Apical resection is surgery to remove granulation tissue, cyst or granuloma present in the bone at
the tip of the tooth root.
Indications
Apical resection is indicated when there is:
anatomical difficulties that prevent proper
cleaning and obturation of the root canal
difficulties related to the prosthetic
rehabilitation of affected teeth
horizontal root fractures with apical
necrosis
blockages along the length of the root canal
which cannot be removed by endodontic treatment
procedural errors in endodontic treatment
large periapical lesions that cannot be treated
endodontically.
Efficiency
The success rate for apical resection differs depending on the cause for which it is performed.
In the case of unsuccessful endodontic treatments, retreatment is often not feasible or better results cannot be achieved with classical endodontic treatment. If the causes of failure cannot be overcome, a surgical approach is indispensable.
In certain situations, depending on the characteristics of the periapical pathology, biopsy of tissues removed by apical resection is required to make a correct differential diagnosis.
If we refer to the anatomical difficulties that prevent a correct endodontic treatment, they can be:
canal calcifications
severe root curvatures
very narrow root canals
foreign objects obstructing the root canal
fragments of canal needles
cement
fragments of metal pins
When these anatomical features do not allow for correct treatment, removal of the uninstalled root portion and sealing of the remaining bridge is the optimal solution.
Teeth with prosthetic restorations showing periapical infection may present a difficulty if endodontic retreatment is attempted.
Drilling the prosthetic crown to gain access to the root canal may weaken the stability of the prosthetic crown.
In the case of teeth restored with metal posts, removing the posts from the root canal is a procedure with a high risk of root fracture. In this case apical resection of the infected tissue and sealing of the bridge is the only conservative solution.
The invasive alternative is tooth extraction followed by dental implant or dental bridge prosthesis.
Canals may have remaining foreign bodies such as broken root canal pins, restorative materials, fractured post fragments.
In these cases, the foreign bodies must be surgically removed along with a portion of the root.
Procedure
Apical resection can be performed on all teeth, but the indication is guided by the different anatomical variants of the roots in relation to the bony surfaces of the jaws and the relationship to the surrounding anatomical structures.
Apical resection is often performed in the dental office and does not involve the use of complex surgical instrumentation.
The anesthesia usually used is loco-regional or in some situations (anxious, difficult patients) general anesthesia may be used.
Anesthesia removes pain or embarrassment, the patient will not feel discomfort, will communicate with the doctor throughout the apical resection surgery.
The condition after the apical resection is similar to the post-extraction condition.
A mucoperiosteal incision is made, the mucosa and periosteum are removed and then the bony tab is revealed.
Bone trepanning is performed and the affected bone and dental apex are removed.
The root canal is mechanically cleaned, washed and then obturated, performing a visible calibrated filling.
When the canal cannot be permeabilized, sealant is applied to the remaining bridge.
The wound is sutured with non-absorbable sutures which are removed after 6-7 days.
After the operation the teeth will be kept away from hard food and excessive masticatory stress.
After apical resection, regional oedema usually occurs in the first 24-48 hours, then recedes.
If the oedema persists, worsens or if pain appears a few days after the operation, this indicates the appearance of septic complications which can be prevented by the dentist with appropriate medication.
