With the continuous development of the science of dentistry, there are now many procedures used in modern dental practices that offer the possibility of preserving one's own teeth.

Many people believe, for example, that root canal treatment is the last chance for a tooth to be saved, which is no longer true in its traditional form. If conventional root canal treatment is unsuccessful, apicoectomy can help save the teeth.

This intervention is a special surgical procedure, the essence of which is briefly nothing more than the removal of the root tip, so that the treated tooth can perfectly fulfil its function for years to come, without the need for removal and replacement.

What else do we need to know about root tip resection, and how does this procedure actually take place in practice? We have explored this topic in the professional article below.

If you need a root-end resection: Naturadent Dental Clinic in Budapest.

Apical resection preparation at Naturadent

What do we call root tip resection?
Apical resection is the surgical procedure where the tip of the tooth root, along with the surrounding inflamed tissues, is removed.

Unlike most oral surgery procedures, resection can be classified as a minor intervention, yet its performance nonetheless requires outstanding care and practice.

It represents the best alternative if a problematic tooth cannot be saved even after multiple root canal treatments, meaning it continues to hurt and become inflamed, which can lead to numerous complications.

A gyökércsúcs rezekcióra akkor van szükség, amikor a fog gyökerének csúcsánál gyulladás vagy fertőzés található, amely nem gyógyul hagyományos fogászati kezelésekkel.
From the patient's perspective, an apicectomy is often the last chance to save a tooth that still exists but is diseased.

However, when viewed from a dental perspective, root apex resection presents several reasons why this procedure can be a good alternative.

In addition to failed root canal treatments, the intervention can be ideal in cases, for example, where the tooth's canals cannot be properly cleaned for some reason, or the root canal cannot be dried when creating the root filling.

A common procedure, even if a cyst has formed at the root of the tooth, which not only has a negative effect on the surrounding bone tissue but can also cause illness in other parts of the body in the long term.

It may also be necessary to perform a root-end resection if, during previous root canal treatment, the root filling material has extruded into the bone tissue, where it causes various discomforts.

The steps of apicoectomy
As described above, root apex resection is considered a minor oral surgery procedure, which can usually be performed under local anaesthesia, but can also be carried out under general anaesthesia depending on the patient.

In most cases, the procedure is preceded by an X-ray examination so that the location of the problematic tooth root can be properly identified.

Gingivectomy
The first step of the surgery, after administering anaesthetic, is for the oral surgeon to make an incision in the gum and detach it from the bone surface. This is called flap raising.

Exposure of the root apex
At the root tip of the problematic tooth, the oral surgeon opens a so-called bone window with a dental drill, which allows access to the problematic region, thus to the root tip to be removed, as well as the inflamed tissues located around it.

Apical resection
The most crucial part of the intervention is the removal of the final 3-5 millimetres of the tooth root, along with the surrounding inflamed tissues. This is particularly important because if inflamed tissue remains around the root tip, there is a risk of the infection recurring. In the case of laser root tip resection, the root tip is removed with a laser, and the surrounding tissues are sterilised, disinfected, and inflamed tissues are removed with the help of laser light.

Root canal retreatment
It's not always necessary, but if it appears that the root filling doesn't provide a complete seal for the tooth during root end resection, then there is an option to correct it, thereby preventing future complications.

Gum sealing
The final step of a root-end resection is always the closure of the incised gum, which is done with special sutures for aesthetic and problem-free healing.

What precautions need to be followed after a root apex resection?
As an apical resection is considered a surgical procedure, it is very important for the patient to adhere to a few very important basic rules.

For example, it is important that although oral hygiene should not be neglected, the teeth around the wound must be cleaned very carefully. It is forbidden to scrub the area around the wound with a toothbrush until the stitches are removed.

It is recommended to gently clean the surface of the tooth with a soft-bristled brush, without touching the gums, but the use of a suitable mouthwash can have a very good effect on both oral hygiene and healing. We should always seek advice from our doctor regarding the latter!

It is also important to avoid consuming foods that are too hot, spicy, or irritating, but fizzy drinks and coffee are also on the forbidden list during the healing period, as is smoking.

As it is a stitched wound, it is advisable to avoid straining the jaw, eating difficult-to-chew foods, and strenuous physical activity, and indeed, exercise should also be avoided until the stitches are removed.

How long does recovery take after an apicoectomy?
Due to the surgical nature, the healing time for a root apex resection can be prolonged. Following the procedure, patients typically experience generalised swelling for 2-3 days and find the area of the opened gum to be painful.

This can be alleviated with over-the-counter painkillers and by icing the area around the wound. In many cases, antibiotics are also necessary, but the decision on this is always made by the specialist who performed the procedure.

Specifically, stitches can be removed as early as the fifth day after surgery, but with slower wound healing, the patient may have to wait 7-10 days. The stitch removal itself is not painful, so it can be performed without anaesthesia.

However, removal of the stitches does not mean the healing process is complete, as bone regeneration can take many months.

It is crucial at this point that the patient attends dental check-ups at set intervals – typically in six-month cycles – until the entire bone mass has regenerated.

A patient can only be considered fully recovered after a root apex resection when the gap in bone tissue has regenerated following the healing of the incised gum.

A gyökércsúcs rezekció számos lehetséges szövődménye lehet, amelyek közé tartoznak: * **Fertőzés:** A seb vagy a gyökércsúcs körüli terület elfertőződhet. * **Vérzés:** Lehetséges túlzott vérzés a műtét során vagy azt követően. * **Idegsérülés:** Ritka, de előfordulhat az arc vagy az ajkak érzésének átmeneti vagy tartós elvesztése, ha sérülnek a közeli idegek. * **Sinus tractus kialakulása:** A fertőzés vagy gyulladás miatt kis csatorna alakulhat ki az íny és az arcbőr között. * **A fog vagy a környező csont sérülése:** Ritka esetekben a fog gyökere vagy a környező csontállomány megsérülhet a műtét során. * **Arcüreg problémák:** Ha a felső metszőfogak gyökércsúcsát érinti a beavatkozás, előfordulhat, hogy a fog gyökere behatol az arcüregbe, vagy irritációt okoz benne. * **Ciszták vagy granulómák kialakulása:** A sebgyógyulás során vagy a gyulladás következtében új ciszták vagy granulómák fejlődhetnek ki. * **A fog elvesztése:** Nagyon ritka, de előfordulhat, hogy a beavatkozás után a fog kilazul és elveszik. * **Sikertelen gyógyulás:** Előfordulhat, hogy a seb nem gyógyul megfelelően, és továbbra is problémák merülnek fel. Fontos megjegyezni, hogy ezek a szövődmények viszonylag ritkák, és a legtöbb gyökércsúcs rezekció sikeres és szövődmények nélkül gyógyul. A fogorvos minden lehetséges kockázatról tájékoztatni fogja a beavatkozás előtt.
As with any dental procedure, root-end resection can naturally have complications.

In modern dentistry, this is already a very rare case, but as it is a surgical procedure, cases may occur where bleeding or haematoma develops at the site of surgery, or the wound becomes infected and inflamed.

In such cases, you should immediately consult your GP, who will take the necessary steps to prevent any further problems.

It is also important to know about apicoectomy that there is no guarantee of success for the procedure if it is not performed with due diligence. It may occur that the patient's condition does not improve after surgery or they continue to experience discomfort.

In such cases, there is no other option but to remove the problematic tooth.

A patient who has undergone root apex resection can only be considered healed if they remain completely free of symptoms after bone healing.

How much is the functionality of a tooth that has undergone root apex resection affected?
After complete healing, teeth that have undergone root-end resection can perform the same function as their healthy counterparts, however, due to their reduced load-bearing capacity, it is advisable to spare them from heavy strain.

It should also be known that in the future, teeth that have undergone such treatment are not recommended to function as abutments for a dental bridge, and indeed, even the creation of a crown for them should be considered.