What is an Apicoectomy?

Apical resection is a surgical method by scraping away the periapical lesion tissue and removing the infected apex, treating the apical stump, and depositing calcified substances by using blood clot mechanization to promote periapical disease healing. On the basis of apical resection, some additional or other operations are also performed, such as apical curettage, broken apical excision, and root canal filling.

Apical resection

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Apical resection is a surgical method by scraping away the periapical lesion tissue and removing the infected apex, treating the apical stump, and depositing calcified substances by using blood clot mechanization to promote periapical disease healing. On the basis of apical resection, some additional or other operations are also performed, such as apical curettage, broken apical excision, and root canal filling.

Chinese name

Apical resection

Foreign name

apicetomy

Be applicable

Apical resection is an operation that removes the apex of a tooth and scrapes away the diseased tissue around the apex. Suitable for

This method is suitable for cases in which root canal therapy cannot be performed by conventional methods. Generally, it is only used for anterior teeth and premolars. Molars can be treated as appropriate according to anatomy.

1. Root canal treatment fails and the root canal filling material cannot be removed or the post crown has been made;

2. The root canal is curved and narrow; the root canal instrument is broken in the root canal and blocked;

3. Root apical rupture has formed chronic apical periodontitis;

4. Chronic apical periodontitis combined with super-filled root canal filling materials that are difficult to remove.

Due to the larger scope of chronic periapical inflammation, those who failed to make the lesion disappear after root canal treatment.

At work

1. Acute periapical inflammation or acute osteomyelitis of the jaw.

2. Alveolar bone atrophy, deep periodontal pockets, teeth loosening significantly.

3. Those with severe tooth defects cannot be repaired.

4. It is estimated that the supporting tissue of the tooth is not enough to stabilize the tooth after the operation.

5. The root canal is penetrated beyond the 1/3 of the apex.

6. The general health status is not suitable for the operation.

1. Take X-rays before surgery to understand the root shape, location, relationship with adjacent tissues, the extent of bone destruction, and the status of root canal treatment. Those with unclean oral hygiene should be cleaned. Sedatives should be given to sensitive patients before anesthesia. Root canal filling is best performed on the teeth before surgery, or root canal filling is performed at the same time.

2. Routine disinfection and anesthesia. Local anesthesia is usually selected. To avoid bleeding, add a little adrenaline.

3. Incision flap: make a semi-circular incision at the root apex of the affected tooth, about 1.5-2cm long. After flapping, bone defects can usually be seen to the apex.

1. Routine use of antibiotics.

2. The teeth should not be used to bite hard objects within one week after surgery.

3. Rinse mouth with salt water after meals to keep oral hygiene clean.

4. The suture is removed one week after the operation, and the wound can heal within two weeks.

5. Regular X-ray examinations were performed regularly at 6 months and 1 year after operation to compare bone healing. ^[1]

In general, the wound can heal 2 weeks after surgery, and the bone cavity is filled with new bone within 6 months to one year. The ideal restoration is to form a hard bone plate on the surface of the tooth root and connect it to the periradicular hard bone plate.

The apical resection has a high success rate of backfilling. According to Japanese scholars, 73 cases of retrograde root canal surgery were successful, 53 cases were successful, accounting for 72.63%, 16 cases were improving, 21.91%, and 4 cases were failure, accounting for 5.46%.

1. Apical resection is not in place

2. Incomplete root canal filling

3. Root apical filling is not tight, showing adverse reactions

4. Double root canals are formed after apical resection, and a root canal treatment is missed.

5. Root injury: lateral canal puncture; occlusal trauma; longitudinal root split; horizontal root fracture

6. Deep blind bag, lack of supporting tissue, periodontal destruction

7. Lateral accessory root canal lesions ^[2]

Root canal treatment should be performed on the affected teeth first and overfilled. The operation can be performed 4-5 hours after the filling. Root canal filling can also be performed during the operation.

Apical resection should be used for maxillary and mandibular anterior teeth.

When separating the mucoperiosteal flap, the periosteum must be completely separated, and the mucoperiosteal flap cannot be damaged during the operation.

The stitches were removed 5-7 days after the operation.

The incision of the maxillary central incisor should avoid damage to the lip band.

Ask the patient not to brush their teeth temporarily after the operation, but need to rinse their mouths to keep the mouth clean.

Give anti-infective drugs and analgesics.

Apply a cold compress to the face after the incision to prevent edema.