Resection of the tooth root: what is it
Apicoectomy or resection of tooth root — an operation that allows to remove the affected inflammatory process of the upper part of the tooth root together with formed cyst. This method is used when chronic periodontitis, ensuring the elimination of inflammation in the canal of the affected incisor, canine or molar with preservation of the healthy part of the tooth. Thus it is possible to prevent the further spread of infection to nearby tissue without compromising the integrity of the dentition.
What is apicoectomy
What is the resection of the tooth root? Most patients do not have to deal with such operation. Therefore, in order to better understand what it is — apicoectomy, let us consider in more detail how it is performed. Surgery lasts 30-60 minutes. It is usually performed on the incisors and the canines, so as to access the top of the root of the molars difficult. Anaesthesia performed using local anesthesia. During apicoectomy identified a number of steps.
Preparing for surgery
If planned resection of the tooth root, the channels which are not sealed, they are sealed for 2 days before surgery. In earlier periods, this procedure cannot be performed as there is a risk of transition of inflammatory process on the sealed surface. The foramen, treated with antiseptics to destroy the infection and is filled with liquid filling material, usually phosphate cement. To increase the strength of the root, if necessary, apply a metal pin.
Type of anesthesia is determined by the location of the tooth. When the location of the tooth in the upper jaw used infiltration anesthesia on the lower conductor. The first type of anesthesia the action of pain medication lasts longer and covers the deeper layers of tissue. As an anesthetic used or Ultracain Lidocaine. It is administered under the mucosa of the gums.
Because the bones of the upper jaw have a porous structure, the drug by diffusion passes through the bone to the nerve fibers of tissue in the periodontal ligament, providing them with the blockade. There is a decrease in blood flow to the periodontium, visually observed blanching of the gums.
When regional anesthesia an anesthetic is injected into tissue that is located close to a nerve (usually the trigeminal). The drug penetrates into the nerve fibres, blocking it.
Access to the upper part of the root
On the gums the incision is performed, the periosteum is peeled from the bone. Bur hole is drilled in the bone at the location of the apex of the tooth root.
Resection top of the root
Through this orifice is made by cutting off the top root. After separation of the tooth is removed along with a cyst and inflammation of the tissues using special tools. The cavity is thoroughly cleaned, sharp edges are smoothed out by the mill.
Restoration of bone volume
If necessary, the channel is sealed. With a significant size of the removed cyst to fill a cavity use synthetic bone.
Dissected tissue and the mucosa sutured to prevent accumulation in the wound area of lymph drainage is installed. Reduce the formation of edema allows the imposition of a pressure bandage, to prevent the hematoma is applied to the ice.
The use of laser equipment
Resection of the tooth root may also be performed using laser technology. Laser allows to reduce the width of cut of 1 cm, to accelerate bone reconstruction, to prevent the occurrence of bleeding and complications. The laser beam completely destroys the pathogen, preventing the recurrence of inflammation.
Indications for apicoectomy
Resection of the tooth root is required when the formation of the granuloma or cyst. Granuloma is called a small cavity (0.5 cm in diameter) filled with pus and do not have a dense shell. In contrast, the cyst is bigger and separated from adjacent tissues by a fibrous wall. These formations can lead to inflammation of the periosteum, local lymph nodes, appearance of headache, toothache, swelling of gums and cheeks, to the development of sinusitis. The indications for resection of the root apex are:
- Poorly executed filling the canals. With the development of pulpitis or before the prosthesis is the removal of the dental nerve (pulp). If the subsequent sealing of the canal is filled with cement not completely, the remaining space in the apex of root can develop inflammation and form a cyst. Use the unsealing in the treatment of such a tooth is dangerous because there is a risk of perforation, particularly when there is significant tortuosity of the channels. In addition, when the size of the cyst of 1 cm resection of the root is mandatory.
- Breaking the tips of the tools used in deponirovanie or prosthetics. Staying in the channel, they may lead after some time to the appearance of inflammation and cyst.
- Previously root was installed a pin or fixed post-and-core tab. These designs are attached using very strong cement, so there is a high risk of root fracture when removing. In cases where for virtually the entire length of the channel, the sealing quality is good and the tip is not filled with material, the optimal output is the resection of the tooth root.
- If the tooth crown is installed and the channels were previously sealed. Instead of unsealing roots with subsequent production of new crowns, which will increase the cost of treatment, it is better to carry out the operation for resection of the tooth root.
- With a substantial diameter of cyst is more than 1 cm to Treat such education is a conservative treatment that difficult — the treatment lasts long and often unsuccessful. If we consider that inside the cyst is pus, depressed immunity, the probability of exacerbations of inflammatory process, accompanied by swelling of gums, severe pain. To eliminate them you will need to open the gum, which brings additional discomfort.
- Perforation or fracture of the tooth root to the apex.
Contraindications to surgery
Resection of the tooth root is not possible:
- with severe mobility, the occurrence of cracks or significant destruction of the tooth;
- in the later stages of periodontitis, when the settling of the gums exposing tooth root;
- in the acute exacerbation of periodontitis;
- if the patient is suffering from an acute infectious disease or heart disease;
- when the location of the tooth in a remote place.
In case of bad operation or non-patient medical recommendations for the care of the wound, the possible emergence of postoperative complications:
- When entering into the tissues of the infection or insufficiently thorough cleaning from residues of pus can form an abscess.
- Damage to the vessel might lead to bleeding.
- If the upper teeth are very close to the maxillary sinus, there is a risk of damage during surgery.
- When damage to the trigeminal nerve can occur paresthesia, violation of skin sensitivity on the face.
- When there is insufficient redevelopment of the cavity of relapse of the cyst.
The rehabilitation period
Immediately after the operation is applied to the cheek for half an hour the ice. It is possible to eat 2 hours after suturing. It should be warm and have a semi-liquid consistency. On the first day after the treatment it is undesirable to engage in physical labor. When caring for the oral cavity it is recommended to use non-corrosive toothpaste and washes, such as Chlorhexidine, Miramistin, decoctions of chamomile, sage. During the first days of the recovery period, avoid using irritate products: spicy, salty, sour, sweet.
To avoid recurrences of inflammation need to take prescribed antibiotics and stimulating drugs, such as Lincomycin, Dibazol, Diclofenac, Hloropiramin. The duration of rehabilitation is 5-30 days. After 3 months check the status of tissues using x-rays. Some time after surgery may experience swelling of tissues and pain for days, sometimes disappears the sensitivity of the gums. The tooth, which carried out the resection, capable of a long time to perform its functions.
Reviews about surgical method of removing cysts in the apex of a tooth root
According to the majority of patients, resection of the tooth root occurs without pain. For 3-5 days after surgery, slightly swollen cheek and lip. Until the wound is fully tightened, it can get food particles. As for the operating joints are used filament, which can gradually dissolve, does not require special visits to the doctor to remove them. Tissue healing occurs rapidly. When you contact an experienced operation gives a good result and no complications.
Due to the resection of the upper division of the root (along with a cyst) is provided by the preservation of the tooth and its functions in various diseases of infectious origin, in particular, periodontitis and periodontal disease.
For successful treatment it is necessary to consult a doctor at the first signs of the disease. In this case, you can minimize the risk of injury of adjacent teeth and inflammation of the surrounding tissues.