The term root tip resection refers to the surgical removal of a root tip.

A root tip resection is performed in cases of chronic bone inflammation at the root tip.

One common symptom is a fistula on the gums, as shown here. The operation often needs to be performed as a result of faulty root treatment. In the animation you can see how a deep cavity – containing bacteria – can infect the tooth nerve – you feel pain so the dentist performs root treatment, removing the infected tissue and closing the canal using a special paste. If the root canal is not thoroughly cleaned and filled, as shown in this animation, then years later bacteria can cause an infection in the bone. If the infected area is not too big, renewed root treatment (revision) can help to heal the area – assuming that this time it is performed correctly.

However, a thorough revision is a lot more difficult to perform than a root tip resection. It takes a coffer dam, a microscope and a lot of patience – meaning time. This is probably why it is more common to perform a root tip resection than a revision. A revision is also not always successful, if an infected area has attained a certain size, then surgical removal of the „core“ is often the last resort – the alternative being tooth extraction.
Cleaning or filling the canal are therefore the most important steps in root tip resection – here you can see a badly treated tooth with a large infected area, due to the size of this area, a revision of root treatment would not aid healing – so instead a root tip resection is performed, with an orthograde filling. In this case the canal is filled from the top, the tooth is opened as in root treatment and paste is poured into it. Root tip resection is then performed, first the gums are flipped open, then the bone around the root tip is removed and the root tip is exposed. The root canal often splits into several smaller channels at the root tip, and when the tip is removed these side channels (shown here by blinking lights) which cannot be filled are also removed. The interior of the tooth is once again cleaned and closed – this procedure is known as a root tip resection with orthograde filling.

Simply cutting away the root tip – without filling up the tooth afterwards - is not enough, if the canal is not cleaned the infected core may be removed, and you may be alright for years, but then the same problems will re-appear.

Sometimes, orthograde cleaning, cleaning the tooth from the top, is not possible, for example if there is a post, or a dental instrument has been left behind in the root canal (shown by the blinking light). In cases like these the canal must be sealed from below. Through an opening in the bone, the canal is treated using special instruments rotated in a conical motion, then cleaned, dried and filled. The membrane is stitched up and the wound usually heals well, this procedure is called root tip resection with retrograde filling. A simple x-ray is used to check whether the procedure was performed correctly – the bright spot (marked by the arrow) shows where the root was sealed – this type of retrograde resection is also known as retrograde apex sealing.