Dental Treatment: Root Tip Resection
Root tip removal refers to the surgical removal of the root tip from the tooth root.
Chronic inflammation of the root tip will eventually necessitate surgery. How does this bone inflammation happen?
In the video "Root Resection" you see how deep caries (bacteria infecting the tooth nerve), for example, cause you to experience pain resulting in necessary root treatment. The dentist removes the infected tooth nerve material, also known as endodont, and seals the canal with a special material. If the root canal (as seen on the video entitled "Root Canal Treatment") is not cleaned thoroughly and filled, remaining canal bacteria may lead to chronic bone infection.
If the root treatment is correctly performed but the tooth is only filled with a simple filling (for example, amalgamate), the filling may develop leaks over the years and this in turn allows undetected bacterial invasion in the tooth interior. Root tip inflammation is a probable consequence. Chronic bone infection is usually the consequence of bad root treatment or teeth that are no longer filled in tightly. If bone inflammation is not significant, repeat root treatment (called a revision) can sometimes promote healing, provided the root treatment is carried out under hygienic conditions.
However, a thorough revision is more complicated than a root tip resection. The work requires a rubber band, microscope and patience and takes a long time. This is surely one of the reasons why a root tip resection is often chosen over a revision. If the root treatment revision does not lead to the desired result and/or if the infection is already too large, the surgical cleaning of the “focus,” also known as a root tip resection, is usually the last option.
Hence, tooth canal filling and cleaning are a top priority, both during root treatment and root tip resection. During orthograde root tip resection, canal cleaning and filling should be done from the top down; in other words, from the tooth crown down. There will be more about this in the video entitled "Root Tip Resection with Orthograde Filling". Sometimes access from above is not possible, for example on:
- pivot teeth
- or if a root canal instrument is chipped and stuck in the tooth interior
Using the retrograde root tip resection, the tooth can be cleaned and sealed from below, meaning from the capped root tip. There will be more about that in the clip by the same name! By cutting the root tip, all non-refillable side canals are removed. The root tip often branches out into several single canals and therefore has only one cleanly filled main canal remaining. The inflammation origin is also removed.
Root tip cutting alone without interior tooth cleaning and filling cures the pain in the short-term – meaning acute symptoms will disappear – but this does not cure the cause of the pain and your problems will reoccur, often in just a few years! You often do not feel the bone infection itself for a long time (up to a few years); a relatively late symptom is a hard swelling and/or a fistula on the gums, as seen in this picture.
An alternative to this surgery would be tooth extraction.
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 that is required can then lead to further complications and these can eventually be life-threatening. Here we will only discuss root tip resection-specific complications. For example:
- Bone inflammation (osteomyelitis) due to non-adherence to hygiene standards during surgery
- Damage 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 due to non-adherence to conduct rules, for example
- Sinus cavity openings that can 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.
This post is also available in: German