Apicectomy or Root End Surgery

Root end surgery is necessary when root treatment fails and retreatment has been ruled out.  Retreatments may be ruled out due to obstructions such as posts preventing retreatment, or just patient preference.  Retreatment of the failed root, otherwise, is always the first choice for treatment.

 A patient was referred for assessment for the surgical approach due to the lesions associated with two adjacent teeth.  The patient has suffered recurring abscess which has been previously managed with anti-biotics.  The x-ray below shows reasonable root fillings although the first premolar is slightly overextended and the second premolar is slightly short.  The crowns are supported with posts.  There are lesions associated with both teeth. 

 

apicectomy

A full thickness flap was raised with vertical relieving incision mesial to upper canine.  A papilla based incision was made to prevent gingival recession, especially around the crowns.  Osteotomy windows were made of about 4mm diameter and under steromicroscope 3mm of the root ends were removed. 

The root ends were stained with Methylene Blue to check for any cracks.

The root ends were prepared by ultrasonics tips (JeTip, by B&L Biotech) to accept MTA to a depth of 3mm.  MTA was packed in a dry field. 

The gum was sutured closed with 5/0 Ethilon sutures and the patient was given post-op instructions regarding controlling swelling, bleeding or pain.

The x-ray below shows the retro filling in place.

apicectomy

Knowledge, Training and Skill is the key to successful surgical treatment.  The surgical option can provide a good long term result and is well tolerated by patients.  In our case the patient actually fell asleep during the procedure!! 

I look forward to sharing some interesting surgical cases. 

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