Unfortunately, people don't really like visiting the dentist. The procedure may seem very unpleasant and painful. However, to maintain dental health, you must visit the dentist at least twice a year. If you have problems with your teeth, you will have to visit the doctor more often. In this article we will tell you what to do if your teeth are loose.
Why are teeth loose?
IN childhood loosening of teeth is physiological and does not require doctor’s intervention if it does not cause a lot of inconvenience to the child and does not interfere with the eruption of permanent teeth.
Why do teeth become loose?
- Physiological reasons
- Pathological causes
Physiological unsteadiness is observed in children preschool age when replacing milk teeth with permanent ones. In this case, their loosening is absolutely normal, since baby teeth do not have roots and do not sit tightly in the surrounding tissues. They are replaced by permanent teeth, which have a root connected to the bone tissue of the skull.
An adult's teeth are loose: reasons
In adulthood, teeth also have a certain amount of looseness. Many people think that they are absolutely motionless, but this is not so. Minor vibrations of the teeth in the gums are allowed; this is literally a fraction of a millimeter, allowing you to chew food. If there were not these small gaps and movement of the teeth, then, most likely, they would crumble with the destruction of the jaw and skull bones.
However, significant loosening of the teeth, over a distance of approximately 1 mm in both directions, is considered pathological and can cause tooth loss. Such problems most often require a doctor’s examination and consultation. There are several reasons why teeth become loose in adults.
An adult's teeth are loose, reasons:
- Periodontitis
- Periodontitis
- Periodontal disease
All these diseases require treatment, which can be carried out both surgically, with the assistance of orthodontists, and at home. It all depends on the specific ailment.
My front teeth are loose, what should I do?
- The disease most often occurs in children between 3 and 6 years of age.
- Diabetes
- Women taking hormones and oral contraceptives
- Complications after ARVI and sore throat, as well as influenza
My front teeth are loose, what to do:
- With gingivitis, the gums become inflamed and an infection penetrates into the gum pocket, which destroys the tissue and contributes to the loosening of the tooth. To cope with this problem, you need to thoroughly clean your teeth, use dental floss, irrigators, and special medications.
- Dentists often prescribe antiseptics to disinfect the cavity and prevent bacteria from growing in the pockets that form between the tooth and gum. Next, strengthening agents are prescribed that help make the gums denser and more elastic.
- The prognosis for the treatment of gingivitis is positive, since the connection between the gum and tooth is not disturbed, and only inflammation of the gums is observed. At proper treatment It is possible to completely get rid of loose teeth and heal all kinds of wounds.
Pathology occurs in case of complications of nasal breathing, chronic rhinitis or sinusitis, as well as a deviated nasal septum.
- Most often, gingivitis is treated with outpatient setting, and if you follow all the doctor’s recommendations, you can cure him. Often used for treatment antibacterial agents, which are used not only topically, but also internally. However, this method of treatment is used only in advanced cases when gingivitis progresses to periodontitis.
- To treat gingivitis, cephalosporin antibiotics, Penicillin, and Doxycycline are used. Hepilor, Givalex, and astringent liquids are used as rinses, which help disinfect the oral cavity and prevent the growth of bacteria.
- You can also use a solution of Miramistin, Chlorhexidine. Sometimes Decasan applications are used. These are all antiseptics that help eliminate pathogenic microorganisms. This applies not only to bacteria, but also to viruses and fungi that cause gingivitis.
A fairly common cause of loose teeth is periodontal disease. This is the destruction of the tissues that surround the teeth, with the transition to the bone. As a result, the tooth initially becomes loose and then falls out.
How to strengthen your gums if your teeth are loose:
- There are several methods of treating this disease, the most popular are dental ones, which are carried out in the doctor’s office. The modern dentist has great amount devices and devices that help cope with periodontal disease.
- At the initial stage, a treatment is carried out during which all plaque and tartar are removed, where bacteria and microorganisms that destroy the gums accumulate. Further, after cleaning, it can be carried out laser treatment, during which the inflamed tissues drain and the areas surrounding the tooth are restored. After healing, the teeth are restored and no longer become loose.
- Also in dentistry, the help of an orthodontist is often used. If one specific tooth is loose, it has been treated, and there is no inflammation, then a kind of splint is often used. These are plastic or metal overlays that are fixed to the teeth using a special compound.
- Don’t worry, these products are attached on the side of the tongue, so they are not visible at all during a conversation, as well as a smile. Thanks to such splints, a loose tooth is fixed to two nearby ones, thereby stopping its destruction and loss.
Nowadays, many people do not have much time to visit the dentist, so they strive to cure most diseases on their own. This can be done with simple manipulations. Below we present several remedies that perfectly help cope with loose teeth.
- Salt is an excellent antiseptic and promotes tissue healing. To prepare the solution, use two teaspoons, which are diluted with 200 ml of water. The result is a fairly strong solution. A sip of this solution is taken into the mouth and held in it for one and a half minutes. It is necessary to roll the water from side to side to rinse out all the plaque from the teeth.
- Mustard can also be used along with salt. It helps to cope with gum inflammation and prevent tooth loosening. You need to mix a teaspoon of powder with a teaspoon of salt and add a little vegetable oil, before receiving the posts. This paste is applied to the teeth and left for 5 minutes. You can brush your teeth using a soft brush.
- Basil is great for relieving inflammation. To do this, you need to pour 1.5 teaspoons of dry and fresh leaves into 200 ml of boiling water and leave for 20 minutes. Next, you need to rinse your mouth with the mixture. Rinse should be done early in the morning and in the evening, before going to bed.
- In 2014, in one place of dental universities in the USA, they conducted a study, during which they found that coconut or Sesame oil. For treatment, you need to take a tablespoon of oil into your mouth and roll it from side to side for 20 minutes. Remember, this remedy should never be swallowed, but should be spat out. The product helps get rid of gingivitis and periodontal disease. It has a great effect on the condition of teeth and the tissues that surround them.
- Turmeric will help cope with periodontal disease and loose teeth. In order to cure the disease, it is necessary to dilute the spice with water until a paste is obtained. Next, the product is applied to cotton swab and every tooth is lubricated. The product is kept for 10 minutes. You can perform the procedure at night, after brushing your teeth. In the morning, clean with a soft toothbrush and rinse thoroughly. Remember, if you periodically experience periodontal disease, or peritonitis, you need to visit the dentist frequently.
A tooth becomes loose after an impact, how to strengthen it?
Many men have encountered a situation where, during a fight and a blow to the jaw area, their front teeth begin to loosen. There is no need to be upset; you need to see a doctor. There are several reasons why teeth become loose and hurt after an impact.
- The first is a tooth root fracture. In this case, with almost one hundred percent probability it will have to be removed, since there is a fracture
- Tooth dislocation. The main symptom is loosening and change in position relative to the dentition
- Minor offset
A tooth becomes loose after an impact, how to strengthen it:
- In all these cases, immediately after a fight, it is necessary to provide this tooth with rest, eat only liquid food, refuse apples, crackers, nuts, as well as foods that need to be bitten off with the front teeth.
- Next, cold water is applied to the gum and lip to relieve swelling. After this, rinse your teeth with any antiseptic; the ideal option would be a solution of Furacilin, Decasan or Miramistin. This will help reduce the chance of re-infection. After all, in the area of dislocation there are damaged tissue, which can become infected.
- If there is no fracture, but only a slight dislocation, then long rest, as well as care oral cavity with rinsing, after a few months it helps to tighten the tooth and strengthen it. In this case, the tissue is restored and the tooth no longer wobbles. But most often, the help of a dentist is needed.
Treatment of loose teeth
You can save a tooth that has fallen out. Please note that if this happens, the tooth should never be completely dried out. Because this way you will make him dead.
Treatment for loose teeth:
- The ideal option is to put it by the cheek and in this position come to the doctor. You can put it in regular saline solution, which is sold at the pharmacy and costs a penny. In a container with saline solution, you need to bring the tooth to the dentist.
- The dentist places the tooth in place and splints it. That is, they apply a splint, fastening it to adjacent teeth. Special medications are prescribed that will prevent the development of infection and the attachment of bacteria to the affected area.
- Further, strengthening drugs may be prescribed that accelerate tissue healing. After 3-12 months, the splint is removed and the tooth is no longer loose. During this time, the bone tissue is restored, as well as the gums that are located around the tooth.
My front tooth is loose, how can I strengthen it?
The tooth is splinted. This is a common procedure performed for periodontal disease. The fact is that most often periodontal disease does not damage the entire dentition, but only a few teeth.
Unsteady front tooth how to strengthen:
- To reduce the load, it is redistributed between other teeth. The manipulation is done during the period of remission of periodontal disease, under local anesthetic.
- The patient is injected with an anesthetic and a special device is used to cut out a furrow into which a fiberglass tape is inserted.
- Next, the “trench” is laid using special photopolymers, which harden under the influence of ultraviolet radiation.
- After curing, a kind of bridge is obtained that holds the dentition in a stationary state. This helps to redistribute pressure from one tooth to the entire dentition.
Home remedies are good, but you can still achieve excellent results and completely overcome the disease with the help of a dentist. The fact is that some gum diseases can have similar symptoms, but the reasons differ. The dentist will help you understand the cause that caused the disease and eliminate it.
Some patients, upon hearing from the doctor that they are facing resection of the apex of the tooth root, begin to panic. But are these premature worries justified? Resection or, in medical terms, apicoectomy refers to a surgical intervention, the purpose of which is to eliminate the source of infection in the root of the tooth by partially cutting off the affected area. Thanks to this operation, it is possible to restore the basic functions of a diseased tooth, and therefore save its life.
What is the essence of the procedure, when is it necessary and whether there are alternative options - we will consider in detail in the article below.
In what cases is resection performed?
Decide on the advisability of such surgical treatment there will be a dentist, or more precisely, a dental surgeon or maxillofacial surgeon. Usually, this operation appointed when conservative methods turned out to be powerless or simply impossible to use.
The main prerequisite for resection is a cyst or a so-called “sac” covered with fibrous tissue and filled with pus. Diagnosis of pathology at an early stage allows you to do without surgery. But the most dangerous thing is that identifying the problem early stages It can be quite difficult - without x-rays and a professional examination this cannot be done.
Another reason why such an operation is performed is. The disease occurs due to inflammation of the tooth tissue and is in most cases a consequence of untreated caries, pulpitis, and advanced oral diseases. It is a kind of precursor to the formation of a cyst.
Important! In cases where the diameter of the cyst is more than a centimeter, resection is the only option to preserve the tooth, as well as health in general. It is worth remembering that a cyst can cause intoxication of the entire body and other serious consequences.
The following indications for resection are also distinguished (mainly inflammation or neoplasm on the root, which arose as a result of various circumstances):
- mistakes made by the dentist at the stage of filling the root canals: so, before filling, the doctor must carefully remove the pulp if necessary, clean the canals and fill them along the entire length with filling material, because infection can penetrate into the remaining voids and cause inflammation. But medical errors sometimes lead either to the fact that the root canal is not completely filled, partially, or the filling material, on the contrary, extends beyond the apex of the root, which leads to the formation of inflammation,
- resection is effective when there is an inflammatory process and the canals are severely curved: other manipulations can seriously damage them,
- the presence of an intracanal metal pin: the pin is fixed inside the canal with very strong dental cement. Trying to extract it, you can injure the tooth, which will cause its partial removal,
- if the tooth is inflamed under an artificial crown: therapeutic treatment will require a lot of time and money. To get to the source of inflammation, you need to remove the crown, remove the filling, eliminate the cause of the disease, and then install a new crown. Under such circumstances, it is easier to perform a resection operation by removing the inflamed area.
For whom surgery is contraindicated?
Like other surgical interventions, resection has contraindications. It is not performed if the patient’s medical history includes the following cases:
- advanced periodontal disease: treatment cannot be carried out in the presence of loose and mobile teeth - it will simply be ineffective,
- the crown of the tooth is seriously damaged and cannot be restored with a filling or,
- the root of the tooth is seriously damaged or it is impossible to get to the source of infection. The latter concerns a multi-rooted tooth,
- the presence of viral and exacerbation of chronic diseases, pathologies of the cardiovascular system,
- the cyst has grown more than half of the root.
In all of the above cases, resection is useless. As a rule, the doctor decides to remove the affected tooth and prescribes prosthetics.
Features of the procedure and its stages
1. Preparatory stage of the operation
The procedure is considered non-traumatic, but requires preliminary preparation. So, first an x-ray is performed to clarify the scale and characteristics of the problem.
Next, the specialist removes the nerve of the tooth, if it is still present. All dental canals are filled. If they appear the slightest signs inflammatory process, you should carefully check again to see if there are any voids left in the dental canal. If inflammation is detected, the canal is thoroughly cleaned, suppuration is removed and re-sealed.
Important! In most cases, patients encounter cysts, granulomas and other inflammatory processes already when the tooth has been previously treated, therefore the need for depulpation and filling preparatory stage does not arise.
2. Anesthesia for pain-free treatment
The patient does not have to worry - he can feel painful sensations in the moment surgical intervention He will not. After all, the procedure is carried out under painkillers. Two options are used: infiltration and conduction.
Infiltration is more often used by doctors when the operation will take place on the upper jaw - the anesthetic drug will easily spread throughout the tissues adjacent to the source of inflammation. In this case, the injection is given in the area of the submucosal gum.
If the operated area is on the lower jaw, conduction anesthesia is used. The injection is made into the part of the jaw where the nerve is located. The medicine quickly covers nearby tissues - you can begin the procedure.
3. The operation itself
Let's take a closer look at how the operation will take place. As a rule, all manipulations take 20-40 minutes and involve the following:
- one small incision is made on the mucous membrane of the gum: the mucous flap is peeled away from the bone, allowing access to the apex of the tooth root,
- V bone tissue a small hole is drilled in the gums, through which all purulent formations are completely cleaned out, the tumor is removed,
- then the wall of the tooth is knocked out with a chisel or hammer: this is necessary to completely expose the diseased root, which will allow the dentist to carry out high-quality canal filling in the future,
- then the doctor finds the tip of the root, carefully cuts off this area and uses tweezers to pull it out,
- placed into the resulting wound synthetic material to restore damaged bone tissue,
- at the last stage, the incision on the gum is sutured and a bandage is installed. This device will protect the operating area from any external influence and speed up the tissue healing process.
In the future, the dentist may prescribe additional drug treatment to avoid re-inflammation and speed up tissue repair.
Laser technique
Laser resection is a more gentle procedure, but also more expensive. The operation is faster, the oral cavity is practically not injured, and postoperative period goes easier. What is this method? To begin, a small incision about 10 millimeters deep is made on the gum. Through it, special ultrasonic equipment is used to cut off the root tip, as well as the neoplasm itself, which was the reason for the operation - for example, a cyst.
After the area is treated with a laser, the wound is filled with synthetic bone tissue and covered with a biomembrane. By the way, laser processing allows you to minimize possible complications, shorten and facilitate the rehabilitation period.
Rehabilitation period
In order for tissue restoration to proceed easily and without deviations, it is important to follow all the dentist’s recommendations. The very first thing to do is apply cold to the operated area for half an hour. This is necessary to prevent swelling from developing after resection. You can eat only 3 hours after completion of all surgical procedures.
You also need to temporarily avoid foods and drinks that will cause discomfort and may cause complications: you need to exclude cold, hot, sweet, spicy, and salty foods from your diet. These products can further injure the mucous tissues of the oral cavity. It is equally important to choose a gentle toothpaste, rinsing agents and a soft brush. Hygiene procedures must be carried out carefully.
On a note! If the doctor has prescribed medications with anti-inflammatory, antiseptic or immunostimulating effects, they must be taken. Medicines will help tissues recover faster. You can also rinse your mouth with decoctions of chamomile, sage, and oak bark. Once every 3 months you need to visit the dentist and have an x-ray done.
Are complications possible?
In order to exclude undesirable consequences, resection should only be performed experienced doctor. Swelling of the gums, minor painful sensations Some time after surgery is normal. But if these symptoms do not go away and intensify after 2-3 days, you need to consult a doctor.
For your information! Like other procedures, resection has its pros and cons. An undoubted advantage is that the removed bone tissue will be completely restored in 3-4 months and will be able to perform its functions. A tooth that has been preserved can last for decades and even serve as a support for dentures. The possibility of relapses is minimized, soft tissues will heal in 7-10 days. Among the disadvantages are possible complications and relatively high cost.
What other complications are possible: perforation into the maxillary sinus in the upper jaw and hypoesthesia. Perforation is the formation of a hole, in our case connecting the nasal sinuses and upper jaw. The pathology can be fraught with the formation of a fistula, which will provoke purulent sinusitis. Hypoesthesia is a disturbance of sensitivity. A so-called “numb” tongue or chin may indicate that a nerve was damaged during surgery. If this unpleasant feeling within a couple of hours after the procedure, you need to seek help from a doctor.
Alternative Treatment Options
An alternative to resection is therapeutic treatment. It is possible only in the early stages of development of cysts and granulomas, when they are still small in size. The treatment is carried out by a dentist-therapist. The patient should immediately adjust to the duration of all manipulations and frequent visits to the doctor.
First you need to completely eliminate the source of infection in the root canals. Only after this can they be sealed with a material that includes calcium hydroxide. After a couple of months you need to go through and, if everything is fine, the doctor will remove the temporary filling and finally seal the canal.
It is worth noting that therapeutic treatment does not always bring desired results. After some time, the disease may return and recur. Resection is still often performed because therapy leads to frequent relapses diseases.
Video on the topic
1 According to IDA - International Dental Association.
2.Relevance of the topic being studied: is that periodontitis is one of the common diseases among the population, and this dictates the need to study the causes of its occurrence, prevention and treatment.
3. Objectives of the lesson: Based on theoretical knowledge and practical skills, the student must:
3.1.Know modern methods of surgical treatment of chronic periodontitis.
3.2.Know the operation of root apex resection.
3.3. Know the operation of hemisection.
3.3.Know the operation of root amputation.
3.4.Know the operation of tooth replantation and implantation.
3.5.Be able to conduct instrumental examinations of patients with chronic periodontitis.
3.6.Have an idea of the possible complications of surgical treatment of chronic periodontitis.
3.7. Have skills in surgical treatment of chronic periodontitis.
4. Plan for studying the topic:
4.1. Independent work:
- supervision of patients (110 min)
Demonstration by the teacher of practical skills in choosing methods of surgical treatment of chronic periodontitis, with interpretation of the results obtained and additional research methods.
Independent supervision of sick students, identification of typical errors.
4.2. Initial knowledge control
Testing, individual oral or written survey, frontal survey, standard tasks. Original Questions level of knowledge, initial tests on the topic of the lesson.
4.3. Independent work on the topic:
Independent supervision of patients by students, identification of typical errors, analysis of thematic patients.
Listening to abstracts on the topic of the lesson.
4.4. Final knowledge control:
Testing, individual oral or written survey, frontal survey, standard tasks. Questions to consolidate the level of knowledge, tests of the 2nd level of control on the topic of the lesson, with the announcement of the assessment of each student for theoretical knowledge and practical skills on the topic of the lesson studied.
5. Basic concepts and provisions of the topic:
TREATMENT OF CHRONIC PERIODONTITIS
Surgery chronic periodontitis consists of tooth extraction, replantation, resection of the apex of the tooth root and sometimes hemisection of the tooth root. After tooth extraction with granulating and granulomatous periodontitis, granulation growths or granulomas should be carefully scraped out. If there is a fistula tract on the gum, it should be inspected and granulations scraped out along its entire length. In some cases, it is advisable to excise the fistula tract and sew up the wound using 2-3 catgut sutures. In case of chronic granulating periodontitis, complicated by submucosal, subperiosteal, subcutaneous granulomas, after tooth extraction, granulomatous growths are scraped out from under the mucous membrane, periosteum, subcutaneous tissue, and skin. When removing pathological tissues in subcutaneous tissue and on the skin of the face the cord is first cut along transitional fold and the resulting wound is packed with iodoform gauze. Outbreak in soft tissues the fistula tract is scraped out, the wound is sutured. For aesthetic purposes, especially with significant retraction of the fistula and scar changes, after its excision, tissue plastic surgery is performed by moving two opposing triangular flaps. In the postoperative period, analgin, amidopyrine, etc. are prescribed, on the 3rd-4th day - physical methods treatment.
Tooth replantation. Replantation is the return of an extracted tooth to its alveolus.
Tooth replantation is carried out when:
1) chronic granulating and granulomatous periodontitis of multi-rooted teeth, when, due to certain circumstances, neither conservative therapy nor a root apex resection operation can be used;
2) complications that arose during conservative treatment of chronic periodontitis of multi-rooted teeth (root perforation, fracture in the root canal of the pulp extractor, root needle);
3) trauma accompanied by tooth dislocation, or accidental tooth extraction;
4) acute odontogenic periostitis of the jaws, exacerbation of chronic periodontitis, which is not subject to conservative treatment (in these cases, delayed tooth replantation is performed).
The tooth to be replanted must have a well-preserved crown and not have significantly divergent or crooked roots. The method of tooth replantation is as follows. Under general anesthesia, the tooth is carefully removed with minimal trauma to the soft and hard tissues in the alveolar area. The extracted tooth is immersed in a warm (37 °C) isotonic sodium chloride solution with the addition of antibiotics. The alveolus of the extracted tooth is carefully cleaned of granulations with a sharp curettage spoon and washed from a syringe with an isotonic solution of sodium chloride with antibiotics or furatsilin and covered with a sterile gauze swab. Then the tooth is treated, which consists of mechanical cleaning of the root canals and carious cavity. During tooth processing, the rules of asepsis are strictly observed. The tooth is held in a sterile gauze moistened with an isotonic solution of sodium chloride with antibiotics. The drill tip and bur must also be sterile. Periodontal remains on the tooth root are not removed. The root canals are filled with phosphate cement or quick-hardening plastic. After filling the canal, the root apex should be resected, since in the area of the root apex there is a large number of deltoid branches of the canal with necrotic content. Penetration of infection from these branches beyond the apex of the root of the replanted tooth leads to relapse of chronic periodontitis.
The tooth prepared for replantation is inserted into the alveolus after the blood clot is removed from it and irrigated with an antibiotic solution. Single-rooted teeth should be fixed for 2-3 weeks using a wire splint or a pre-made plastic splint. Multi-rooted teeth, as a rule, are well retained in the alveolus, and no additional fixation is required. At first, it is necessary to create resting conditions for the replanted tooth - to turn it off from articulation. A gentle diet, analgesics, and sulfonamides are prescribed. 3-4 sessions of UHF therapy can be recommended.
With exacerbation of chronic periodontitis and acute periostitis of the jaw, delayed replantation is possible. The operation differs from that described above in that it is a two-stage operation. The first stage consists of removing the tooth and preserving it in an antibiotic solution at a temperature of 4°C. The second stage is carried out 14 days after the signs of acute inflammation disappear. The tooth is treated and replanted using the usual method. The healing process of the replanted tooth is greatly influenced by the preserved periodontium and alveolar periosteum. Healing during tooth replantation lasts from 4 to 6 weeks, which depends on the type of fusion.
There are three types of fusion of the transplanted tooth with the alveolus:
1) with complete preservation of the alveolar periosteum and periodontal remains on the roots of the tooth - periodontal;
2) with partial preservation of the alveolar periosteum and periodontal remains on the tooth root - periodontal fibrous;
3) when complete removal periosteum from the alveoli and periodontium of the tooth root - osteoid.
The prognosis for the viability of a replanted tooth is most favorable with periodontal and least favorable with osteoid type of engraftment. The function of the transplanted tooth is preserved from 2 to 10 years or more. The longest periods are observed when transplanting a healthy tooth that was accidentally removed or dislocated from its socket.
Tooth transplantation- tooth transplantation into another alveolus is rarely performed. It is indicated when removing a decayed tooth and if it is possible to transplant a supernumerary tooth in its place. The surgical technique is identical to tooth replantation. However, the outcomes are not always favorable. Healing is often complicated by trauma to the bone during the formation of the dental socket for the tooth.
Allotransplantation - the transplantation of a tooth from one person to another - has been little developed, although there is information about isolated successes. The main thing is the selection of a tooth to replace the extracted one, its correct preliminary conservation and overcoming the rejection reaction after transplantation. The surgical technique is the same as for replantation.
A more promising operation is the introduction of metal grafts into the socket. They are used to fix crowns, bridges, etc. on them. The surgical technique consists of removing the tooth, treating the alveoli, introducing a metal structure into the tooth and suturing the wound of the mucous membrane. After 4-6 weeks. You can use it for prosthetics.
Resection of the apex of the tooth root. Currently, this operation is used in the following cases:
1) for chronic granulating and granulomatous periapical periodontitis that are not subject to conservative treatment, or after an unsuccessful attempt at conservative treatment;
2) in connection with complications encountered during the conservative treatment of periodontitis: a) root perforation, b) removal of filling material in excessive amounts beyond the root apex;
3) if there is part of a broken root needle or pulp extractor in the root canal;
4) regarding a fracture of the tooth root in its upper third;
5) when removing single-gene cysts and some intraosseous benign tumors (fibroma).
Contraindications to tooth root apex resection surgery are:
1) significant destruction of the tooth crown and no prospect of using the tooth for prosthetics;
2) tooth mobility due to destruction of the periodontal pathology by more than 1/3 of the root length or due to damage to the marginal periodontium;
3) exacerbation of inflammatory phenomena in the periodontal tissues;
4) acute infectious diseases, blood diseases, heart disease with symptoms of decompensation, acute glomerulonephritis, active tuberculosis, etc.
Preparing the tooth for resection of the root apex. In case of chronic periodontitis, in order to avoid exacerbation of the inflammatory process, which is often observed due to a violation of the outflow of exudate from the pathological focus, filling the carious cavity of the crown and root canal should be carried out immediately before surgery. It is best to use liquid-mixed phosphate cement as a filling material and strive to fill the root canal along its entire length, pushing the filling mass past the root apex. If the tooth is intended to be used as a support for a fixed prosthesis or a crown is to be placed on it, then all orthopedic procedures are also completed before surgery.
Operation technique. The operation is performed under conduction and infiltration anesthesia.
In area outer surface of the alveolar process, an arcuate, linear, angular or trapezoidal incision is made so that when suturing the wound, the incision line does not pass at the level of the burr hole, and the flap covers it with its edges (Fig. 1, a - g). Having separated the mucoperiosteal flap from the bone using a rasp, it is pulled towards the transitional fold with a blunt or sharp dental hook. Often, the area of the anterior wall of the dental alveolus in the area of a chronic periapical lesion is changed. Porosity of the outer compact plate is often observed, manifested in an increase in the number and size of small holes present here and under normal conditions. Sometimes the outer wall of the socket is uzurized, and the peri-apical focus in the area of the resulting bone defect is fused to the periosteum. In this area, the mucoperiosteal flap should be separated using a scalpel, carefully cutting through the adherent tissue.
Trephination of the outer wall of the dental alveolus is carried out with a flat chisel, removing thin layers of tissue until the anterior surface of the apical part of the root is exposed. After this, the hole in the wall of the alveolar process is expanded using a grooved chisel. They also expand the existing wall of the dental alveoli to the required size in some cases. The anterior wall can be trepanned and removed to the required extent using large spherical and fissure burs. Having thus exposed the root tip surrounded by granulation tissue, they begin to remove it. As observations have shown, when cutting off the root tip with a chisel, oblique fractures of sections of the tooth root often occur. Taking this into account, the root tip should be cut down with a fissure bur, which prevents unwanted damage to the root, as well as tooth dislocation.
The separated root tip is removed with a spoon or tweezers, after which the granulations and areas of softened bone are scraped out. If it is discovered that the root stump protrudes slightly into the lumen of the cavity and prevents thorough scraping of the bone area located behind it, then it is smoothed with a milling cutter or a large spherical bur, while simultaneously treating the edges of the bone wound.
Rice. 1. Resection of the root apex of the central upper incisor (operation stages):
a - arcuate incision;
b - trapezoidal section;
c - separation of the mucoperiosteal flap;
d - trepanation of the outer wall of the hole with a spherical bur;
d - trephination of the socket wall, detection of the apex of the tooth root and the lesion;
e – resection of the apex of the tooth root, removal of granuloma;
g - placing the mucoperiosteal flap in place, applying interrupted sutures.
Sometimes during an operation, when examining a cross section of the root stump, it is discovered that there is no filling material in the tooth canal, or it is established in advance that it is impossible to fill the canal due to the presence of a metal pin, a stuck piece of bur, etc. In such cases, after removing the root apex, the canal is filled tooth retrograde. To do this, grind the root stump several diagonally with a milling cutter, expand the lumen of the canal with a small spherical bur, then use a reverse-cone bur to form a cavity in the root stump and fill it with silver amalgam, which is introduced in small portions and condensed with a filling instrument, immediately removing its excess (Fig. 2, a - d).
Rice. 2. Retrograde filling with amalgam of the upper part of the root canal during the operation of resection of the root apex.
a - cutting down the root tip with a fissure bur;
b - treatment of the root stump with a milling cutter;
c - filling with amalgam an expanded area of the root canal;
d - the upper part of the root canal is sealed, sutures are applied.
If the walls of a bone wound are bleeding, carefully blot the blood with a gauze ball, carefully ensuring that the amalgam does not get on the surface of the bone, as this complicates the healing of the wound.
In cases where copious discharge exudate from the tooth canal prevents its filling, it is recommended to trephine the wall of the dental alveolus, resect the root apex, and then, having tightly packed the bone wound, finish processing the canal and seal it with cement.
After this, having made sure by examining the root stump that the canal lumen is well filled with filling material, a mucoperiosteal flap is placed in place and 3-4 interrupted sutures are placed along the incision line.
Sometimes, before suturing, the bone wound is washed with a solution of hydrogen peroxide, and then powdered with streptocide, washed with staphylococcal or streptococcal bacteriophage, or both in combination, and anti-staphylococcal plasma is administered.
To avoid the formation of a postoperative hematoma, a pressure bandage is applied to the patient’s lip according to the surgical site for 10-12 hours.
There are a number of features during the operation of resection of the root apex of individual teeth. Thus, when resection of the apices of the roots of the lower small molars, the incision should be made higher (at the level of the middle of the tooth root) so as not to damage the neurovascular bundle emerging from the mental foramen. When resection of fangs on the upper and lower jaws, the incision is made below and, accordingly, above the gingival sulcus to avoid injury to the developed network of vessels located there. When resection of the upper first small molar, it is necessary to know the number of canals before the operation (visually when filling them and from an x-ray). If only one is found, then the interradicular septum should be resected and then the second root. When resection of the first and especially the second small molar, one should remember the possibility of perforating the maxillary sinus and pushing granulation growths or the apex of the tooth there. One should also keep in mind the possibility of perforation of the bony wall of the hard palate.
Complications. During resection of the root apex of the first, as well as the second upper incisors accidental perforation of the bottom of the nasal cavity is possible, and when intervening in the area of the upper small molars and, less often, the canine - the bottom maxillary sinus. To prevent these complications, based on an x-ray, you need to know the relationship of the roots of the teeth to the bottom of the nasal or maxillary sinus and carefully remove the granulation tissue in the upper part of the bone wound.
If the cavity is accidentally opened, the perforation hole is not probed or tamponed. The operation should be completed according to all the rules, removing the granulations and amputating the root tip. The bone wound is closed, as usual, with a mucoperiosteal flap and sutures are applied.
During resection of the root apices of the lower molars, damage to the mental nerve is possible. To prevent this complication, the mucoperiosteal flap should be separated so that the mental foramen and the neurovascular bundle emerging from it become visible. After this, the bone tissue of the outer wall of the socket of the tooth being resected is trepanned above the level of the mental foramen and, carefully bypassing it, the bone wound is expanded; then the root tip is separated with a fissure bur, it is removed, the granulations and softened bone are scraped out, and then the wound is sutured. It is recommended to remove the tooth from the bite for 3-4 weeks.
The outcome of root apex resection is usually good; teeth with resected root tips are preserved for many years, participating in chewing and serving as a support for fixed dentures. Unsatisfactory results are a consequence of violation of conservative treatment methods and surgical techniques.
Hemisection and root amputation.
One of the methods of surgical treatment of teeth affected by chronic periodontitis is hemisection and amputation of the roots (Fig. 3). During hemisection, the root is removed along with the adjacent coronal part of the tooth. Root amputation involves removing only the root part of the tooth to the point of its origin, i.e., bifurcation. The preserved part of the tooth is subsequently used to fix the bridge.
Indications for hemisection and amputation of tooth roots are much broader than for resection of root apexes. This operation should be performed in the presence of deep intraosseous pockets in the area of one of the roots of the lower molar, one of the two buccal roots or the palatal root of the upper molar, in case of resorption of the bone substance of the interradicular septum, in case of perforation in the area of bifurcation of the roots. Hemisection and amputation of roots are contraindicated in case of significant resorption of bone tissue in all roots, the presence of fused roots that cannot be separated, the presence impassable channels in the roots to be preserved.
Hemisection is performed after endodontic therapy and filling of the tooth crown. Using a fissure diamond bur, a diamond disk used to separate teeth in orthopedic dentistry, and a turbine drill, the tooth crown is cut into two halves. The root is removed with dental forceps or an elevator. The interradicular septum, as well as the bone tissue surrounding the remaining tooth segment, should be preserved. Amputation of the root is preceded by detachment of the mucoperiosteal flap from the buccal or palatal surface and excision of the corresponding bone wall of the alveolus. The root is cut with a diamond fissure bur and removed with an elevator or dental forceps. The sharp bone edges of the alveoli are removed with bone nippers or a dental cutter. After antiseptic treatment of the bone wound, the mucoperiosteal flap is placed in place and fixed with polyamide thread or catgut.
Fig.3. a – hemisection of the tooth; b – amputation of the tooth root.
Resection or apicoectomy of the apex of the tooth root is one of the types of tooth-preserving operations. It is carried out during inflammatory processes on or near the roots. Manipulation allows you to save the unit. In this case, the incisor, canine or molar practically does not lose its functions.
IN general outline The answer to what resection of the apex of a tooth root is is excision of the last third of the affected root along with purulent formations through an incision in the gum. The main indications are periostitis, granulomas and cysts. However, for the operation a number of conditions must be met:
- cyst size from 1 cm in diameter - otherwise drug therapy is preferred;
- 2/3 of the canals have been passed and sealed with high quality;
- there is either a pin installed in the tooth - they are seated on heavy-duty glue, and their removal can lead to a root fracture;
- installed crown or bridge - in this case conservative treatment with refilling of canals and fillings medicines are not carried out: the prosthesis will have to be completely changed, which will significantly increase the cost of treatment.
The main indications are periostitis, granulomas and cysts.
Important! Resection is also indicated for fractures of the upper third of the root, tortuous canals, or when they cannot be completed to the end after previous unsuccessful treatment.
Contraindications
Mostly, contraindications to resection are associated with periodontal diseases. Due to significant bone resorption and high risk tooth loss, apicoectomy is not performed for:
- mobility of teeth III and IV degrees;
- significant exposure of the cervix;
- more than 5 mm deep.
Additional limitations are significant damage to the crown and cracks in the roots.
The operation is carried out in stages.
Important! Apicoectomy is not performed during periods of exacerbation of inflammatory processes at the root apex. First they shoot acute symptoms and only then is surgery scheduled.
Also root resection tooth contraindicated if there is infectious diseases and severe heart pathologies. It is postponed until the patient’s condition stabilizes.
Operation technique
Resection of the apex of the tooth root is considered a complex operation. It requires specific skills and caution from the dentist. Apicoectomy takes place over several stages:
- Preparation. At least 2 days before surgical intervention It is necessary to fill the root canals. If they were poorly treated along the entire length, they are opened, cleaned, expanded and refilled. If there is a problem only at the top, there is no point in re-treating it - it will be cut off anyway. If the tooth is “alive”, it is depulped and filled.
- Anesthesia. Infiltration or conduction anesthesia is administered.
- Providing access. An oval, trapezoidal or angular incision is made. The gums are peeling off. Using a bur, a hole is drilled.
- Direct resection. Through the hole made, the affected root is cut off with a fissure drill to the sealed area. The cyst, granuloma and affected tissue are scraped out.
- Drug treatment. The cavity is irrigated with antiseptics. If there are serious bone lesions, the hole is filled with osteogenic materials to 80%.
- Stitching. The tissue flap is returned to its place and sutured. Drainage is installed in the oral cavity to ensure the drainage of blood, ichor, and saliva. Impose pressure bandage. It can be removed after a few hours. A bag of ice is immediately applied to the face at the operation site for half an hour. Cold is needed to reduce swelling.
The root canals must be filled at least 2 days before surgery.
Resection lasts from 20 minutes to 1 hour. The duration of the manipulation depends on the location of the tooth. The easiest way to perform an apicoectomy is in the area of the incisors and canines. It’s more difficult in the molar area.
Additional Information! Another manipulation technique is laser resection. This method is minimally invasive: it injures less tissue, is painless, and provides better sterility. However, it costs several times more.
Minimum price normal operation– 3,000 rubles in Moscow clinics. Whereas laser removal costs up to 15,000 rubles.
Rehabilitation
The recovery period lasts 2 – 3 weeks. On days 7–8, the sutures are removed if they were not applied with self-absorbable threads. Special attention require the first few days of rehabilitation. To avoid complications and speed up the healing process, it is recommended:
- stop smoking and drinking alcohol;
- do not eat or drink for the first 3 hours;
- stick to a diet: eat chopped food at room temperature;
- rinse your mouth antiseptic solutions after meals and at night, chlorhexidine is most often used;
- brush teeth soft brush and paste with reduced abrasiveness;
- refrain from eating solid food for 3 months: nuts, crackers, etc.
The recovery period lasts 2 – 3 weeks.
Important! Patients report swelling and toothache after surgery. This is fine. They should gradually subside and completely disappear on the 3rd – 5th day. To relieve symptoms, take painkillers and anti-inflammatory drugs.
Complications
In some cases there are Negative consequences. They appear because medical errors or under unfavorable anatomical conditions. For example, close proximity upper teeth to the maxillary sinuses.
The following complications are possible:
- perforation of the nasal passages;
- damage to the branches of the nerve and, as a result, loss of facial sensitivity - paresthesia;
- extensive injuries to blood vessels;
- recurrence of the cyst - in 1 - 3%, develops due to an incompletely cleaned cavity.
Resection allows you to extend the life of the tooth by several years. Previously, cysts and inflammation of the root apex were considered direct indications for removal. However, the operated unit is less stable and cannot fully perform its functions. Such teeth are used with caution as a support for prosthetics.
From this article you will learn:
- in what cases is tooth resection performed?
- photo and video of the operation,
- tooth root resection: patient reviews, price 2019.
The article was written by a dental surgeon with more than 19 years of experience.
Resection of the apex of the tooth root is surgical method treatment of granulomas and cysts that form at the root apex due to a chronic inflammatory process (caused by infection in the root canals of the tooth). Granulomas and cysts are subtypes of a disease called chronic periodontitis.
They differ from each other only in size... If the focus of inflammation at the root apex is more than 1 cm in diameter, the formation is called, and if it is less than 1 cm, it is called a cystogranuloma. Visually, they look like a “bag of pus” attached to the top of the tooth root.
Thus, the main indications for resection are the presence of an inflammatory focus at the apex of the tooth root, which is difficult to cure using conservative treatment methods for chronic periodontitis. The latter consists of temporarily filling the root canals with preparations based on calcium hydroxide (for a period of 2-3 months).
How is tooth root resection performed?
The meaning of the resection operation is to cut off the apex of the tooth root with a drill along with the “purulent sac”. And many patients are therefore immediately interested in the question of how long the tooth will last after resection. It must be said that the operation does not affect the service life of the tooth in any way, because The size of the root part to be removed is very small.
Tooth root resection is a fairly simple operation and usually lasts from 20 to 40 minutes. The front teeth are operated on faster, which is due to the convenience of visual control of the operation, but the lateral teeth (6-7 molars) require more effort and time from the doctor. In the animation below you can see all the main stages of the operation.
Tooth resection: animation
1. Preparation for surgery –
Tooth resection can be carried out only if there is no active purulent inflammation in the area of the root apex. If there is swelling of the gums or pain when pressing on a tooth, you must first remove the active inflammatory process.
If there was a cyst big size, then bone healing can be stimulated with special osteoplastic materials based on synthetic hydroxyapatite - the preparations “Kolapol” or “Kollapan”. In some cases, retrograde root canal filling may also be used during resection surgery (see below).
Tooth resection: video of the operation
In the videos below you can see how an incision is made in the gum, bone tissue is exposed in the projection of the tooth root, and the surgeon drills a window in the bone tissue, after which the apex of the tooth root is cut off with a drill. Please note that along with the apex of the root, the doctor also scrapes out the inflammation that has formed at the apex of the tooth root (granuloma/cyst).
Resection of the apex of the tooth root: price 2019
How much does resection of the apex of a tooth root cost? The price in economy-class and mid-price clinics for 2019 will range from 4,500 to 10,000 rubles.
This difference in price will primarily depend on the position of the tooth - access to the roots of the front teeth is quite simple, and therefore the operation is carried out quite quickly. However, surgical access to the apices of the roots of the lateral teeth (especially 6-7 molars) is very difficult, so the operation requires much more time and effort from the doctor.
Important : The cost indicated above already takes into account anesthesia, surgery, and repeated examinations. Are medications included in the price? quick recovery bones (“Kolapol” or “Kollapan”) - need to be clarified in advance. Also, the above price does not take into account the cost of retrograde root canal filling, which is not always necessary.
Retrograde root canal filling during resection –
The very name of the technique “retrograde root canal filling” implies that after cutting off the apex of the tooth root with a drill - top part The root canal will also be additionally sealed from the side of the cut off tip.
The essence of the technique (see video below) is
Using an ultrasonic nozzle, the upper part of the root canal is unsealed (2 mm deeper than the cut). After this, the unsealed part of the root canal is filled with a special material like “ProRoot” (ProRoot-MTA). This guarantees tight obturation of the root canal with the filling substance and will not allow infections to multiply in the root canal, which will cause re-formation of the cyst.
Retrograde filling is the gold standard when performing resection throughout the civilized world, because... almost completely eliminates the risk of re-formation of cysts. In Russia, it is rarely used due to the poor qualifications of most dental surgeons (some have not performed a single similar operation in their entire lives, and do not see the point in it), as well as due to the need to use expensive materials.
Retrograde filling: video
This method is especially necessary when resection is performed on teeth whose root canals were filled long ago, and the doctor decided that there is no need to additionally fill them before the operation. The latter sometimes happens when a tooth has an artificial crown, and retreatment of the tooth will lead to the need for re-prosthetics.
Root apex resection: patient reviews
All patients note that the operation is absolutely painless. However, postoperative pain will occur immediately after undergoing anesthesia ( severe pain not typical after resection). The next morning you may see swelling of the soft tissues of the face in the projection of the operation, sometimes a hematoma. In rare cases, suppuration occurs surgical wound, but this doesn't happen often. Helps prevent this complication prophylactic appointment antibiotics.
After surgery, they are usually prescribed –
Relapse and reoperation
–
relapse rate by official statistics– about 1-3%. If the operation is performed according to all the rules, then there should be no complications. There are 2 main points that determine the quality of the operation. Firstly, the cyst shell must be completely removed (since even a small fragment of the cyst shell remains, it will appear again).
Secondly, this is the quality of root canal filling. If the root canal was poorly prepared, for example, it was not sealed tightly, this will lead to the spread of infection along the canal walls and a new cyst formation. And retrograde root canal filling, which we described above, can also help here.
Alternatives to tooth resection –
Resection in most cases is not mandatory and is the only method of treating granulomas and cysts. Mandatory resection is required only in the presence of large cysts (for example, 1.5-2 cm or more). The latter is due to the fact that the shell of large cysts is very dense and thick, and does not completely disappear even with good conservative treatment (although the cyst itself decreases in size).
if there is a crown on a tooth, then in order to begin conservative treatment, this crown must be removed, then the root canals must be filled, etc. At the end of treatment, you cannot simply put on the old crown - you need to make a new one, which significantly increases the cost of treatment.
Therefore, if there is a crown on the tooth (especially if with a pin) - as in Fig. 13-14, and the root canals are poorly sealed only at the very apex of the root, then it is better to perform a resection of the root apex. During the operation, the unfilled part of the canal, together with the apex of the root, is cut off with a drill, and the cyst is removed. We hope that our article was useful to you!
Sources:
1. Higher prof. the author's education in surgical dentistry,
2. Based on personal experience work as a dental surgeon,
3. National Library of Medicine (USA),
4. “Outpatient surgical dentistry” (Bezrukov V.),
5. " Surgical dentistry And Maxillofacial Surgery"(Kulakov A.).
