remaining teeth, resection is performed less frequently.

Indications for surgery

The indications for resection are inflammatory processes in the root of the tooth or to eliminate various negative consequences conventional treatment teeth.

Cyst at the top of the tooth root

It has the following properties:

Evens out damage and fills microcracks on the enamel surface
Effectively removes plaque and prevents the formation of caries
Restores natural whiteness, smoothness and shine to teeth

Stages of resection of the apex of the tooth root

The operation is performed on an outpatient basis using local anesthesia and can take up to one hour. General anesthesia optional, but can be given at the request of the patient and in the absence of contraindications.

The operation itself is performed in several stages, requiring sufficient experience and qualifications from the doctor:

Tooth preparation. The root canals require filling. Most often, it is performed one to two days before surgery. The tooth canal is disinfected and sealed approximately two thirds of the length.
Anesthesia. During surgery on the upper jaw, an anesthetic is injected into the submucosal region of the gums. For the lower jaw, an anesthetic is injected into the nerve area. Modern anesthesia provides complete insensitivity to pain during resection.
Root apex exposed. The gum in the area of the diseased tooth is cut, and its mucous membrane exfoliates. Then, using a drill with a special nozzle, a hole is made in bone wall. The patient does not feel these actions.
actual resection. Through the resulting hole, the top of the root is cut off with a boron machine and removed with tweezers. Together with it, the focus of inflammation (cyst) is also removed.
Cavity treatment. The resulting cavity is washed and disinfected. If a large cavity has formed after the operation, a special synthetic bone tissue is placed in it, which contributes to further bone regeneration.
Wound closure. Produced by special suture material mucocutaneous membrane. For two days, a drainage is installed at the suture site to drain the ichorus.

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Consequences of the operation

Possible complications are related to the quality of the operation.

These most often include:

Bleeding. Occurs when blood vessels are damaged. To reduce the risk to the patient during preparation for the intervention, a blood coagulation test is performed.
Perforation of the nasal cavity(during surgery on the upper incisors).
Perforation maxillary sinus (with resection of small molars).
Mental nerve injury(during surgery on the lower small molars).

If the resection was incomplete or the cavity was not cleaned enough, infection and pain may return.

All these complications require subsequent long-term and rather expensive treatment.

Therefore, in order to prevent them and minimize risks, the patient is recommended:

Find out the doctor's qualifications who will perform the resection. Talk to him and your doctor. Consult about the medical history and indications for surgery.
Evaluate the experience of clinics and in which the treatment takes place, in this area.

After the operation, the patient is applied cold to the incision site for half an hour (to reduce swelling) and at 12 o'clock apply a pressure bandage.

Prescribed antibiotics and antiseptics mouthwash. Painkillers may also be prescribed if pain occurs during healing.

To reduce the risk of developing harmful effects during postoperative recovery the patient is advised:

Eat no earlier than three hours after resection. In this case, the food should be liquid and not cause thermal irritation of the oral mucosa. In the future, for the recovery period (it takes from five days to two weeks), you should refrain from hard, spicy, too hot or cold food as well as alcohol.
Do not practice on the first day physical labor and sports.
Until the final healing of the wound, after removing the stitches, you should not visit baths and saunas.
An x-ray should be taken every three months for a year after the operation. and consult a dentist. This is done to prevent possible negative consequences associated with maintaining the stability of the operated tooth and possible development infections.

Service price

Resection of the apex of the tooth root will cost (per one tooth) from 4 to 7 thousand rubles depending on the clinic, the condition of the tooth, the complexity of the operation and the selected drugs for anesthesia.