Apical resection is a surgical procedure that is performed to remove infected or necrotic tissue from the tip of the tooth root. This procedure is necessary when a tooth has an infection at the root tip (apical point) that cannot be treated by other methods, such as endodontics (root canal treatment).
The apical resection procedure is carried out under local anaesthetic and the patient may feel mild pain or discomfort after the procedure. Before starting the procedure, the dentist will take an X-ray to assess the condition of the tooth root and determine the size of the area to be resected.
During the procedure, the dentist will make an incision in the gum above the infected area and remove the soft tissue covering the tip of the root. Then, he or she will use a special tool called a periosteal to remove the bony tissue around the root tip. Finally, he will clean the root tip and remove any remaining necrotic tissue.
After the procedure, the dentist will suture the incision and advise the patient to take an anti-inflammatory and apply ice to the area to reduce inflammation and pain. The patient may feel pain or discomfort for a few days after the procedure, but these should go away in a few weeks.
It is important to follow postoperative care instructions to ensure a speedy recovery and avoid complications. It is also important to avoid cold or hot foods and drinks in the affected area for at least a week after the procedure.
Apical resection is an effective procedure to treat infections at the tip of the tooth root and can prevent the loss of the affected tooth. It is important to consult a dentist if a root tip infection is suspected to determine if an apical resection is necessary.
Teeth are made up of the crown, which is the visible portion in the oral cavity, and the root, which is the element that is implanted in the alveolar bone and gives the tooth support and anchorage to ensure that it stays in the arch as well and as long as possible.
Front teeth usually have only one root. Premolars may have one or two roots, and molars two or three, depending on their arrangement and individual morphology.
Of course, exceptions to these rules may occur. The roots are crisscrossed by canals, through which the teeth are vascularized and innervated (sensitized).
Nerves and blood vessels run through the tooth from the coronal pulp chamber to the root apex, i.e. the tip of the tooth root.
Apical resection may be the solution for infections at the apexes of teeth already treated endodontically.
During endodontic treatments, canals are cleaned and infected tissues are removed.
Canals are usually not linear. They have many branches, which is why it is impossible to clean them completely and perfectly.
Apical resection means the removal of the root tip by surgery to remove the focus of infection from a tooth already treated endodontically and to alleviate the patient’s painful symptoms.
Precautions before performing apical resection
Being a more complex surgical procedure than endodontic treatment, due to the sectioning of the gum and root apex, it is good for the patient to understand that this is a more laborious procedure than traditional dental treatments.
X-rays are important to detect the position of the dental apex, to calculate the site of the intervention.
Oral antiseptic rinses are indicated before the intervention and if the doctor considers it, even antibiotics.
The doctor should be informed about cardiac pathologies. The amount of adrenaline used for an apical resection is double that for a normal operation. Therefore, if the patient has high blood pressure and has not mentioned it during the history, he should remind the doctor of this.
Adrenaline is used to produce vasoconstriction, i.e. to collapse the vessels to reduce bleeding and increase the duration of anesthesia.
What does apical resection involve?
The doctor will section and remove the gum at the apex to create a direct access to the surgical site.
The infected tissue will be removed along with a few millimeters from the root tip.
Then, following excision of the apex, the endodontist will obdurate the last 3-4 millimeters of the root, retrograde, i.e. starting from the apex towards the crown.
An intraoperative radiograph will be taken to check the correctness of the procedure before suturing the previously detached gum flap.
The apical resection is a procedure that takes between 30 and 90 minutes, depending on access to the tooth in question and the complexity of the case.
The endodontic specialist will provide the patient with information on the postoperative care protocol.
It is important that the patient adheres strictly to what they are told in order to promote a complete healing without side effects.
Post-operative monitoring is designed to assess healing and reintegration of affected tissues.
In general, patients tolerate the procedure well, saying that their general condition and comfort are often better than after endodontic treatment.