Root-end surgery (apical resection, apicoectomy) (90)

​Apicoectomy or apical resection or is a surgical procedure aimed at retaining the tooth. Apical resection is a treatment consisting in the removal of the root-end and scraping its immediate environment.

Prior to the intervention an intraoral radiograph is required. A panoramic radiograph is insufficient for viewing the details, which necessitates a small intraoral radiograph or a 3 dimensional CBCT scan. Digital radiographs are richer in detail and lend themselves to easier analysis than their analogue film based counterparts.

What are the indications for performing the intervention?

• If the cyst-like lesion around the necrosed root tip is unlikely to resolve.

• The tooth’s root canal is not fully penetrable due to a post and core abutment.

• In the event of a constriction (due to mineralisation, sclerosis) or large curvature. In such cases sections inaccessible with a root filling must be removed.

• In the event of a chronic inflammatory process around the root tip (granuloma) with no inclination to heal.

• If the root filling substance is pressed outside the apical area of the tooth (into the bone tissue).

• If drying the root canal required for a root filling is unfeasible.

• If in the course of a root canal treatment a pseudo canal formed, that is, the root canal expansion tools took a wrong course.

• In the event of the breakage of the root filling or expansion device into the root canal.

What are the contraindications of an apical resection (apicoectomy)

• A fresh, seamless and perfectly sealing root canal filling (no older than 6 months) is a prerequisite for a successful apicoectomy. If the root canal filling was performed earlier its replacement is highly recommended prior to the resection.

• If the length of the root is insufficient, the surgery is futile since an insufficiently long root is incapable of retaining the tooth. Overall, it holds that at least twice the length of the root to be resected should be available for the operation to be viable (that is, the resected length should be 1/3 of the overall root length) and for the tooth to retain its functionality even post-surgery.

• In case of the close proximity of different anatomical formations such as that of the inferior alveolar nerve in the lower molar region, where an intervention would entail serious complications.

• In case of deep pockets around the tooth.

• In case of the patient’s inadequate health condition.

• In the event of large-scale bone decay where the retention of the tooth is inadequate.

Intraoral radiograph of the upper left premolar with the new root canal filling prior to resection

The surgery is performed under topical anaesthesia but the intervention may also be performed under conscious sedation. During the intervention the gums are lifted from the bone, an incision is made into the bone at the site of the root tip and the apical section of the root is resected and scraped. Removal of the sutures is due after 10 days. Following a successful apicoectomy a dental check-up is and radiograph are recommended half yearly in the first 2 years following surgery.

Intraoral radiograph of the upper left central incisor 6 years after root canal filling and apicoectomy. It is readily visible that the root canal filled tooth is 3 mm shorter and the bone above it has seamlessly healed

Bibliography

Gy. Szabó: Oral and Maxillofacial surgery. Semmelweis Kiadó, Budapest, 1999.