Dental Procedure: Retrograde Root Tip Resection

Grafik einer Wurzelspitzenresektion mit retrogradem Verschlussbelsky

retrograde Wurzelspitzenresektion

Root tip resection with retrograde filling refers to the surgical removal of a root tip and the cleaning of the tooth canal from below.

It is also referred to as a retrograde apex seal. A root tip resection is performed on the root tip when a patient is suffering from chronic bone inflammation. You can find out how this happens in the video entitled "Root Resection".

In the video "Tooth Root Resection with Retrograde Filling" you see a patient with frontal teeth crowns. After a few years he developed infections at the root tip, caused by bad root treatment. In the past, a root tip resection without orthograde (or retrograde) filling was performed. Today is a repeat root tip resection with retrograde filling. Only this will seal the canal tightly. First the gum is folded back. A mucosa lobe is prepared; you see the infection on the root tip and there still is no bone formation.

Granulation tissue is removed and a medication to stop bleeding is inserted. Now the root is conically refurbished from below using special instruments. The pink parts are remnants of the old root canal filling. Root refurbishment is done with ultrasound instruments and water is used for cooling. As soon as a nice opening has been prepared, renewed measures are taken to stop bleeding and clean the area with alcohol.

The clean and dry opening is now sealed with special cement. Cone cement is repeatedly pressed into the root with a small spatula and plugged in further with a special darner. This is done a few times. The dentist then waits for the cement to harden. Later, surplus is removed and the filling is polished. The white spot on the root tip is the hardened cement. The root is now sealed tightly. In about a year, new bone should form around the root tip. This process is monitored with x-rays. Lastly, the wound is sutured. This procedure is called root tip resection with retrograde filling.

An alternative to this surgery would be tooth extraction, or, if possible, root tip resection with orthograde filling.

Risks associated with this surgery are negligible if performed by an experienced surgeon. However, there can be complications in isolated cases that may require additional measures to be taken. Any additional measure required can lead to further complications which can eventually be life-threatening. Here we will only discuss root tip resection-specific complications such as:

  • Bone inflammation (osteomyelitis) due to non-adherence to hygiene standards during surgery
  • Injury to neighboring structures such as the tongue, cheek, nerves, blood vessels, neighboring teeth/roots and related consequences such as sensation disturbance in the tongue, and/or lips
  • Wound infections resulting from non-adherence to conduct rules
  • Sinus cavity openings, which can then lead to sinusitis as an additional consequence
  • Inflammation recurrence after surgery
  • Incomplete resection and/or overlooking of root parts/roots

Luckily, such complications are very rare today because of positive medical developments over the last few decades.

Click here to see the video: Tooth Root Resection with Retrograde Filling

This post is also available in: German

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