After cutting, the roots of the tooth formed a large cavity. Resection of the apex of the tooth root - stages of the operation, prices and reviews. Resection technique

Tooth resection is a microsurgical operation to remove a cyst in the upper part of its root. Usually, purulent formations, growths are formed near the cyst, which, without timely treatment cause Negative consequences for the body. The main ones include the appearance of headaches, the development chronic sinusitis, general malaise.

The operation is carried out in dental clinics experienced surgeons with the use of modern equipment and painkillers.

The main stages of the operation

The duration of the resection of the root of the tooth can take from half an hour to an hour and a half. So, the front incisors and canines are in a place easily accessible to the doctor, the operation will take place quickly and without complications. But back teeth much more difficult to operate. The whole process is carried out under potent local anesthesia.

Preparatory process

Before the operation, the doctor examines the patient. The canals of the tooth must be sealed, otherwise they are pre-filled a few days before the resection.

Canal filling includes the following steps:

• opening access to them;
• cleaning and expanding with a file;
• filling empty root canal;
• installation permanent filling or crowns.

As a filling material, phosphate cement is used, which has a long service life. The hardening of the filling material takes place over several minutes.

Anesthesia

Resection of the root of the tooth upper jaw is performed using infiltration anesthesia, on the lower - using conduction anesthesia. Ultracaine or lidocaine is used as an anesthetic.

The essence of infiltration anesthesia: an anesthetic is injected into the region of the submucosal gums, spreads into bone tissue and blocks the nervous response to pain.

The essence of conduction anesthesia: an anesthetic is injected into the tissue adjacent to the nerve of the tooth, the nerve is impregnated with an analgesic, resulting in blockage nervous reaction for pain.

The gum at the injection site of the analgesic turns white, which indicates the beginning of the drug's action. The type of anesthesia is local.

Gingival opening

Before carrying out the operation, it is necessary to provide access to the root. For these purposes, the surgeon cuts the gum with a scalpel, mucosal exfoliation occurs, as a result of which bone tissue becomes available.

Using dental burs, a hole is cut into the bone tissue for exposure upper root. The opening of the gums is accompanied by profuse bleeding.

Direct operation

The first stage of the operation is the detection of the root, the second stage is cutting off its upper part. Clipping occurs using a drill, extraction - using a scalpel. The result of a successful operation is the extraction by the surgeon of the upper root along with the outgrowth or cyst.

In some cases, after the operation, an empty cavity is formed in the gum. In order to fill the space and speed up the healing process, synthetic bone tissue is injected into the gum.

Suturing gums

To restore the gum structure, it is sutured suture material. For the outflow formed after the operation blood secretions, drainage is placed in the gum between the sutures. A sterile gauze bandage is applied to the patient, cold is applied to relieve swelling.

In order to better understand what it is resection of the apex of the tooth root - we suggest watching the following video:

rehabilitation period

The postoperative recovery period lasts from several days to a week. On the day of the operation, do not eat next days reception allowed liquid meals. It is worth limiting the consumption of spicy, salty and hard foods (nuts, hard vegetables and fruits).

To prevent the occurrence of inflammatory processes, the doctor prescribes mouthwash by special means several times a day. Effectively rinsing the mouth with a decoction chamomile, St. John's wort or oak bark. natural ingredients in herbs relieve puffiness, prevent the occurrence purulent formations at the site of the resection.

If, after a week, blood or pus is released from the wound, it is necessary to consult a specialist, take an x-ray and eliminate complications.

Indications for carrying out

When methods cannot be applied effectively surgical intervention(endodontic treatment), the patient is prescribed a procedure called resection.

Indications:

• The presence of purulent cysts larger than one centimeter. Conservative treatment in such cases is ineffective, its main disadvantages are: the duration of the process, frequent relapses;
• The presence of sealed canals and crowns on the tooth. With conservative treatment, first of all, it is necessary to remove the crown, then unseal the canals and begin therapeutic procedures. The cost of conservative treatment is high;
• The presence of a metal pin in the root canal. In dentistry, the removal of pins is not recommended, since during the procedure, a fracture of the tooth root often occurs, which is a prerequisite for its removal. Performing a resection in this case inevitably;
• Poor quality root canal filling contributes to the penetration of infection into them and, as a result, to the development of cysts. It is not recommended to carry out unsealing and re-sealing, the result of such manipulations may be tooth loss.

Tooth resection is a complex and painful operation, in many cases requiring a long recovery period, however, its main advantage is the preservation of the diseased tooth.

Contraindications for carrying out

In certain cases, a surgical operation to remove the upper part of the tooth is not possible. The main contraindications include:

• periodontal disease of the second, third and fourth degree;
• the presence of cardiovascular diseases;
• the presence of acute respiratory diseases;
• cracks in the root of the tooth.

Not all teeth can undergo such surgical interventions. The operation is most conveniently performed on incisors and canines; it is not recommended to perform the procedure on chewing teeth.

Possible consequences of

Resection of the upper part of the tooth root is a complex type of surgical intervention. The dentist must have extensive experience in performing similar procedures so as not to cause harm during the resection.

Possible injuries during the operation:

• damage to blood vessels;
• damage to nerve endings;
• damage to adjacent healthy teeth;
• infection.

Complications often occur after resection of the apex of the tooth root. The main ones are:

• profuse bleeding at the wound site;
• festering gums at the site of resection;
• the occurrence of swelling and swelling of the jaw;
• numbness of the lower part of the face;
• relapse.

In case of poor-quality removal of the tooth root and cyst, a relapse occurs. This phenomenon usually occurs in acute form, requires surgical intervention.

Before choosing a clinic for treatment, it is recommended to study the basic information about it, read the reviews in order to get an appointment with qualified specialists with sufficient experience in performing such surgical interventions.

Price

The price for the operation ranges from three to twelve thousand rubles. The cost varies depending on the location of the operation (in large cities the cost is often overpriced), on the quality of the filling materials used, on the quality of anesthesia, and on the degree of neglect of the disease.

Table #1: average cost operations in Russian cities

As can be seen from the table, the most high prices for dental services in Moscow and St. Petersburg. It is worth noting that medical centers There are much more people performing resection operations in large cities.

The prices in the table are indicative. More accurate information can be obtained by visiting a dental clinic.

The doctor will conduct an initial diagnosis, on the basis of which a treatment plan will be drawn up and the cost of assistance will be determined.

Resection of the apex of the tooth root - surgery which is carried out in the treatment chronic inflammation periodontal, to eliminate the focus of inflammation in the canal and remove its upper part. In this case, a cyst is formed on the root, which is a cavity with a fibrous membrane and filled with pus.

Computer graphics - image of the procedure

The procedure is carried out as a last resort, only when endodontic methods have failed. The method allows you to remove the focus of inflammation without affecting the healthy part, and keep the dentition intact.

Resection operation

It must be remembered that the operation is quite complicated and involves surgical manipulations to approach the root of the tooth and remove the focus of inflammation. Recommended for:

• root perforation;
• poor-quality filling and curvature of the canals;
• formation of cysts
• periodontitis;
• curvature and fracture of the root apex;
• the presence of an inflammatory process under the prosthesis or foreign body.

Resection of the tooth root lasts 30-60 minutes. Most often performed on the front teeth. The procedure is performed in the dentist's office in one visit under local anesthesia.

Stages of a tooth extraction operation:

1. Preparation - a few days before the resection, the canals are checked. If they are not sealed, then the dentist fills inner region 2/3 of the entire root. Treatment is carried out with special materials that provide maximum rubbing to the root walls.
2. Anesthesia - local infiltration or conduction anesthesia is performed.
3. Creating an approach to the apex of the root - an angular, oval or trapezoid incision of 0.5 cm is made on the jaw in the place of the transitional fold. The incised flap is turned towards the entrance to oral cavity is essential for a good blood supply. A hole is made in the projection of the root using a burr, and the outer bone tissue is removed.
4. Root resection - through the hole made, the top of the tooth root is separated with a fissure drill to the place of filling. This can be seen from the bright dot in . The bone cavity is cleaned of suppuration, cysts or other formations are removed. Sharp and overhanging fields are cleaned with a cutter.
5. Stimulation of bone tissue growth - if necessary, retrograde filling is performed. If the cyst was large, then the cavity is filled with 80% synthetic material, which is pre-moistened with a special solution. This allows you to quickly build up bone tissue and fill the defect.
6. Wound suturing - the mucosa at the incision site is sutured. Drainage is inserted between the sutures to drain the ichorus, and a pressure bandage and cold are applied to the injured area for 30 minutes. Drainage is removed after 2-3 days.

Important! The operation on the teeth is carried out only in the remission stage.

Most patients notice swelling after resection of the tooth root, which disappears after 3-5 days. This is a normal situation during such a complex procedure.

Since the appearance in, in some clinics, resection of the apex of the tooth root with a laser has been performed. The technique has significant differences, both in execution and in the condition of the patient during the rehabilitation period.

Laser correction method:

1. The incision is made no more than 1 cm.
2. The work is carried out with an ultrasonic device, which contributes to the rapid tightening of bone tissue.
3. Inflammatory formations are treated with a laser. The radiation penetrates deep into tissues and kills microorganisms that are not even visible to the eye.
4. The damage is closed with artificial bone tissue and biomembrane, which helps to prevent complications.

Contraindications for surgery

In some cases, tooth resection is not only inappropriate, but also impossible. The operation is contraindicated in the following cases:

• tooth mobility II and III degree or their strong destruction;
• significant exposure of the neck or root in periodontal disease;
• cyst larger than 1 cm in diameter. formations are long and often fail.
• exacerbation of periodontitis;
• the presence of crowns and fully sealed canals;
• pathologies of the heart;

With tooth mobility of I or II degree, displacement, as well as the formation of a gum pocket with a depth of not more than 5 mm, gum resection is recommended.

Rehabilitation after surgery

On the sore spot apply cold for 30 minutes, eating is possible after 2-3 hours. During the recovery period, it is necessary to carefully observe oral hygiene procedures. Rinses and toothpastes should be as non-aggressive as possible.

Food is accepted only in a warm and semi-liquid form. In the early days, salty, sweet and spicy foods should not be introduced into the diet.

Rehabilitation after resection of the apex of the tooth root can last from several days to a month. To prevent inflammation, the specialist prescribes immunostimulating, anti-inflammatory, antimicrobial agents: diclofenac, suprastin or chloropyramine, dibazol. It is allowed to rinse with decoctions of herbs and antiseptic preparations: chamomile, linden, sage, miramistin, chlorhexidine. Don't forget to go every three months x-ray examination resection areas.

After the operation, as a rule, there is swelling and soreness. There may be a loss of sensation in the gums for several days.

The service life of the tooth after resection of the root apex can last quite a long time. It does not lose its functional qualities; if necessary, it is covered with a crown.

After the resection of the apex of the tooth root, after the operation, it is necessary to carefully follow the recommendations of the dentist. Otherwise, re-inflammation and tooth extraction is possible.

Complications after intervention

Any surgical intervention, including the operation of resection of the apex of the tooth root , requires the surgeon's attention, extensive experience and knowledge. When performing such complex manipulations, there is always a risk of complications. Backlash appear in the form:

• damage to blood vessels;
• perforation of the maxillary or nasal cavity;
• injury facial nerve which can lead to muscle paralysis;
• incomplete removal of granulomas and cysts;
• inadequate resection.

Complications after resection of the apex of the tooth root are possible with an incorrect anatomical and topographic structure, for example, close proximity to the maxillary sinus.

If the prescriptions and advice of the doctor are not followed, the tooth may bleed after root resection. It is impossible on your own, so you should immediately seek help from a dentist.
Removing part of the tooth leads to shortening of the roots, so its instability can be observed. However, in most cases, resection contributes to the preservation of the functionality of the tooth and the inadmissibility of complications.

What is a resection of the apex of a tooth root? What is it for? You will find answers to these and other questions in the article. Resection of the apex of the tooth root is a procedure that is performed with a cyst or granuloma of the root in medicinal purposes. This operation allows you to save the integrity of the dental arch. It is used to eliminate the focus of inflammation through the gum, or rather, the upper one. In more detail, we will consider the resection of the root apex below.

modern medicine

The current dentists, when treating teeth, try to save them to the last. They always try to prevent the resorption of the tissues of the alveolar crest and leave the physiological activity of the dentition. Tooth extraction is considered last resort.

To save teeth when conservative treatment is powerless, help special operations. They do not involve the removal of masticatory organs and are the excision and disinfection of infected tissue areas. To do this, doctors often have to correct the root of the tooth itself, which has undergone inflammation. The advantages of such surgical interventions are as follows:

• saving money on implantation;
• minimal traumatism of the oral cavity;
• maintaining a healthy and aesthetic smile;
• inhibition of the development of the infectious process by eliminating the affected tissues, adding a lifetime to the tooth;
• full, but temporary preservation of the function of the dentition for an unknown period (sometimes saved teeth served for decades).

Surgery

One of the tooth-saving operations is the microsurgical action of incomplete root cutting. Its execution allows you to eliminate various formations and save the tooth from the irradiation of inflammation.

The most important condition for the execution of such an operation is timely appeal person to the dentist.

AT advanced cases when the bone defect is 2 cm across, these interventions are not successful.

A preventive annual visit to the doctor with a picture immediately reveals the presence of cysts. And long-term ignoring the symptoms of the pathological process in the mouth leads to the fact that the implementation of the operation that saves the teeth becomes impossible, and the dentist has to completely amputate the tooth and then replace it with an implant.

The essence of the operation

The operation for resection of the root apex is a process of excision of pathological foci of inflammation in the root zone or near it if conservative treatment is untenable or the patency of the canal is closed by foreign bodies.

This type of surgical treatment was previously considered to be time-consuming and minimally traumatic. The function of the tooth is not fully preserved, because its length is reduced. More often surgical procedure carried out on incisors and canines, and much less often - on multi-rooted teeth. The operation in dentistry is called apicoectomy, which literally means "removal of the tip."

Modern dentistry allows performing an emergency resection of the root apex without any risks to the patient. The rehabilitation period does not cause him much discomfort and takes a little time. The most important advantage of this procedure is complete healing dentition from a bacterial process that is steadily progressing.

Indications for the operation

• Blockage of the canals of the tooth. The reason for this situation may be congenital anomaly development, poor quality filling, fixation ceramic-metal crown on the tooth, installed pin and so on. The doctor has no choice but to perform an operation to save the tooth.
• The presence of a growth in the form of a granuloma that destroyed the root, or cysts. The dead root zone and cyst are removed with minimal resection. Such a diagnosis was previously a sentence for a tooth, because it was simply eliminated. Today this problem is solved by apicoectomy.

The cyst is an underlying problem requiring apical resection and cystectomy. It is a separate zone of inflammation, which looks like a sac with a cavity, usually filled with pus. The cyst can become aggravated and in the patient's condition cause serious transformations:

• increase lymph nodes;
• headache;
• discomfort in the area of ​​the tooth itself and so on.

She can also become the main reason the spread of inflammation to nearby structures: ears, sinuses, tonsils.

Cyst treatment

Many people ask the question: "Resection of the apex of the tooth root - what is it?". In the current conditions, the treatment of a tooth cyst is reduced to cystectomy with excision highest point root, but better with root polishing and root conservation.

If tooth filling was carried out with cement during the Soviet era, then this process repeat is not recommended due to the high risk of perforation and other complications. Usually conservative treatment turns out to be useless, and the cyst, instead of resolving, continues to grow. Surgical intervention is best done as soon as possible, since the involvement of new tissues in the pathological process may become a contraindication for apicoectomy.

x-ray

In preparation for root excision, full-fledged X-ray testing has importance, since surgical intervention is possible only if there is at least 5 mm of healthy bone tissue of the alveolar crest.

Otherwise, during the operation, a crack may appear on the bone. Since each patient's situation is special, the doctor makes a private decision about the resection. He personally assesses the risk of manipulation, thinks through other options and tends to the most optimal.

To whom is the operation contraindicated?

Patients should be aware that, as with any surgical intervention, there are pros and cons of root resection, the suitability of which is assessed by the doctor. Disadvantages of healing by excision of the highest point appear most often in the case of the implementation of the operation in the presence of simple general clinical contraindications.

Therefore, on primary stage examination, it is necessary to exclude conditions that do not allow resection. These include:

• involvement in the pathological process of more than 1/3 of the tooth;
• redundant;
• cracks in the damaged tooth root;
• too close placement of adjacent tooth roots with defective ones;
• damage to the highest point of the tooth without the possibility of its reconstruction;
• mental illness in the acute stage;
• poor clotting blood;
• Availability oncological disease;
• immune deficiency in severe stages;
• decompensation and exacerbation of protracted severe ailments body (asthma, diabetes mellitus, hypertonic disease, IBS, etc.).

Risk assessment here for each patient occurs individually.

Preparing for the operation

The surgery is very simple and is performed under local anesthesia. First, the specialist seals the canals of the tooth with special antiseptics, and then with BeeFill sealant. He thoroughly cleans them in advance, and then hermetically clogs them. If such manipulation is not possible, then retrograde filling is performed. The procedure is carried out no later than two days before resection, so that there is no inflammatory response.

Anesthesia

For resection, anesthesia is always local, but it can be of two types:

• Conductor. For mandible use the following anesthesia: the drug is injected into the area near the nerve. Usually branch segments are used for this. trigeminal nerve.
• Infiltration. It is implemented during operations on the upper jaw and consists in the injection of ultracaine or lidocaine derivatives into the gums.

Operation steps

The operation consists of the following steps:

1. First, the dentist gets through all the infected layers to the root of the tooth. It performs an arcuate micro-incision of the gums and exposes the periosteum by about 5 mm. Then it exfoliates the periosteum and exposes the damaged alveolar crest of the jaw. As a rule, the bone in the area of ​​the cyst has already melted and sawing is not necessary here. Next, the doctor prepares a tiny hole through which he opens access to the damaged area.
2. Elimination of the cyst and correction of the highest point of the root from the foci of inflammation. The doctor cuts off the dead root perpendicular to the upper axis of the tooth. He carefully removes it along with the cyst and affected tissues through the hole. Then it fills the empty space left after removal with osteoplastic material. Resection is best avoided if possible, as weakening the root reduces the life of the tooth.
3. Suturing the wound area. Wound closure is performed with the installation of a microdrainage through which the ichor should flow. It remains between the sutures after the operation for two days.

Recovery period

What happens after resection of the apex of the tooth root? This operation takes about an hour, and rehabilitation period takes three days. soft tissues are reborn within the first seven days, and the bone heals for a couple of months.

On the first day after the intervention, the patient may experience moderate pain and swelling. Within a week, they should imperceptibly decrease, and then disappear.

Tips after resection of the apex of the tooth root:

• discard hard brushes, too powerful rinses and toothpastes;
• limit exposure chemical irritants on the oral cavity (sour, spicy, salty, spicy dishes);
• during the first seven days after the operation, do not play sports;
• use antibacterial solutions for rinsing your mouth (according to the instructions painted by the doctor);
• accept full course antibacterial medications to prevent the development of an infectious process;
• to evaluate the results of the intervention, perform x-ray testing a couple of months after resection;
• you can eat only 3 hours after the completion of the manipulation (food should be warm and chopped);
• refrain from eating too hard foods during bone healing (approximately 3 months).

Doctor and patient should also remember about possible complications that may occur after surgery.

Price

What is the price of resection of the apex of the tooth root? It is set according to:

• volume of surgical intervention (number of operated teeth) - up to 15,000 rubles;
• additional costs for the material - 10,000 rubles (Bio-Oss Spongiosa granules) or 12,000 rubles (for anesthesia and a container).

The price of resection of the apex of the tooth root in different clinics varies depending on the experience and qualifications of the dentist, the use of special equipment and other manipulations performed as necessary. Approach the choice of a clinic for treatment carefully so that you do not have to visit the dentist additionally and spend extra money if the cyst recurs.

Resection of the apex of the tooth root (apicectomy) — surgical method removal of foci of inflammation and infection along with a part of the upper part of the tooth root, while maintaining the functions of the tooth. Most often, resection of the root apex is performed on canines and incisors (less often on multi-rooted teeth).

Indications for an apicoectomy

The presence of cysts, granulomas in the apex of the tooth root. Cysts form completely imperceptibly at the roots of the teeth, causing an inflammatory process and destroying bone tissue. The cyst outwardly resembles a sac, lined from the inside with dense fibrous tissue and filled with pus. In the acute stage, the cyst can cause headaches, inflammation of regional lymph nodes, headaches, periostitis, local swelling of the cheek from the side of the causative tooth, severe pain. The presence of a cyst can provoke the development of chronic sinusitis.

Treatment of cysts in the area of ​​the tooth root

Cyst in the area of ​​the tooth root

The easiest way to get rid of a cyst is to remove a tooth. That's exactly what they did before. But tooth extraction entails aesthetic problems. Fortunately, it became possible to treat cysts and granulomas of the tooth with apicoectomy and conservative ways. Conservative treatment consists in administering special drugs into the root canals or directly into the cyst, eliminating infectious process and relieve inflammation. This treatment takes several months. When the cyst reaches a diameter of 1 centimeter, then a resection of the apex of the tooth root is indicated.

Complications of conservative treatment of periodontitis
Poor-quality filling of the canals of the tooth causes the development of the inflammatory process. During depulping (during the treatment of pulpitis, preparation for prosthetics), the pulp is removed and the canals are sealed to the entire depth of the tooth root. If the dentist made a mistake in measuring the length of the root canals and did not fill them up to the end, then an infectious process with the formation of a cyst may develop in this unfilled empty segment.

If the canals of the root of the tooth are poorly sealed only in the region of the root apex, then it is necessary to unseal them and carry out all the stages of filling again. But when re-filling root (especially excessively tortuous) canals, perforations often occur, so it is much easier to resect the top of the tooth root and remove the inflamed focus (together with the cyst).

If the root canal is not filled at the very top of the tooth with a crown or a pin, then it is also advisable to resect the tooth root. Because conservative treatment will require the replacement of the old crown, the filling of the canals and the installation of a new crown (which forces the patient to bear additional material costs), and the extraction of the pin can lead to a fracture of the tooth root, since the material on which the pins are attached are particularly strong. In these clinical examples, root apex resection is the easiest and most safe way elimination of the focus of infection in the area of ​​​​the tooth root.

The presence of a foreign body in the root of the tooth serves as an indication for resection. During dental interventions, there are often cases of leaving fragments of endodontic instruments in the root canals, which can subsequently cause an inflammatory process.

Sometimes there is a perforation of the root canal in the area of ​​the apex. This violation can occur during endodontic treatment: during careless handling of files and inlays, various instruments.

1. Fracture of the tooth root in the upper third. Resection of the apex of the tooth root is shown.
2. Significant tortuosity of the root canals.
3. The lack of the possibility of opening the channels.

Contraindications for root resection

• severe tooth mobility;
• exacerbation of infectious and cardiovascular diseases;
• periodontitis in the acute stage;
• significant destruction of the crown part of the tooth;
• the presence of cracks in the root of the tooth.

Stages of resection of the apex of the tooth root

Resection of the apex of the tooth can last from 30 to 60 minutes. The duration of the operation depends on the location of the diseased tooth: the operation on the front teeth does not take much time and is relatively easy, it is more difficult to operate on the back teeth located in hard-to-reach places for the dentist. The operation is performed under local anesthesia.

Preoperative preparation

With a planned root resection on a tooth with unsealed canals, their obligatory filling is carried out a few days before the operation - not earlier than two days, otherwise a pronounced inflammatory reaction to the filling may occur.

The most commonly used filling material is phosphate cement. The root canal is expanded and thoroughly disinfected, and then liquid cement is introduced into it, so that it penetrates beyond the root apex. For better filling, a special metal pin is sometimes inserted into the canal until the cement hardens.

Pain relief procedure

Anesthesia

If the resection of the apex of the tooth root is performed on the upper jaw, then the use of infiltration anesthesia is indicated, which provides a long-term effect of anesthesia and sufficient great depth fabrics.

The essence of infiltration anesthesia is the introduction of an anesthetic (ultracaine, lidocaine) with a needle into the submucosal gum area. medicinal product with the help of diffusion, it gradually penetrates the bone tissue and affects the nerve fibers of the soft and bone tissues, the periodoctal ligament.

Infiltration anesthesia is characterized by blockade of nerve fibers of all tissues and exsanguination of the periodontium. At the injection site, there is a noticeable whitening of the gums. For the implementation of high-quality diffusion, the bone tissue must have a porous structure, therefore, the method of infiltration anesthesia is carried out mainly in the treatment of teeth of the upper jaw.

If the resection of the apex of the tooth root is planned to be carried out on the lower jaw, then conduction anesthesia is used. This type of anesthesia is characterized by the introduction of an anesthetic into the area located next to the nerve. In this case, the tissue surrounding the nerve and the nerve fiber itself are impregnated, with its further blocking. As a rule, the site of injection of the anesthetic drug is the area near the trigeminal nerve.

Creating access to the area of ​​the apex of the tooth root

An arcuate incision is made in the gum and detachment of the mucous membrane of the gum to expose the bone tissue with further detachment of the periosteum. Then, in the intended area of ​​​​the root apex, the dentist cuts out a small hole with a drill. The patient does not experience any pain.

Carrying out the resection of the apex of the tooth root

The hole that was sawn out with special burs serves as a channel through which the detection of the root tip and its further cutting off from the rest of the root part (perpendicular to the upper axis of the tooth) is carried out. Then the doctor, using tweezers or a special spoon, removes this root tip from the existing hole along with the cyst and the focus of inflammation.

If after the removal of the cyst a large empty space has formed, then a special bone is lowered into it. synthetic fabric, accelerating the regenerating processes in the bone tissue. This is necessary for its speedy recovery and filling the empty cavity.

The process of suturing the wound after root resection

The mucosa-osseous membrane is sutured with suture material. Drainage is placed in the space between the sutures - this ensures the outflow of sanious secretions during the first two days after the operation.

per region upper lip and the chin, a special bandage is applied for 10-12 hours, and a bubble with people is applied to the damaged side of the face to prevent the appearance of a hematoma.

Possible complications after resection of the root of the tooth

Resection of the root of the tooth - enough complicated operation, requiring a lot of experience and relevant knowledge from the dentist conducting this species surgical intervention.

During the resection of the tooth, the following complications may occur:

• damage to blood vessels;
• perforation of the nasal cavity;
• traumatization of the alveolar nerves;
• perforation maxillary sinus;
• paresthesia of the face;
• suppuration of the wound surface;
• re-formation of cysts (with poor-quality cleaning of the wound cavity).

Unfavorable anatomical and topographic conditions contribute to the occurrence of many of these complications - when upper teeth too close to the floor of the maxillary sinus, but with careful handling and wider incisions, the development of these complications can be prevented.

Due to trauma to the nerve, parasthesia of the face may occur. With such violations, physiotherapy is carried out (UHF, electrophoresis using potassium iodide), vitamin therapy, the use of dibazol.

Resection of the tooth root lasts no more than an hour, but after such an operation it is recommended to refrain from heavy physical labor for a day. Eating is allowed 3 hours after the operation. In the future, it is worth limiting the impact on the oral cavity of thermal irritants, salty, spicy foods food and drinks, as well as overly aggressive mouthwashes and toothpastes.

In the first two days, edema may develop, moderate soreness. In order to prevent the development of suppuration and the inflammatory process, antibacterial drugs and special solutions for rinsing the mouth (chlorhexidine, decoctions of anti-inflammatory herbs). Recommended x-ray examination a few months after the operation.

The patient should refrain from eating hard foods, cracking nuts and other objects for three months after root resection.

Resection of the root of the tooth: reviews

Apicoectomy or resection of the apex of the tooth root - an operation that allows you to remove the affected by the inflammatory process upper part tooth root along with the resulting cyst. This method is used in chronic periodontitis, ensuring the elimination of inflammation in the canal of the affected incisor, canine or molar, while maintaining a healthy part of the tooth. Thus, it is possible to prevent further spread of the infection to nearby tissues without compromising the integrity of the dentition.

What is an apicoectomy

What is a resection of the apex of the tooth root? Most patients have not had to deal with such an operation before. Therefore, in order to better understand what it is - apicoectomy, let's consider in more detail how it is performed. The duration of the operation is 30-60 minutes. It is more often performed on incisors and canines, as it is more difficult to access the upper part of the molar root. Anesthesia is carried out using local anesthesia. During the apicoectomy, there are several stages.

Preparing for the operation

If a resection of the apex of the tooth root is planned, the canals of which are not sealed, they are sealed 2 days before the operation. In more early dates this procedure cannot be performed, as there is a risk of the inflammatory process moving to the sealed surface. The channel expands, is treated with antiseptics to destroy the infection and is filled with liquid filling material, which is usually used as phosphate cement. To increase the strength of the root, if necessary, a metal pin is used.

The type of anesthesia is determined by the location of the tooth. When the tooth is located on the upper jaw, infiltration anesthesia is used, on the lower jaw - conduction anesthesia. In the first type of anesthesia, the effect of the anesthetic drug lasts longer and covers deeper layers of tissues. As an anesthetic, Ultracaine or Lidocaine is used. It is injected under the gum mucosa.

Since the bones of the upper jaw have a porous structure, the drug diffuses through the bone to the nerve fibers of the tissues in the region of the periodontal ligament, providing their blockade. There is a decrease in blood flow to the periodontium, visually marked blanching of the gums.

With conduction anesthesia, an anesthetic is injected into tissues located near a nerve (usually trigeminal). The drug penetrates into nerve fiber, blocking it.

Providing access to the top of the root

An incision is made on the gum, the periosteum is exfoliated from the bone. Boron drills a hole in the bone tissue at the location of the top of the tooth root.

Through the resulting hole, the top of the root is cut off. After separation from the tooth, it is removed along with the cyst and inflamed tissues using special tools. The cavity is thoroughly cleaned, sharp edges are smoothed out with a cutter.

Restoration of bone volume

If necessary, the channel is sealed. With a significant size of the removed cyst, synthetic bone tissue is used to fill the cavity.

Suturing

The dissected tissues and mucosa are sutured, to prevent accumulation of ichor in the wound area, drainage is installed. Reduce the formation of edema allows the imposition pressure bandage Ice is applied to prevent bruising.

Application of laser equipment

Root apex resection can also be performed using laser technology. The use of a laser makes it possible to reduce the width of the incision to 1 cm, accelerate bone recovery, and prevent bleeding and complications. Laser ray completely destroys pathogenic microorganisms preventing recurrence of inflammation.

Resection of the apex of the tooth root is necessary when a granuloma or cyst forms on it. Granuloma is called small cavity(up to 0.5 cm in diameter), filled with pus and not having a dense shell. In contrast, the cyst larger size and is separated from adjacent tissues by fibrous walls. These formations can lead to inflammation of the periosteum, local lymph nodes, the appearance of headache and toothache, swelling of the gums and cheeks, and the development of sinusitis. Indications for resection of the root apex include:

1. Poorly executed canal filling. With the development of pulpitis or before prosthetics is produced (pulp). If, during subsequent filling, the canal is not completely filled with cement, an inflammatory process may develop in the remaining space in the region of the root apex and a cyst may form. It is dangerous to use unfilling in the treatment of such a tooth, since there is a risk of its perforation, especially with a significant tortuosity of the canals. In addition, with a cyst size of 1 cm or more, root resection is mandatory.
2. Breaking off the tips of instruments used in depulpation or prosthetics. Staying in the channel, they can lead through certain time to inflammation and cyst formation.
3. If a pin was previously installed in the tooth root or a stump tab was fixed. These structures are fastened with highly durable cement, so there is high risk root fracture during extraction. In cases where the quality of filling is good along almost the entire length of the canal and only the tip is not filled with material, the optimal solution is resection of the tooth root.
4. If a crown is installed on the tooth and its channels were previously sealed. Instead of unsealing the roots and then making a new crown, which will increase the cost of treatment, it is better to perform an operation to resect the tooth root.
5. With a significant diameter of the cyst - more than 1 cm. Treat such formations conservative method difficult - treatment takes a long time and is often unsuccessful. Given that there is pus inside the cyst, with a decrease in immunity, there is a high probability of exacerbations of the inflammatory process, accompanied by swelling of the gums, severe pain. To eliminate them, you will need to open the gum, which brings additional discomfort.
6. Perforation or fracture of the tooth root at the apex.

Contraindications for the operation

Resection of the apex of the tooth root is not performed:

• with pronounced mobility, the appearance of a crack or significant destruction of the tooth;
• on the late stages periodontal disease, when there is a subsidence of the gums with exposure of the tooth root;
• with exacerbations of periodontitis;
• if the patient is suffering from acute infectious disease or heart disease
• when the tooth is located in a hard-to-reach place.

Possible Complications

In case of poor-quality performance of the operation or non-compliance by the patient with medical recommendations for wound care, postoperative complications may occur:

1. When an infection enters the tissues or insufficiently thorough cleaning of them from the remnants of pus, an abscess may form.
2. Damage to the vessel is fraught with the appearance of bleeding.
3. If the upper teeth are very close to maxillary sinuses, there is a risk of damage during surgery.
4. If the trigeminal nerve is damaged, paresthesias, a violation of skin sensitivity on the face, may occur.
5. With insufficient sanitation of the cavity, a recurrence of the cyst is possible.

rehabilitation period

Immediately after the operation, ice is applied to the cheek for half an hour. You can eat food 2 hours after suturing. It should be warm and have a semi-liquid consistency. On the first day after treatment, it is undesirable to exercise physical labor. When caring for the oral cavity, it is recommended to use non-aggressive toothpastes and rinses, such as Chlorhexidine, Miramistin, decoctions of chamomile, sage. During the first days of the recovery period, you should avoid taking foods that irritate the mucous membrane: spicy, salty, sour, sweet.

To exclude relapses of inflammation, it is necessary to take antibiotics and stimulants prescribed by the doctor, such as Lincomycin, Dibazol, Diclofenac, Chloropyramine. The duration of rehabilitation is 5-30 days. After 3 months, the condition of the tissues is monitored using an X-ray examination. For some time after the operation, swelling of the tissues and pain may disturb, sometimes the sensitivity of the gums disappears for several days. The resected tooth is able to perform its functions for a long time.