Root apex resection: gentle and long-term tooth preservation

Sometimes root canal treated teeth start to hurt – even after they have been very inconspicuous for many years. In order to preserve the tooth, an apicoectomy can be useful in such cases, if a further root canal treatment is not promising. However, an apicoectomy may also be necessary if there are inflammatory changes at the root tip or certain tooth injuries.

Dr. med. Thomas Franke carefully checks in advance whether an apicoectomy is advisable. For this purpose, we use the most modern diagnostic methods in our practice, among other things, which enable a clear and reliable clarification. If apicoectomy is medically indicated, the procedure is performed as an outpatient in our practice in Berlin Charlottenburg.

What is apicoectomy and what is the difference to conventional root canal treatment?

If a root tip is inflamed or damaged and there is no possibility of repairing this with a root canal treatment, then an apicoectomy can be a surgical alternative in order to still preserve the affected tooth.

While a root canal treatment only cleans and disinfects the canal of the inflamed root from the crown of the tooth, apicoectomy is a major surgical procedure.
In apicoectomy, the root of the tooth is accessed from the outside through the jawbone. The gums are opened up to the tip of the root and the inflamed tissue at the tip of the root and the affected tip of the root itself are removed. The root canal is then cleaned and, if necessary, additionally sealed to prevent the penetration of infectious pathogens.

Root tip resection is often the last alternative before the removal of the affected tooth.

When is a root tip resection useful?

It does not always make sense to perform an apicoectomy. But there are some cases where the tooth can still be preserved by this treatment.

During a root canal treatment, for example, it can happen that despite the greatest care and the most modern treatment methods, small curvatures and ramifications in the area of the root apex are not completely cleaned and disinfected. As a result, the inflammation cannot heal and can even spread further. Those affected then often feel a pressure pain in the affected region.

Sometimes a root canal treatment does not lead to the desired healing success and both the inflammation and the pain persist, so that a root tip resection is a possible alternative. An apicoectomy is also indicated in the case of a cyst located near the root of the tooth, if there are broken instruments in the root canal or if the roots of the tooth are damaged.

How does a root tip resection work?

First of all, the results of the dentist or other X-rays are used to determine whether an apicoectomy is really necessary.

If an apicoectomy is medically indicated, the procedure is performed as gently and minimally invasive as possible by Dr. Thomas Franke on an outpatient basis in our practice in Berlin Charlottenburg. We attach great importance to a pleasant atmosphere and always have an open ear for questions, fears and wishes of our patients.

Before the procedure itself, local anaesthesia is used to eliminate the pain. In rare or special cases it is also possible to carry out the treatment in twilight sleep or under general anaesthesia.
If the pain elimination works reliably and the focus of inflammation could be localised exactly in advance, an access to the affected tooth root is placed over the gums.
For this purpose, Dr. med. Franke cuts through the gums and finally also the periosteum of the affected tooth and folds the tissue over so that the part of the jawbone under which the tip of the root is located is exposed. Now the bone is removed with a special tool such as a laser or a fine milling cutter so that the tip of the root is visible. The affected tip of the tooth root is shortened by 2 to 3 mm until the branched and fine root canal spurs are completely removed. Of course, the inflamed tissue at the tip of the root is also gently removed and the root canal cleaned. Here, the surgical access allows work at the root tip and root canal to be carried out in the smallest of spaces.
If necessary, the root of the tooth is still sealed. This seals the tooth permanently and prevents the penetration of infectious pathogens.
The surrounding tissue is then repositioned and the wound is sutured with the finest material.

The procedure usually takes 15 to 30 minutes.

What happens after the apicoectomy?

In the first few days after the apicoectomy, we recommend that you only eat soft food and take care of your body. Physical exertion or sport should be avoided for at least two to three days.
For better wound healing, it is essential to avoid nicotine and caffeine for at least 24 hours after the procedure.
To counteract bruising, the wound should be cooled sufficiently from the outside via the cheek.

In general, there is no intense pain, but the sensation of pain is very individual. We therefore provide our patients with appropriate pain medication for the first few days after the operation. At the latest ten days after the apicoectomy, the pain should have decreased significantly.

As a rule, the wound in the soft tissue inside the tooth heals after one week to ten days, so that the stitches can be removed at this time. In order to check the success of the procedure, the healing of the bone and the root of the tooth is checked after three to six months by means of X-rays.

What are the risks with a root tip resection?

The surgical procedure of apicoectomy can lead to the usual side effects of an operation. These include the occurrence of pain, swelling, bleeding and inflammation of the wound.
Other risks include the possibility that inflammatory lesions remain and cannot be completely removed. In this case, the affected tooth may have to be removed completely after weighing up all the circumstances. The gap can be filled again with a dental implant.