Dental Procedure: Root Tip Resection

Watch Dental Video about Root Tip Resection

Root tip resection denotes the operational shortening of the root after the creation of operational access through the bone with or without concurrent root filling.

Should an infection of the dental nerve occur due to major caries a root treatment needs to be carried out. If this is not done properly then there is a danger that the inflammation will persist and the inflammation in the nerve can spread to the bone or more precisely to the bone in the area of the root tip.

Often a repeat of the root treatment – a so-called revision – will bring an end to this horror but if this doesn’t do then a root tip resection is another possible treatment.

The main aim of the treatment is to retain the tooth and its function. The target of the whole procedure is a root canal infested with bacteria, and the aim is to ensure that the infection ends there. Root tip resection however is no replacement for a precise root canal treatment.

Does one notice inflammation in the root tip?

Root Tip Resection

Root Tip Resection

No, indeed you might not even feel any pain. Most people have problems when the chronic inflammation becomes acute. The classic complaints which some patients talk about are:

  • lack of reaction to heat/cold
  • pain and a feeling of pressure both locally and radiating to other parts of the face
  • development of a fistula
  • acute pains with local or regional development of abscesses

 

What does the dentist do?

  • In the early stages the dentist observes a widening of the periodontal spaces in x-rays and a reaction by patients to horizontal and vertical tapping of the tooth
  • First the mouth is thoroughly examined in order to clinically establish the possibility of retaining the tooth
  • Percussion test and palpitation of the bone in the affected region
  • Sensitivity test of the affected tooth and its neighbours
  • X-ray examination to get a full picture of the tooth including the inflammation around the root tip

 

In some cases further examinations may be helpful:

  • The identification of specific periodontal parameters
  • Sensitivity checks (lingual nerve and inferior alveolar nerve)
  • Biopsy in the case of pathological changes
  • Eccentric x-rays (x-rays on two levels or where applicable computer tomography or 3D x-rays in the case of extensive pathological changes which exceed the area of the root tip)
  • Laboratory checks for accompanying ailments (such as coagulation parameters etc.)
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    What are the alternatives to root tip resection?

    • Repeat of the root treatment
    • According to existing scientific records a repeat of a root treatment will achieve comparable results and therefore on the basis of analysis of existing records alternative treatments are suggested
    • Extraction
    • Where it is not possible to operate antibiotic treatment is the least one can do

     

    Complications

    Apart from the routine consequences which accompany an operation like bleeding, swelling and pain, the following procedure-typical complications are particularly possible:

    • Persistent infection with clinical and/or radiological symptoms
    • Postoperative infection
    • Continuous periodontitis varying between marginal and apical
    • Fracture of the root
    • Damage to sensitive branches of the trigeminal nerve
    • Damage to neighbouring teeth
    • Dislocation of the root tip in the socket/nasal cavity/floor of the mouth/nerve canal
    • Bone necrosis
    • Root fragments left in situ

     

    Recommendations about determining the indication – when should a root tip resection take place?

    The methodological quality of existing studies about differential indication of root tip treatments is generally very low. The following recommendations about the indication for root tip treatments can be deduced from the existing data:

    Indication for root tip treatment

    • in the case of persistent inflammation with clinical symptoms or increasing loss of bone as demonstrated radiologically after a complete or incomplete root canal filling or repeat treatment in case this cannot or only under unreasonable risks can be removed or improved upon (for example in the case of complex prosthetic treatments and particularly with treatment with root pins)
    • after root canal filling with over-compressed root filling material and clinical symptoms or the involvement of neighbouring structures (jaw sockets, mandibular canal)
    • in the case of conservatively unimplementable root canal treatment and seriously extraordinarily formed roots which do not permit a complete and effective root canal filling
    • in the case of teeth with obliterated no longer accessible root canal as evidenced by clinical and/or radiological symptoms

    Click here to see the video: Root Tip Resection

     

    This post is also available in: German

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