Apicectomy of Tooth | Procedure and complications

Apicectomy of Tooth | Procedure and complications

No matter how difficult the condition of the tooth, an experienced dentist strives to do everything to preserve it. This can often be achieved by a root apex resection called apicectomy. It is carried out in order to remove the focus of inflammation in the root area.

Apicectomy - what does it mean

The inflammatory process in the root canals can develop for a number of reasons. One of the most common is periodontitis. Over time, a pus bag forms at the site of infection, as a result of which granulomas and cysts appear. To fix the problem, a root apex resection (apicectomy) will be required.

If suppuration is detected at an early stage, the dentist pre-uses therapeutic methods of treatment. If they do not give positive results or they have turned to a specialist already at the later stages of the development of the disease, an apicectomy is prescribed. The essence of the operation is the excision of a neoplasm with purulent contents. In this case, the main part of the tooth root remains intact.

Benefits

Rapid elimination of the focus of infection;
Improvement of the general condition of the body after surgery;
Getting rid of unpleasant symptoms.

Disadvantages of Apicectomy

Soreness during apicectomy;
Long subsequent recovery period.
The need to strictly follow the recommendations of the dentist.

Contraindications

Periodontitis in the acute stage
Viral and infectious diseases
Strong mobility or root fracture, high degree of destruction of the tooth crown
Launched periodontal disease

Indications of Ampicectomy

Launched periodontitis
Osteomyelitis of bone tissue
Root damage after inserting or removing a metal post
Poor canal filling>

Stages of the operation

Before performing a resection, it is necessary to carefully fill the dental canals. This procedure is performed several hours before the apicectomy. Next, the dentist will carefully make sure that no inflammation occurs. This can happen if the canals are complex and, after the completion of the filling, cavities may remain unfilled with material. In such a situation, you will have to remove the filling, eliminate the inflammatory process and re-fill the canals.

The operation itself is carried out under local anesthesia, in the following sequence:
The dentist cuts the gums so that the mucous tissue is separated from the bone. As a result, access to the root of the tooth opens.

Makes a hole of small diameter (in this case, a spherical or fissure type of instrument for a drill is used.
if a granuloma is found during drilling, it is removed along with the granulation tissue. The procedure is more complicated if it is performed on the upper molars, in the area of ​​ where the maxillary sinuses are located (they are quite easy to damage). During this operation, a curettage spoon is used;

In order to provide access to the upper sections of the tooth root, a hammer or chisel is used, which knocks out the wall on the alveolus. As a result, the root is completely exposed, which makes it possible to identify all foci of inflammation around it;

If a cyst is found, it is also excised and carefully removed. An artificial bone substitute material is used to fill the resulting cavity. This allows you to speed up the wound healing process and eliminates the appearance of deformities on the gums;

At the last stage, sutures are applied, between which drainages are inserted to remove the ichor.

Rehabilitation after resection (Apicectomy)

Food intake is allowed no earlier than 2 hours after the completion of surgical procedures (its consistency should be soft.
For 2 weeks it is necessary to exclude hot or cold, salty and sour foods from the diet.
Use a cooling compress in the area of ​​the operation to prevent swelling
Temporarily give up sports and heavy physical labor
Do not visit the bathhouse, sauna, pool.
Use anti-inflammatories to rinse the mouth.

CONSEQUENCES AND COMPLICATIONS AFTER ROOT APEX RESECTION (APICECTOMY)

Resection of the apical part of the dental root is a complex dental operation that requires appropriate knowledge from the dentist. During its implementation, various complications may arise. This happens through the fault of the doctor, but the patient often provokes a negative outcome of the operation with incorrect behavior. Complications are facilitated by anatomical conditions, especially when the anterior upper teeth are resected, which are too close to the bottom of the maxillary sinus.

This is a surgical procedure that allows you to get rid of the infection center located inside the gum without removing the dental unit. It is also called root apex resection. Often, infectious foci are formed in the area of ​​the tooth root, and an apicectomy allows you to cut and remove the affected part of the root without affecting healthy tissue. This method of treatment is considered the best for granulomas, periodontitis and similar serious pathologies, in which the affected teeth were removed in the past.

What causes complications

Negative consequences often arise either due to a medical error or through the fault of the patient during rehabilitation. Reasons for complications of resection:

Late filing. This procedure is performed 1-2 days before the apicectomy, otherwise there is a risk of inflammation after the operation as a negative reaction.
Poor filling. The canals inside the tooth must be tight, otherwise inflammation will occur if the infection continues to spread.

Tooth decay. With the wrong approach to treatment during the operation, there is a risk of damage to the tooth, which will lead to its loss.
Unprofessionalism. Occasionally, serious injury during surgery is caused by a physician due to improper use or careless handling of the instrument.

Incomplete resection. If the inflamed tissue and the focus of infection are not completely removed, then a recurrence of the cyst is possible in the future.

Tissue infection occurs during surgery due to incomplete sterility or after improper oral care.
Destruction of the root. The operation involves removing only the apex of the root, the minimum part of it, but if the dentist makes a mistake, the root can collapse completely, which makes the tooth loose.

Non-compliance by the patient with postoperative appointments. Proper care, lack of physical activity, diet and other medical prescriptions accelerate the rehabilitation process.

What are the consequences after the operation of resection of the apex of the tooth root?

Apicectomy can result in various complications, for example, soft tissue edema (this is a temporary reaction to injury) or even a recurrence of the cyst. All negative consequences are usually divided into two types: conditionally normal and pathological.

Elevated temperature

This is the body's natural response to injury during surgery. The temperature rises on the first day after apicectomy. Typically ranges from 37.5 ° C to 38 ° C. In the evening, the temperature rises, decreases in the morning. It normalizes on its own in 1-2 days. It is not recommended to knock it down if the mark on the thermometer is below 38 ° C. But if you feel very unwell (general weakness, dizziness, body aches), it is allowed to take an antipyretic drug.

Sometimes a rise in temperature and chills signal the development of serious complications. In this case, a high rate lasts 2-3 days after the operation, increases every day and does not get lost with pills. In the presence of complications, it is accompanied by additional symptoms:
Pain
Severe swelling of the soft tissues of the face.
Putrid odor from the mouth.
The presence of purulent plaque on the wound
Pressure instability.
With such a set of symptoms, you should immediately contact the dentist.

Loose tooth

Apicectomy result
Resection involves removing the tip of the root, which often results in reduced tooth stability. If the root collapses during the operation, the tooth will become very loose and may fall out. Also, the patient himself provokes tooth shakiness if he loads the operated area with solid food.

The dentist returns stability to the tooth if you contact him immediately after the problem occurs.
To avoid such a complication, it is necessary to follow a sparing diet in the postoperative period. The tissue healing process lasts 4-6 months, during which time the cavity formed during the operation will completely overgrow, and then the stability of the tooth will become the same. Until this moment, you should not gnaw nuts, dry foods and hard candies on the operated side.

Gums turned white

White plaque can be a sign of a natural healing process or complications: gum inflammation, purulent infection:
A day after the operation, a white fibrin plaque forms on the gums.
After two to four days, the plaque becomes as noticeable as possible.

By the 7th day, the swelling subsides, the pain disappears, but the gum remains white.
By the 14th day, the plaque disappears, a new mucous tissue forms under it, the gums acquire a normal color.

The following symptoms indicate the development of a purulent infection:
Severe growing pain;
Bleeding or profuse ichor (bleeding wound);
Putrid smell;
Swelling and redness of the gums for more than a week;
Discoloration of the plaque to yellowish, gray, brown;
Poor general condition.

Such a consequence will have to be treated with anti-inflammatory and antibiotics, and you can prevent it by rinsing with antiseptic solutions (Miramistin, Chlorhexidine).

Polypoid purulent sinusitis

Apicectomy of the upper dental units is accompanied by the risk of breaking through the wall of the maxillary sinus. If this happens, a fistula is formed between this cavity and the vestibule of the mouth, which further provokes purulent polypous sinusitis. Its symptoms:

Pain in the lower part of the eye sockets;
Nasal congestion;
Talk in the nose (nasal);
It hurts to chew, press on the disturbing place and move your mouth;
Persistent headaches;
Weakening or loss of smell;
Purulent fluid from the nose;
A feeling of the presence of a foreign object in the nasopharynx.

This complication is treated with conservative and surgical methods. Conservative treatment consists of taking antibiotics and intranasal hormonal drugs (such drugs include Mometasone furoate). Surgical treatment involves closing the fistula.

Nosebleed

Epistaxis during or immediately after surgery indicates perforation (penetration) of the sinus bone. It can open during resection on the upper teeth, since the roots in the jaw are located close to these sinuses, which is why the sinuses are easily injured at the slightest careless movement of the doctor.

If a sinus perforation occurs, the doctor must stop the bleeding, make sure that nothing has fallen into the hole (perhaps a piece of the root has fallen off and pressed into it), disinfect and close the resulting wound. Then antiseptics for gargling, antibiotics and anti-inflammatories are prescribed. If fragments and foreign objects fall into the sinus, a more serious operation will have to be performed.

Painful sensations

The resection itself is completely painless thanks to anesthesia, but when it stops working (2-3 hours after the procedure), the patient may feel soreness, which is a natural reaction to trauma. In the first few hours after the operation, the gum aches a lot. The drugs Diclofenac, Dikloberl, Ketanov and the like, which the dentist will recommend, will help relieve pain. With each subsequent day, the severity of pain decreases. After 3-5 days it disappears completely. If the pain pulsates, the sensations do not go away after 3-5 days, you need to go to dentistry again.

Damage to the maxillary, nasal sinuses, blood vessels of the jaw

problems associated with root resection Damage to the maxillary sinuses during root resection of the upper tooth is manifested by severe bleeding with air bubbles in the blood, the patient's nasal voice and nosebleeds. Such a postoperative complication is eliminated on the spot. Damage to large blood vessels is manifested by prolonged bleeding from the wound.

Stopped with sterile swabs with vasoconstrictor drugs. If it has opened at home, it is necessary to put a gauze pad on the wound, squeeze it and change it periodically. If the blood does not stop within 2-3 hours, you should seek help. To prevent bleeding, you need to stop taking blood-thinning drugs before the operation, and also not to take them after the procedure.

Numbness of the face

This symptom is possible if the trigeminal nerve is damaged or irritated, as well as its branches. The main symptoms are: pulling pains;
Burning sensation in soft tissues;
Numbness of the soft tissues of the cheek (the cheek hangs and is not felt);
Weak sensation when touching the cheek.

Injury to the trigeminal facial nerve is rarely done with an instrument. More often it is irritated due to the pressure exerted by the filling material on the branches. If the face is numb, it is necessary to undergo a course of neurological treatment in combination with a solution to the cause of the nerve damage.

Suppuration, fistula, lump, abscess

A fistula is a canal that connects foci of infection with the surface of the gums, through which pus flows out. Its appearance indicates poor-quality cleaning of the root canal and wounds during the operation. This can be avoided by sealing the perforated area with a special filling, which must be done by the dentist. Also, a complication often provokes the patient with improper oral care in the postoperative period.

To prevent rotting of the gums (the formation of a purulent lump), it is necessary to regularly disinfect the oral cavity after surgery: rinse with antiseptics (for example, Chlorhexidine) or soda solution. Treatment of a complication in the form of a purulent fistula is carried out in two ways:

Medication with the appointment of antibiotics (Levomekol, Lincomycin, Metranidazole).
Surgically (the seal is opened and cleaned so that all the pus comes out).
The success of the resection depends not only on the professionalism and experience of the dentist, but also on the patient's compliance with all appointments during the rehabilitation period.

Conclusion

Despite the fact that resection is no longer something new and rare, the rehabilitation period takes place in different ways and is sometimes accompanied by complications. To prevent possible negative consequences, it is necessary to carefully choose a clinic, not neglect the diagnosis and follow all the recommendations of the dentist before and after the operation.


Den Tim


Practicing Dentistry for 20 years