The purpose of tooth root tip extraction surgery is to achieve a microbial-resistant root filling in order to get rid of inflammation on the base of the root tip. Inflammation of the medulla (pulp) in the tooth root canal is a frequent cause of toothache and inflammation around the root of the tooth.
If root canal treatment doesn’t yield desired results or is not possible at all due to previous root canal treatment or a pin in the root canal, the only option to save a tooth is root tip extraction. The same operation is also undertaken in case of a cyst or tooth root fracture.
How is root tip extraction surgery carried out?
Since the purpose of root tip extraction surgery is the microbial-resistant closing of the root canal, the surgery is not done instead of a proper root filling but rather in addition to that. If necessary, a root filling is made during the surgery on the root tip part, where it is missing.
The surgery is carried out with local anesthesia.
The bone and tooth root tip are removed with a drill, inflamed tissues are cleaned and the unfilled part of the root tip is filled with a microbial-resistant filling. The wound is stitched and the sutures are removed after one week.
How to decide over root tip extraction surgery?
The following is considered upon making a decision:
- Has the root canal already been treated before and is it possible to remove the inflammation without surgery by means of root canal retreatment?
- Is the root canal accessible or blocked by a crown or pin?
- What are the risks and prospects of success for root canal treatment and root tip surgery?
What are the dangers of root inflammation?
A healthy tooth is isolated from the jaw by a connective tissue capsule, which holds the tooth in the bone. In case of an inflammation, bone surrounding the tooth root decays, leading to an inflammation lesion visible on X-rays.
Such inflammation lesions can lead to:
- Acute inflammation or abscesses;
- Chronic inflammations or osteomyelitis;
- Cysts causing major bone defects;
- Maxillary sinus inflammation in the maxilla;
- Acute inflammations in case of autoimmune diseases or immunosuppressant treatments (chemotherapy, organ transplantation).
What are the risks of root tip extraction surgery?
In addition to general surgical complications like inflammation and bleeding specific surgical risks can occur:
- Some mandibular tooth roots extend to the mandibular nerve which can get damaged during surgery. Typically such sensory disorders pass in a few months, but in very rare cases can persist.
- Maxillary tooth roots can extend to the maxillary sinus. Like the inflammation lesion itself, a surgery can also result in maxillary sinus agitation or inflammation.
- If teeth are spaced very closely, adjacent teeth can get damaged during surgery.
- Tooth root tip surgery isn’t always successful. It is possible for a new inflammation to occur and the tooth needs to eventually be extracted.
- Sometimes surgery reveals that the tooth cannot be preserved and needs to be extracted.
When should a root tip extraction surgery be carried out?
- Persisting pain or inflammation lesion seen on X-rays despite repeated root canal treatment.
- Filling reaching over the root tip, that causes pain.
- Curved teeth with additional canals that cannot be treated well.
- Canals that are closed off, impenetrable to instruments, as a result of aging or previous treatment.
Additionally, a root tip extraction surgery should be considered in following cases:
- Inflammation lesions over 5 mm in size.
- Root canal treatment instrument fracture.
- Perforation of the root canal.
- Root fracture.
- Toothache despite impeccable root canal treatment.
- A second operation for a repeated attempt to preserve a tooth.
