Apicotomy, treating inflammatory diseases of the teeth

What is apicotomy? A very common term that we are often exposed to while visiting a dentist. In order to better explain the concept and treatment procedure we will start from the very beginning.

Cyst, granuloma, periapical lesion, fistula – are all terms encountered, quite often, in dental practice and vocabulary. You must have heard of them yourself or your dentist has told you that you have some of these pathological processes in one of your teeth.

What all of them have in common is a bone loss and its replacement with granulation tissue (newly formed tissue in the area of wound healing) around the apex of the tooth root affected by the inflammatory process.

In addition to bone loss, blood flow can transport the inflammatory contents of these lesions to the heart, kidneys, joints, and other tissues and organs of the body with consequent complications.

What are the causes?

The primary causes of these lesions can be endodontic (the part of dentistry that deals with the treatment of dental pulp and root), periodontological (coming from soft tissues in the oral cavity surrounding the teeth), or their combination. In addition, trauma and complications in the treatment of dental tissues are also an important factor.

The pain, swelling, fistula (the newly created channel through which the inflammatory contents reach the surface of the tissue) are the most common symptoms of these conditions.

Sometimes these lesions are discovered accidentally on x-ray images and can exist for a long time without any external symptoms. In larger and longer-lasting processes, sometimes it is possible to palpate a soft bone above tooth crowns (the ping-pong ball effect). Their size ranges from a few millimetres to a few centimetres in diameter.

TREATMENT

After confirming the existence of granuloma or a cyst, the doctor needs to assess whether it is possible to preserve the tooth (teeth) or if it (they) need to be extracted.

The treatment is surgical and the procedure itself is called APICOTOMY (Greek for Apex, apicis- tip and tomy- cutting, cutting out). The purpose of this surgical procedure is to remove the tip of the dental root together with the pathological tissue thus eliminating the inflammation.

The procedure is performed under local anaesthesia. First we remove the part of the gum tissue in the area where the pathological process is located and then we use a special drill to puncture the bone to remove the part of the root and all of the inflamed tissue. This prevents reinfection.

Just before the surgical procedure, one or more root canals must be hermetically filled with a special material to prevent re-infection in both directions – to the dental crown and to the top of the remaining root.

Filling of root canals is also possible during the operation itself. Sometimes, due to various prosthetic work in the root canals it is not possible to make a complete revision of the previous filling, so only root resection and removal of inflamed tissue are performed.

The remaining bone defect needs to be thoroughly cleaned from all the remains of inflamed contents and then it can be filled with replacement bone or left to heal naturally. The wound is sutured with several stitches.

After the apicotomy operation, care should be taken not to damage the wound and one should comply with all instructions given by the doctor in oral and written form after the operation (cool the injection site with ice 6-8 hours after surgery, avoid hot food and drinks 24 hours after surgery, not to smoke, maintain oral cavity hygiene…).

CONTRAINDICATIONS

Uncontrolled systemic diseases (e.g. diabetes), bacterial endocarditis, heart failure, and blood clotting disorders are a contraindication to the procedure.

Resorption of more than half of the roots, advanced bone loss around the affected tooth, or pronounced tooth mobility are also an obstacle to the operation.

CONCLUSION

With the correct doctor’s indication before the surgery and with the procedure itself being performed according to the rules of the profession, it is a great possibility that the apicotomised tooth will remain in the mouth for a long time. Apicotomy can be performed on all the teeth unless there are some anatomical limitations (proximity to the nerve and maxillary sinus).