ac. LoganovskayaE.N.
Algorithm for performing the practical skill “Tooth-preserving operations”
Tooth-preserving operations include:
Resection of the apex of the tooth roots;
Hemisection of the tooth;
Root amputation;
Tooth root separation.
The patient must be prepared for any of these operations.
The canals of the teeth should be filled the day before, or better yet, on the day of the proposed operation.
The patient should come to the operation having eaten moderately (except in cases where the operation is planned under anesthesia).
If the patient’s medical history includes general diseases (cardiovascular system, blood, diabetes, etc.), tests (blood, ECG, ………) should be done first and the opinions of relevant specialists should be obtained.
When the patient arrives at the clinic, take off his outer clothing, unfasten his tie, he sits in a chair, his head is correctly fixed on the headrest and the height of the chair.
An apron is put on. The patient rinses his mouth with an antiseptic.
The doctor selects an antiseptic, orders the necessary instruments in the surgical box, prepares the drill, and puts on the handpiece. After this, he washes his hands, puts on gloves, and treats them with an antiseptic (sterillium, bacillol, etc.).
Performs conduction or infiltration anesthesia required in each specific case. Assistants (students, nurses) treat their hands in the same way.
Resection of the apex of the tooth root.
Depending on the location of the tooth (frontal, lateral), as well as on the size of the lesion at the apex of its root (granuloma, cystogranuloma - 0.5-1-1.5 cm), a mucoperiosteal flap is cut out, always facing the base transitional fold, through oval, angular or trapezoidal cuts.
The mucoperiosteal flap is peeled off (without delaminating it).
If there is a bone perforation at the top of the tooth, then the holes are expanded through it, evenly exposing the entire top. If there is no perforation, then a burr is created at the level of the apex of the tooth, and the upper part of the root is also exposed.
Using spoons of various sizes, granulations are scraped out or the membrane of a cystogranuloma or cyst is removed.
Using a fissure bur, the top of the root is cut off either at the level of the bottom of the granuloma or slightly higher, if it is possible to scrape out all the granulations on the back wall of the root.
We swab the cavity with a small swab dipped in hydrogen peroxide and dry it.
The detached mucoperiosteal flap is placed in place and the wound is sutured with polyamide thread (No. 3-4) with knotted sutures. For a small cavity, especially in children, sutures can be placed with catgut (No. 3-4).
The wound is covered with a dry aseptic swab. A pressure bandage (“mouse”) is applied externally for 2 hours.
The patient is prescribed sulfonamides, analgesics, and mouth rinses.
The next day, the patient is examined, and the suture line is treated with antiseptic.
After 6-8 days we remove the stitches.
A gentle diet for about 2 weeks.
Hemisection of a tooth (removal of half the crown with the adjacent root) is carried out in multi-rooted teeth.
The goal is to remove the damaged part of the tooth that cannot be treated.
After the preparation described above, the patient and the oral cavity are given appropriate anesthesia.
Produced by ………………. a section of the gum between the projections of 2 roots (left and removed).
The corner flap is peeled off over the part of the tooth that is to be removed.
The tooth crown is sawed with a bur and a separation disc with a diameter of 0.5-1 cm (along the vestibular surface, then along the bottom of the crown and its inner surface.
The affected part of the tooth (half of the crown and the adjacent root) is removed.
The flap is placed in place. 1-2 stitches are applied.
Polyamide sutures are applied after 5-6 days.
Root amputation.
Performed on the upper molars, the vestibular roots (one or both) are amputated.
Indications: if it is impossible to treat one or both vestibular roots.
After the usual preparation of the patient, appropriate anesthesia is administered.
A vestibular incision is made in the gum or projection of the roots (when one root is removed) or between adjacent and operated teeth.
The corner flap is peeled off, exposing the bone and alveolar ridge.
The cortical plate is removed with a bur over the removed root down to its base. The exposed root is resected with a bur.
The granulations are scraped out with a spoon.
The cavity is treated with a swab moistened with hydrogen peroxide and dried.
The flap is placed in place. The wound is sutured with interrupted sutures. The stitches are removed after 5-7 days.
Separation of the tooth crown.
It is carried out in multi-rooted teeth in case of completeness of its roots due to perforation or destruction of the bottom of the pulp chamber by a pathological process.
All tooth canals are pre-filled.
After preparing the patient as described above, appropriate anesthesia is performed.
An angular incision is made in the gum in the projection of the operated tooth (a vertical incision is up to 1 cm at the border with the adjacent tooth, and a horizontal incision is made through the gingival pocket of the operated tooth; we cut off the circulatory ligament.
Peel off the flap.
Using a fissure bur, we saw the cortical plate above the bifurcation of the roots, then we further saw the crown along the bottom of the pulp chamber at the site of perforation of its bottom.
The smoother ensures precise cutting: both parts of the tooth should not be ……………
The flap is placed in place and the wound is sutured.
After 1-2 days, reconstruction of the tooth crown can be performed.
ac. Loganovskaya E.N.
Tooth-preserving operations are dental procedures aimed at preserving teeth and the integrity of the dentition. They allow you to eliminate inflammatory processes and the consequences of injuries, as well as long-term lack of treatment for caries and avoid tooth extraction.
Types of service
IN dental clinics carry out:
- Hemisection is an operation aimed at removing one of the roots in a multi-root tooth system, as well as the adjacent coronal cavity. Hemisection is indicated in case of formation of a lesion with chronic infection in the area of one of the roots that cannot be treated.
- Resection of the apex of the tooth root - removal of the upper part of the root and the cysts or granulomas located on it that are not amenable to therapeutic treatment. Resection allows you to eliminate the source of inflammation or neoplasm while preserving the tooth.
- Root amputation is the removal of a damaged root. It is carried out only if therapeutic treatment of the diseased root does not help, but it is possible to preserve the integrity of the tooth.
- Coronal-radicular separation is an operation to divide the tooth crown into two parts. Separation is carried out in cases where a multi-rooted tooth with healthy roots is destroyed in the area of root separation.
Description of hemisection
Manipulations to remove one of the tooth roots are preceded by examination and hardware diagnostics, confirming the need for surgery. Removal is carried out using local anesthesia, and in some cases possible general anesthesia, which eliminates pain.
First, the doctor fills the root canals, which are preserved, then performs resection of part of the dental crown and removal of the pathological root. The resulting space is filled with a special filler.
Prices at the clinic
| Service | Cost, rub. |
| Tooth replantation with ligature-composite splinting | 9 900 |
| Root amputation | 8 900 |
| Resection of the tooth apex with cystectomy | 13 130 |
| Hemisection of tooth | 8 300 |
| Resection of the tooth apex | 12 080 |
How to behave as a patient after the procedure
At the end of the tooth-preserving operation, the dentist gives recommendations to the patient. You should avoid solid, spicy and hot foods for several days, and you should not consume food or hot drinks for 2-3 hours after surgery. After brushing teeth and eating oral cavity tedious to rinse with antiseptic agents.
Treatment is no longer possible or appropriate.
The answer is already contained in the question itself. Dental-preserving operations are surgical procedures aimed at preserving teeth. Previously, when there were some problems with a tooth, they simply removed it, without thinking about the fact that there were fewer and fewer teeth in the mouth. And currently, tooth-preserving operations are a direction in surgical dentistry, aimed at preserving teeth previously subject to extraction.
Dental-preserving operations are performed not only to save teeth, but also to prevent inflammation bone tissue and bone loss, because inflammatory diseases in the perihilar tissues have a strong destructive effect on the bone.
Also, tooth-preserving operations are used when a crown or bridge prosthesis has already been installed on the tooth. Removing the root of the tooth is preferable to removing the tooth itself, since removing the tooth will weaken the structure and negate all efforts aimed at restoring the dentition.
Types of tooth-preserving operations
- Resection of the root apex;
- Hemisection (coronal-radicular separation);
- Lengthening the crown part of the tooth and using the roots for future prosthetics;
- Operations for periodontal disease;
- Tooth root resection
- Retrograde tooth root filling.
Now let’s talk more about these operations so that patients can imagine these procedures
1. Resection of the root apex carried out when there is a pathological focus in the area of one of the roots, and it must be removed along with part of the root. A careful incision and burr hole is made and part of the root is quickly cut off. For quick recovery bone in the area of cutting off the root apex, this resulting cavity is filled with osteoplastic material.
2. Hemisection (coronal-radicular separations)- this is the removal of part of the tooth along with the root, so as not to remove the entire tooth.
During this operation, part of the tooth is cut down and carefully removed. Then, after the end of the process of engraftment of the bone filler in the area of root removal, prosthetics of this tooth is performed after hemisection.
3. Tooth crown lengthening- tooth-preserving surgery, which allows you to use the roots that are below the gum level for future prosthetics. This is required in cases where the tooth that needs to be lengthened is very short or highly susceptible to wear. Usually this problem affects not one tooth, but several, because tooth wear is a problem of malocclusion or improper use. Therefore, in order to save teeth from further wear, they are lengthened during preparation for prosthetics and are successfully prosthetized.
4. Tooth-preserving operations are performed when periodontal diseases to strengthen teeth. These operations remove soft fabrics with pathology and infected foci. To provide access to the source of infection, a flap is peeled off - part of the mucosa - and the altered infected tissue is removed.
All tooth-preserving operations are surgical techniques treatment of periodontal diseases. All of them are aimed at strengthening teeth, eliminating foci of infection and rehabilitating patients with this complex problem. There are a lot conservative methods treatment of periodontal diseases, but in many cases surgical treatment is necessary.
Types of patchwork operations:
- gingivoplasty;
- plastic surgery of bone pockets;
- osteoplasty with a solid allogeneic graft;
- application of the technique of directed regeneration of periodontal tissues.
Effect: periodontal pocket is eliminated, and inflammatory process in the gums goes into remission, as a result of which it disappears or decreases bad smell from the mouth, suppuration from periodontal pockets is eliminated, teeth become less mobile, and the resorption of jaw bone tissue around the teeth is stopped or inhibited.
Closed and open curettage
Curettage of periodontal pockets is aimed at removing pathological tissues around the tooth. Due to this, dense scar tissue is formed at the site of the removed pathological tissue, which reliably protects the periodontal pocket from external irritants. If curettage is carried out without retracting the gums around the tooth, then this is closed curettage, and if at the same time the gums are retracted and the subgingival part of the tooth is exposed, then this is open curettage of the periodontal pocket. With open curettage, it is possible to more efficiently remove granulation tissue and polish the subgingival part of the tooth, which is difficult to do with closed curettage. If necessary, osteoplastic material can be introduced into the deep places of the periodontal pocket to form bone tissue. Closed curettage is used for small and not deep (up to 5 mm) pathological processes around the tooth. After the treatment, the gums begin to recover quickly and after 2-3 weeks have a pale pink color.
After this, the site of the removed tissue is filled with osteoplastic material and sutured. The healing process is very fast and successful.
5. Root resection.
Not all of our teeth have one single root. In fact, the back teeth, which bear the main chewing load, have three roots articulated with each other at the top. And if problems arise with one of these three roots, then in this case only one of the branches can be removed without affecting the other, healthy roots. In this case, root resection is performed - the diseased or rotted tooth root is removed, but the healthy roots remain intact.
6. Retrograde tooth root filling.
If it is not possible to carry out high-quality filling of the root canal of a tooth using the traditional method, and when performing resection of the apexes of the roots of the teeth, the method of retrograde filling is called, i.e. root canal filling with access through an incision in the mucous membrane of the alveolar process and an opening in the alveolar process.
This allows the apical foramen to be sealed and prevent the spread of infection into the periapical tissue. This technology allows you to save teeth that are not amenable to conservative treatment for a number of reasons: curved and obliterated canals, the presence of a fragment of an instrument in the canal; teeth covered with metal-ceramic crowns or having stump inlays and pins, which increases the effectiveness of tooth-preserving operations.
Dental-preserving operations are gradually becoming a thing of the past, but are used as alternative method treatment. The fact is that it is more correct to remove the entire tooth and install an implant in its place than to excise part of it. That is why all tooth-preserving operations end with the introduction of bone defect osteoplastic material. This will allow in the future, if the tooth still needs to be removed, to create conditions for adequate implantation.
All drugs, methods and treatment technologies, medications and equipment described on this site are used by me in everyday practice, and have been repeatedly tested with immediate and long-term clinical results!
In dental practice various diseases There are a great many teeth and gums, and most of these diseases have one outcome - tooth extraction. As soon as the tooth is removed, the question arises about its further prosthetics, i.e. restoration of the lost unit. This can be done either with a dental implant or a bridge, but all these manipulations are quite expensive, so patients often refuse prosthetics.
But often the situation in the oral cavity helps to avoid unplanned removal. Instead of extraction, you can undergo tooth-conserving surgery, which is designed to preserve the tooth with minimal effort.
Types of operations
Such operations belong to surgical dentistry and are performed by a dental surgeon. They are relevant if conservative treatment, i.e. endodontics are impossible for some reason, and the patient refuses tooth extraction.
Plus, after removal, the bone tissue atrophies, i.e. dissolves, and its level decreases both in height and thickness. This is unprofitable from the point of view of future prosthetics, especially if there is talk about implantation.
Tooth-preserving operations are also relevant in the case when the tooth is already covered with a crown or is one of the supports in a bridge. This will allow you to do without tooth extraction and without removing the prosthesis.
Main types of operations:
Root tip resection
You can often find a disease such as periodontitis, characterized by the formation of inflammatory foci in the bone tissue on the roots of the teeth. When they are too large, it is recommended to remove the tooth. In other cases, endodontic treatment is possible, which will save the tooth. If one or another treatment is impossible, resection of the root apexes is performed, during which part of the root is removed along with the source of inflammation.
Hemisection
During this manipulation, a small part of the tooth is removed along with the root, and the resulting space in the bone is filled with bone material. This also avoids tooth extraction.
Dental crown lengthening
This type of operation is often used before prosthetics, helping to lengthen the crown of the tooth by cutting the gums, which somewhat exposes the root. Most often, this method is used for generalized pathological abrasion of teeth, when there is simply nothing to put a crown on.
Operations for periodontal diseases
This includes flap surgery, open and closed curettage, gingivoplasty, etc. All these manipulations are most often aimed at treating severe or moderate periodontitis. During a flap operation or curettage, deep subgingival stones are scraped out, pathologically altered gums are removed, periodontal pockets are sutured, and all actions are accompanied by treatment with antiseptic and medicines. If the bone tissue is severely damaged, the doctor can lay bone material, which will somehow restore the bone level, reducing tooth mobility.
Root resection
Some teeth, especially chewing ones, have not one root, but three. If one of them is affected by caries or simply rotted, then root resection will help, during which the affected root is removed, and the rest remain intact, and the tooth is in its place.
Retrograde root filling
And tooth-preserving operations often lead to complications in the form of the spread of infection, which they tried with all their might to get rid of. Plus, after resection of any part or even the entire root, the tooth weakens, which can lead to cracks and fractures of the root, especially when it comes to its replacement with a crown or bridge.
One way or another, tooth-saving surgery can be effective when other treatment methods cannot be applied and tooth extraction is unacceptable. In this case, the tooth can be saved for quite some time. long time and replace it with prosthetics. But you should remember that such a tooth is weak and can cause complications at any time.
Dentistry itself and dental surgery in particular, like many other sciences, went through several stages and milestones of its development until it reached the modern level. This is due to both the level of technological progress and the knowledge that doctors have accumulated over many decades.
Ancient finds of skull skeletons with preserved jaws indicate that in ancient times the only way to treat teeth was to remove them. Until about the end of the 19th century, this practice was also used quite often, despite the fact that facts are known in the Middle Ages surgical treatment teeth, including their transplantation.
In Russia, only after the First World War, maxillofacial and dental surgery was put on a “scientific track”. From this period throughout the country, and then in all republics Soviet Union faculties and departments dedicated to this area of treatment began to be opened at medical institutes.
Today good doctor is considered to be the one who, even at the slightest opportunity, tries to save the tooth, and does not follow the path of least resistance and remove it. Of course, your own teeth are always better than implants, which will have to be placed in any case. However, even the most good specialist It is not always possible to save a tooth if there are contraindications for this.
There are also patients who themselves will convince the doctor that they want to save the tooth and not remove it, but cure it conservative methods, and that this is the only correct way out. They will go to doctors until they find one who agrees with them. However, before making a decision “to be or not to be,” you need to consider all the pros and cons, and also find out what tooth-preserving surgery is, what indications and contraindications it has.
Tooth-preserving operations are surgical procedure related to endodontics and periodontology. They are used in cases where therapeutic treatment is not enough to solve the problem. At first glance, such operations are quite simple, but their complexity lies in the fact that this is, in a sense, jewelry work - all the nerve endings that are located in the jaw area and in the oral cavity are located very close to each other, they do not need to be hurt.
Therefore, a dental surgeon must not only thoroughly know the anatomy of the maxillofacial part, but also have extensive practical experience in such operations - only in this way can one learn to do them well. In addition, you need to have a very good understanding of the reasons that led to the situation, the solution of which requires an operation of this nature.
Therefore, very often, before prescribing it, a consultation is held with the participation of several specialists in different fields of dentistry to weigh the pros and cons. If, for some reason, the operation may harm the person or will not produce results, it is better to remove the diseased tooth.
There are three types of tooth-preserving operations: resection of the root apex, hemisection and corono-radicular separation. All other types of operations are simply their varieties or modifications.
Resection of the apex of the tooth root consists of treating changes in this area. Among all operations, this is the most common. But if it is possible to do without it, it is better not to do it. It is not recommended to perform surgery if the tooth does not bear a large functional load, it is mobile or is so injured that it cannot be restored. Also, the operation is not performed when diabetes mellitus and stage 2 periodontal disease.
Hemisection is performed only on multi-rooted teeth. This is done so that at least one root remains in the tooth, which will take the load when chewing. But in practice, one root is often not enough for this.
Corona-radicular separation, although it exists as a method, is not used in practice, since it involves not only removing the root, but cutting down part of the crown. After such an operation, almost nothing remains of the tooth, that is, it can no longer function fully. Actually, this is the answer to the question of whether this operation is worth doing.
But before you think about surgery, you need to consider a few nuances. Firstly, such operations have many contraindications - much more than indications. Secondly, no dentist will give an absolute guarantee of a good result of the operation if the doctor followed the patient’s lead and did not remove the diseased tooth. Maybe, the operation will take place successfully and will give desired result, but in this case, the doctor declines responsibility. Thirdly, the cause of the inflammation is first clarified (perhaps it will be enough to eliminate the cause, and the healing process will not require surgical intervention), and consultations with other specialists are carried out - perhaps there is no point in performing the operation. Fourth, the operation must be very carefully planned.
Despite all the complexity and many conventions for such operations, doctors at our clinic perform them. Therefore, if you have a need for tooth-preserving surgery, you can safely contact our specialists. Before starting treatment, they will conduct a detailed examination and consultation, approaching the issue from different angles. And if such an operation really makes sense, it will be carried out at the highest professional level.
