Apical resection

extracted tooth; Root resection performed earlier can be seen

Extracted tooth that has previously undergone apicectomy

The root tip resection ( WSR , also apectomy , root tip amputation ) is a removal ( resection ) of a root tip ( apex ) of the tooth .

A distinction should be made between removal of the root tip or the root. It is a dental surgery measure used to treat inflammation, infection or other damage in the root area. With conventional root canal treatment , access to the root canal system of the root tip is through the prepared tooth crown. In the case of a tip resection, the tooth root is accessed from the outside through the jawbone . About 2-3 mm of the root tip and the inflamed area around the roots should be removed.

Medical background

Schematic representation of an apicectomy with retrograde root filling

Initial situation before the apex resection of a lower molar

Representation of the same molar 6 months after the apical resection

Granuloma on a freshly extracted tooth. Such granulomas are also removed by an ESC - then without extraction

Indications

An endodontological root tip resection may be necessary if complications occur despite correct orthograde - that is, on the "normal route" along the root canal - performed endodontic treatment ( root canal treatment ) :

• in the case of resorbing apical periodontitis ( radiographically you can see a lightening at the tip of the root);
• if no healing success could be achieved after an endodontic treatment ;
• if from the outset sole conservative therapy due to:
  • the extent of the inflammatory change,
  • a radicular (near the root) cyst ,
  • the anatomical peculiarities (e.g. root curvature , ramifications ), branching of the roots.

promises no prospects of success .

Further indications are:

• the removal of broken instruments in the root canal,
• Tooth fractures in the lower third of the root.

Chances of success

Modern techniques of root resection provide for the use of a dental surgical microscope, microsurgical instruments, ultrasound preparation of the shortened tooth root and the filling with metal-reinforced or calcium-silicate-based materials. According to scientifically published information in peer-reviewed journals, the short- and long-term chances of success for root resections with modern surgical methods are 87-97% after 1–7 years if the indication is correct.

Operational risks

The surgical risks associated with a root tip resection are anatomically identical to the basic risks of an operative intervention in the oral cavity (e.g. surgical tooth removal or implantation ):

• Damage to nerves (" numb lip"),
• Opening of the maxillary sinus ,
• Damage to neighboring teeth,
• Loss of the tooth,
• Secondary bleeding,
• Swelling,
• Relapse (may recur).

If the tooth roots of the tooth to be operated on are particularly short or if the existing mobility is too high:

• Reduced tooth strength (cannot be used as an abutment tooth for a bridge ). See also: pillar valency .

Alternatives

A root tip resection is often the last chance to preserve the tooth. If possible, a revision of the root canal treatment (removal of the old root filling, disinfection and new root filling) should be given preference. In general, the German Society for Dental, Oral and Maxillofacial Medicine gives dentists the following recommendation:

"Refraining from an orthograde revision and the decision in favor of a purely apical surgical procedure only makes sense if sufficient orthograde access to the endodontic system or an improvement in the condition by orthograde does not appear possible / likely."

Regardless of the current state of science, revisions of a root treatment are still rare in German-speaking countries, while the tip resection continues to enjoy great popularity. In countries like the USA, the revision is carried out more frequently, as there are dentists specializing in endodontics in many places .

Technical procedure

Retrograde root filling

After performing local anesthesia (dentistry) , a mucoperiosteal flap (gum flap ) is mobilized . Then the bone above the root tip region is removed with a ball burr under cooling with physiological saline solution ( osteotomy ) and the pathological findings are displayed according to their extent. The granulomatous inflammatory or cystic periapical tissue is removed and the tip of the root is separated and smoothed. The root canal filling is checked for leaks at the resection cross-section; the root canal filling may have to be renewed or a retrograde root filling placed. The root canals are closed from the opposite side, i.e. at the root tip, as part of a root tip resection.

Aspects of health insurance law

The costs for treatment with a surgical microscope are not covered by statutory health insurance . (Germany, as of May 2014)

literature

• S2 guideline : Root tip resection , AWMF register number 007/007 (online: full text , status 11/2007)
• Lambrecht J. Thomas, A. Filippi: Periradicular surgery . In: Lambrecht J. Thomas (Ed.): Dental operations . Quintessenz-Verlags, Berlin 2008, ISBN 978-3-87652-703-1 , pp. 83-94.
• Hans Ulrich Brauer, Albrecht Foernzler: Current trends in root tip resection. (PDF; 170 kB) In: ZWPspezial , 9/2008

Individual evidence

1. ↑ Syngcuk Kim, Samuel Kratchman: Modern Endodontic Surgery Concepts and Practice: A Review. In: Journal of Endodontics. 32, 2006, p. 601, doi: 10.1016 / j.joen.2005.12.010 . Detailed review article (English)
2. ↑ Richard A. Rubinstein, Syngcuk Kim: Short-term observation of the results of endodontic surgery with the use of a surgical microscope operational and super-EBA as root-end filling material. In: Journal of Endodontics. 25, 1999, p. 43, doi: 10.1016 / S0099-2399 (99) 80398-7 .
3. ^ RA Rubinstein, S. Kim: Long-term follow-up of cases considered healed one year after apical microsurgery. In: Journal of endodontics. Volume 28, Number 5, May 2002, ISSN  0099-2399 , pp. 378-383, doi: 10.1097 / 00004770-200205000-00008 , PMID 12026924 .
4. ↑ M. Maddalone, M. Gagliani: Periapical endodontic surgery: a 3-year follow-up study. In: International Endodontic Journal. 36, 2003, p. 193, doi: 10.1046 / j.1365-2591.2003.00642.x .
5. ↑ MM Gagliani, FGM Gorni, L. Strohmenger: Periapical resurgery versus periapical surgery: a 5-year longitudinal comparison. In: International Endodontic Journal. 38, 2005, p. 320, doi: 10.1111 / j.1365-2591.2005.00950.x .
6. ↑ T. von Arx, C. Gerber, N. Hardt: Periradicular surgery of molars: a prospective clinical study with a one-year follow-up. In: International Endodontic Journal. 34, 2001, p. 520, doi: 10.1046 / j.1365-2591.2001.00427.x .
7. ↑ ML Zuolo, MOF Ferreira, JL Gutmann: Prognosis in periradicular surgery: a clinical prospective study. In: International Endodontic Journal. 33, 2000, p. 91, doi: 10.1046 / j.1365-2591.2000.00263.x .
8. ↑ BS Chong, TR Pitt Ford, MB Hudson: A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery. In: International Endodontic Journal. 36, 2003, p. 520, doi: 10.1046 / j.1365-2591.2003.00682.x .
9. ↑ Euiseong Kim, Jin-Seon Song et al. a .: Prospective Clinical Study Evaluating Endodontic Microsurgery Outcomes for Cases with Lesions of Endodontic Origin Compared with Cases with Lesions of Combined Periodontal – Endodontic Origin. In: Journal of Endodontics. 34, 2008, p. 546, doi: 10.1016 / j.joen.2008.01.023 .
10. ↑ Igor Tsesis, Vadim Faivishevsky, Anda Kfir, Eyal Rosen: Outcome of Surgical Endodontic Treatment Performed by a Modern Technique: A Meta-analysis of Literature. In: Journal of Endodontics. 35, 2009, p. 1505, doi: 10.1016 / j.joen.2009.07.025 . Meta-analysis (English)
11. ^ Guidelines of the DGZMK: Revision of a root canal treatment

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !