The Apical Resection

apical-resectionThe apical resection is a surgical procedure which removes that part of the root which is located deepest in your jawbone. In most cases, this is needed when tooth infections occur and form a cyst in the bone tissue. In time, if the problem is ignored, the cyst may embrace other teeth or even perforate the bone tissue.

Apical surgery is considered a standard oral surgical procedure. It is often a last resort to surgically maintain a tooth with a periapical lesion that cannot be managed with conventional endodontic (re-)treatment.

The main goal of apical surgery is to prevent bacterial leakage from the root-canal system into the periradicular tissues by placing a tight root-end filling following root-end resection.

What is Apical Surgery?

Although there are many surgical procedures that can be performed to save a tooth, apicoectomy or root-end resection is most commonly performed. Following examination of the patient’s mouth, assessment of radiographs (x-rays), a discussion of the options available to the patient, and informed consent, apicoectomy the following steps:

1. Local anaesthetic is administered. The site is checked for profound anaesthesia prior to starting the procedure. The gum tissue is then raised near the tooth to view the underlying bone.

2. The area of inflammation is identified. The inflamed tissue is then removed. A sample may be collected for biopsy. Apical

3. Often, the tip of the root of the tooth is removed and a small retrofilling is placed. This is done to seal the tooth at the tip and to contain the infection. Apical

4. Small sutures (“stitches”) are placed and the patient is given instructions and prescriptions.

5. Generally, patients are seen twice more in the office. There is a short follow up appointment one week after the procedure to remove the sutures and to assess the soft tissue healing. A second appointment is generally six months or one year later. Radiographs are taken to assess bony healing.

Why is the Procedure Needed?

There’s one single alternative to this, and that is extraction. So the main purpose of apical resection is to save your tooth. Your dentist chooses apical resection if the bone tissue around the radicular apex gets infected and if the classical procedure can’t be followed due to various reasons: faulty root canal treatment, specific anatomic morphology (atypical root canals), when the infection doesn’t step back with medication, when accessing the root canal may compromise a dental bridge etc.