Resection of the apex of the tooth root is a surgical method of treating granulomas and cysts that form at the root apex due to a chronic inflammatory process (caused by infection in the root canals of the tooth). Granulomas and cysts are subspecies of a disease called chronic periodontitis.
They differ from each other only in size ... If the focus of inflammation at the root apex is more than 1 cm in diameter, the formation is called a radicular cyst, and if less than 1 cm, it is called a granuloma or cytogranuloma. Visually, they are a "bag of pus" attached to the apex of the tooth root.
Thus, the main indications for resection is the presence of an inflammatory focus at the apex of the tooth root, which is difficult to cure using the conservative treatment method for chronic periodontitis. The latter consists in temporary filling of root canals with calcium hydroxide preparations (for a period of 2-3 months).
How is the resection of the tooth root -
The meaning of the resection operation is to cut off the apex of the tooth root with a “purulent pouch”. And so many patients are immediately interested in the question - how long will the tooth last after resection. I must say that the operation does not affect the life of the tooth, because the size of the removed part of the root is very small.
Tooth root resection is a fairly simple operation, and it usually lasts from 20 to 40 minutes. The front teeth are operated faster, which is connected with the convenience of visual control of the operation, but the side teeth (6-7 molars) require more time and effort from the doctor. On the animation below you can see all the main stages of the operation.
Tooth resection: animation
1. Preparation for surgery -
Tooth resection can be carried out only if there is no active suppurative inflammation in the area of the root apex. If there is swelling of the gums or pain when you press a tooth - you must first remove the active inflammatory process.
The essence of the preparation for the operation is the qualitative filling of the root canal (Fig. 4). If resection is planned as the final stage of therapeutic treatment of chronic periodontitis, then the root canal is sealed no more than 1 day before the operation. It is important that the canal is very densely filled with a filling substance (for example, gutta-percha), since if the obturation of the canal is not dense - the granuloma / cyst will then reappear.
If the operation is planned in the tooth, the root canals have already been sealed, then the strategy here may be different. For example, if the canal of this tooth is well sealed all over (except at the very top of the root), it is not necessary to unseal this canal, because the top will still be cut down. In all other cases, a root canal resection will be required.
2. Method of operation -
The operation is performed under local anesthesia, and is absolutely painless. Mild painful sensations occur only at the end of the operation, which will require the use of painkillers. Below you will be able to see in detail the course of the operation on the schematic images and video, but first we will draw your attention to the main points during the operation.
The main stages of the operation -
- Creating access to the top of the root -
the gum is dissected and moved away from the bone in the projection of the top of the root of the causative tooth. After this, a “window” is drilled with a drill in the bone, through which the top is cut off at the root and the granuloma or cyst is scraped out (Fig. 4b).
- Root resection and cyst removal -
through a hole created in the bone, the surgeon cuts a root tip and cuts out a chronic inflammatory focus (it could be a granuloma or a cyst). The latter differ only in size. The cyst envelope should be removed completely, since if you leave even a small fragment of it - a cyst forms again.
- Wound closure -
after antiseptic wound treatment, the edges of the gingival mucosa are put in place, and the wound is sutured. In good clinics, the patient immediately after the operation will be given to hold the ice, pressing it to the cheek in the projection of the operation (this will reduce the amount of edema). Stitches are removed after 8-10 days.
Operation scheme (fig.5-10) -
If the cyst was large, then the bone healing can be stimulated with special osteoplastic materials based on synthetic hydroxyapatite - with the preparations "Kolapol" or "Kollapan". In some cases, retrograde filling of the root canal may also be used for resection surgery (see below).
Tooth resection: video surgery
In the videos below you can see how the gum is incised, the bone tissue is exposed in the projection of the tooth root, and the surgeon drills a window in the bone tissue, after which the tooth root is cut off with a drill. Note that along with the root apex, the doctor also scrapes the inflammation center (granuloma / cyst) formed at the root apex.
Resection of the apex of the tooth: price 2019
How much is the resection of the apex of the tooth root - the price in clinics of economy class and the average price category for 2019 will be from 4,500 to 10,000 rubles.
Such a difference in price will primarily depend on the position of the tooth - access to the roots of the front teeth is quite simple, and therefore the operation is carried out fairly quickly. However, surgical access to the tops of the roots of the posterior teeth (especially 6-7 molars) is very difficult, so the operation requires much more time and effort by the doctor.
Important: The above cost already takes into account both anesthesia, and surgery, and repeated examinations. Whether the cost of preparations for the rapid restoration of bone ("Kolapol" or "Kollapan") is included in the price - you need to specify in advance. Also, the above price does not take into account the cost of retrograde root canal filling, the need for which the truth is far from always.
Retrograde root canal filling during resection -
The very name of the method “retrograde root canal filling” implies that after cutting off the root of the tooth root with a drill - the upper part of the root canal will also be additionally sealed from the cut top.
The essence of the technique (see video below) -
Using the ultrasonic nozzle, the upper part of the root canal is unsealed (2 mm deeper than the saw cut). After that, the unsealed part of the root canal is sealed with a special material such as ProRoot (ProRoot-MTA). This ensures a tight obturation of the root canal with a filling substance and will not allow the infection to multiply in the root canal, which will cause the cyst to recur.
Retrograde filling is the gold standard for resection throughout the civilized world, because almost completely eliminates the risk of re-formation of cysts. It is rarely used in Russia due to weak qualifications of most dental surgeons (some have not done any such operation in their entire life, and they do not see the point), and also because of the need to use expensive materials.
Retrograde filling: video
This method is especially necessary when the resection is done on the teeth, the root canals of which were sealed a long time ago, and the doctor decided that they should not be re-sealed before the operation. The latter sometimes happens when there is an artificial crown on the tooth, and retreatment of the tooth will result in the need for re-prosthetics as well.
Root apex resection: patient reviews
All patients note that the operation is absolutely painless. However, postoperative pain will occur immediately after undergoing anesthesia (severe pain after resection is not characteristic). The next morning, you can see the swelling of the soft tissues of the face in the projection of the operation, sometimes - hematoma. In rare cases, there is suppuration of the surgical wound, but this does not happen often. The prophylactic administration of antibiotics helps prevent this complication.
After surgery is usually assigned -
- antibiotic Amoxiclav 625 mg (1 tab. - 2 times a day, 6-7 days),
- analgesics based on NSAIDs,
- rinse with a solution of 0.05% Chlorhexidine.
Relapse and reoperation -
The percentage of relapses according to official statistics is about 1-3%. If the operation is done according to the rules, then there should be no complications. There are 2 main points that determine the quality of the operation. Firstly, the cyst envelope must be removed completely (since if even a small fragment of the cyst envelope remains, it will appear again).
Secondly, it is the quality of root canal filling. If the root canal was prepared poorly, for example, it is not tightly sealed, this will lead to the multiplication of infection along the canal walls and a new cyst formation. And including here can help retrograde root canal filling, which we described above.
Alternatives to tooth resection -
In most cases, resection is not a mandatory and non-alternative method for the treatment of granulomas and cysts. Mandatory resection is required only in the presence of large cysts (for example, 1.5-2 cm or more). The latter is due to the fact that the shell of large cysts is very dense and thick, and does not completely disappear even with good conservative treatment (although the cyst itself is reduced in size).
The therapeutic treatment of cysts is carried out by a dentist therapist, and the only drawback of this method is the duration of therapy and a somewhat larger number of visits to the doctor. In order for a granuloma / cyst to begin to shrink and disappear, it is necessary to completely neutralize the source of infection in the root canals, and then fill the root canals with a calcium hydroxide-based therapeutic paste for a period of several months.
After a few months, the doctor will take you an x-ray to see how much the cyst has diminished, and if everything is fine, you will be assigned to permanent root canal filling. Until that moment you will walk with a temporary filling. It should be noted that conservative treatment is not always effective, and the tooth becomes inflamed time after time. Therefore, it is sometimes easier to immediately fill in the root canal on a permanent basis, and the next day to perform the operation and remove the cyst.
Tooth resection: advantages
We have already said that resection of the root of the tooth is usually done in the presence of cysts and granulomas, the occurrence of which is associated with infection in the root canal. If the root canals in the causative tooth have not previously been sealed, in most cases therapeutic treatment is applied first.
But in most cases, granulomas / cysts occur due to poor quality root canal filling (Fig. 12). Often, in such situations, you can immediately perform a resection - without retreatment of the canals in the tooth, but the prerequisite for this is that the root canal should be poorly sealed only at the very top of the root, and good for the rest of the length.
Situations where resection is better than conservative treatment -
- In the root canal there is a pin or stump tab (Fig.13-14) -
metal pins and stump tabs are fixed in the root canals to a special very strong dental cement. Attempting to extract it in this case can also lead to a fracture of the root of the tooth (and the need to remove the tooth).
Therefore, if there is a pin or stump tab in the root canal, and the canal itself is well-sealed throughout, and only at the root apex is under-filled, then this is also an indication for performing a tooth root resection.
- When there is a crown on the tooth (fig. 13-14) -
if there is a crown on the tooth, then in order to start a conservative treatment, this crown must be removed, then the root canals are unsealed, and so on. At the end of treatment, you cannot just put on an old crown - you need to make a new one, which significantly increases the cost of treatment.
Therefore, if there is a crown on the tooth (especially if with a pin) - as in Fig.13-14, and the root canals are poorly sealed only at the root apex, it is better to resect the root apex. During the operation, the under-filled part of the canal, together with the root tip, is cut off by a drill, and the cyst is removed. We hope that our article was useful for you!
Author: dental surgeon Kamensky KV, 19 years experience.