Apicoectomy

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

Between removal of the root tip or root should be distinguished. Is a measure of the dental surgery for the treatment of inflammation, infection, or other damage in the root area. In a conventional root canal treatment, access to the root canal system of the root tip is made by the prepared tooth crown through. In a root resection of access to the tooth root from outside through the jawbone occurs. In this case, about 3 mm of the root tip and the inflamed area around the roots should be removed.

Medical Background

Indications

An endodontic root resection may be necessary if, despite a correct orthograde - ie " regular way " on the along the root canal - is performed endodontic treatment ( root canal treatment) complications:

• A resorbing apical periodontitis ( radiographic one sees a brightening at the root tip );
• If from the outset a sole conservative therapy does not promise success, due to: the extent of the inflammatory change
• A radicular ( rhizosphere ) cyst,
• The anatomical features (eg, root curvature, ramifications ). Branching of the roots

Other indications are:

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

Prospects of success

Modern techniques of root resection see the use of a dental operating microscope, microsurgical instruments, ultrasonic preparation of the shortened dental root as well as the filling with metal - reinforced or calcium silicate based materials before. After scientifically published data in peer-reviewed journals are the short-and long -term prospects for root resection with modern surgical methods at the appropriate indication after 1-7 years at 87-97 %.

Surgical risks

The inflammation associated with a root resection surgery risks are anatomy necessarily identical to the basic risks of surgical intervention in the oral cavity (eg, a surgical tooth removal or implantation):

• Damage to nerves ( " deaf lip " ),
• Opening the antrum,
• Damage to adjacent teeth,
• Loss of the tooth.
• Rebleeding
• Swelling
• Relapse ( can occur again)

In particularly short tooth roots of the tooth to be operated on, or over existing mobility:

• Decreased strength of the tooth ( as abutment teeth for a bridge unusable ). See also: pillars value.

Alternatives

An apicoectomy is often the last resort for the preservation of the tooth dar. If possible, should a revision of the root canal treatment ( removing the old root filling, disinfection and new root filling ) are given preference. In general, the German Society of Dental, Oral and Maxillofacial Surgery dentist makes the following recommendation:

" A waiver of orthograde revision and opting for a purely apikalchirurgischen intervention is only useful if sufficient access into the endodontic system or improving the condition on orthogradem ways not possible / likely to appear on orthogradem way. "

Regardless of the current state of science revisions of a root canal treatment are in German speaking countries still rare, while the apical resection remains very popular. In countries such as the USA, the audit is performed more frequently, as there are in many places Fachzahnärzte for endodontics.

Technical Procedure

After performing a local anesthetic (dentistry) the mobilization of a mucoperiosteal flap occurs ( gingival flaps ). The bone above the root tip region removed ( osteotomy ) and the pathological findings are then presented according to its expansion with a round burr under cooling with physiological saline. The granulomatous inflammatory or cystic periapical tissue is removed and separated and smoothed the root tip. At the resection, the root canal filling is checked for leaks, where appropriate, the root canal filling must be renewed or retrograde filling are placed.

Health Insurance Legal Aspects

The cost of treatment with a surgical microscope are not covered by the statutory health insurance. ( Germany, as of August 2012)