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Root resections for frontal and lateral teeth

 

This is a surgery procedure consisting in the removal of the end of the tooth root and of the surrounding infected bone tissue, preceded or not by the correct endodontic treatment and the perfect obturation of the canal, by its retrograde obturation using glass ionomer cement.

The recommendations in the case of a root resection can be grouped in several categories:

- anatomical problems which hinder the cleansing and correct obturation of the canal

- problems concerning the protetic restauration of the teeth involved

- horizontal fractures of the root with apical necrosis

- obstacles on the length of the radicular canal which cannot be eliminated through endodontic treatment

- procedural errors in the endodontic treatment

- serious periapical lesions which cannot be eliminated through canal treatment.

The success of endodontic surgery varies according to the reason for the procedure. In the case of unsuccessful canal treatments, the procedure is seldom impossible or we can obtain better results through the classical endodontic approach. In the case the causes of the failure cannot be identified, the surgical approach is more than necessary. In certain cases, a pathological entity in the periapical area requires surgical removal and even a biopsy in order to identify it.

In the case of anatomical problems which hinder a correct endodontic treatment, they can be calcifications along the canals, severe root curves, very narrow root canals. When these anatomical problems hinder the correct treatment, the optimal solution is the removal of the portion of the root and the sealing of the remaining tooth abutment.

The teeth which are prosthetically reconstructed that show periapical infections can represent a problem in the case of a new endodontic treatment. The access to the root canal can compromise the resistance of the prosthetic crown. Also, certain teeth are reconstructed by means of crown root devices (metallic posts) whose removal from the canal may cause a root fracture. In this case as well, the only conservative solution is the resection of the apex with infected tissue and the sealing of the abutment.

Occasionally, after a traumatic root fracture, the apical fragment suffers from pulp necrosis. Because the endodontic approach in this case is not very safe, it is recommended to surgically remove it after the endodontic treatment of the crown portion.

The canals can sometimes be blocked by foreign objects such as fractured instruments (broken canal needles), restauration materials, fragments of fractured posts. In case of apical lesions of the tooth with such problems, these materials must be surgically removed together with a protion of the root.

The procedure errors in the endodontic treatment can be represented by incomplete or overhanging obturations, false routes, residual granuloma (which can persist even after a complete endodontic treatment, because they continue their evolution by closing).

In case of severe periapical lesions, the canal cleansing and treatment, in the absence of surgical treatment, can even cause the aggravation of the chronical infection by introducing germs in the oral cavity.

Procedure

Usually, the resection can be performed for all groups of teeth, but the indication is nuanced according to the different anatomic situations of the roots on the bone surfaces of the maxillary and the surrounding anatomic cavities. Thus, the intervention is limited in the case of the upper and lower second molars, as well as for the lower premolars; in these cases the surgical difficulty is represented by the nearness of the mental foramen and implicitely by the mental vessels and nerves (the possibility of causing lesions in this area).

This surgery is performed frequently in the dental chair and involves no complicated surgical instruments. The anaesthesia used is usually local or in some cases (difficult patients, anxious patients) general anaesthesia can be used. Even in the case of local anaesthesia, the procedure is not painful.

 

A mucoperiosteal incision is performed, uncovering the mucuous membrane and the bone mass. then the trepanation is performed, removing the affected bone tissue and the root apex. The dental canal is cleaned mechanically, washed and then filled by means of a calibrated filling on sight. In case the canal permeability cannot be achieved, a sealing is performed by means of the tough material of the abutment remaining after the root was sectioned.

In certain situations, the bone defect which persists after the curettage of the pathological process is very serious and the body’s ability to recover is exceeded. In order to stimulate the osteogenesis process, we can resort to additions of synthetic bone or bio-bone to the defect.

The stitches of the plague are done with non-absorbant sutures which will be removed after 6-7 days. After the resection, the teeth will be protected for a period by avoiding tough foods and increased mastication effort.

After the surgery, the evolution in the first 24-48 hours is accompanied by a regional edema which then subsides. In case the edema persists, its aggravation as well as tooth aches at a couple of days after the intervention suggest the presence of septic complications. In order to prevent these complications, the doctor must use the adequate medication.

In case the surgery recommendations are correct and the surgery technique is observed, the root resection is a method which allows the conservation of certain teeth whch otherwise would be lost by extraction. This procedure should be embraced by more dentists and recommended more often to patients.

In the rare cases where a tooth does not respond to the canal treatment, a new canal treatment of the root is not a viable option, the surgical intervention at the root can save the tooth. These procedure is a root resection. Also, it is well known that the purpose of the root resection is, simply, to remove the end of the tooth root (and the surrounding infected tissue) in the case of teeth with abscess. This procedure also offers the possibility to detect possible fractures of the tooth root.

Dental extraction   |   Extraction of wisdom molars (teeth)

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