Frequently asked questions about removing the tip of a root
Important foreword: The questions and answers shown below cannot substitute an individual consultation at your dentist or oral surgeon!
When is it necessary to have a removing of the tip of a root?
Sometimes the periodontal or the jaw at the tip of a root gets inflamed. Then, normally, the nerve of a tooth is dead. At first, one tries to remove the dead tissue and to fill the remaining cavity with a dense filling material. In some cases, this is not possible, e.g. because the tooth hurts again after having closed it with a filling or because an old root channel filling cannot be taken off.
Why does a tooth hurt although the nerve of the tooth already has been taken off?
The tooth itself can´t still cause pain after having removed the nerve. But you feel pain because of the pressure the suspension of a tooth transfers to the bone.
Every time after finishing a root channel treatment I felt pain. Is it the same with a removal of the apex of a tooth?
It is not common after having taken off the tip of a root, because the inflamed area around the apex can be treated exactly – in addition to the cleaning of the root channels themselves. The pain is caused by an over-pressure (this means the boost of the pain caused by a pressure on the tooth). This over-pressure in a cavity of the jaw is built up soon if there´s no possibility to drain off. On the other hand, the access to the jaw (made during the operation) allows the pressure to take down.
What do I have to understand by a removal of the tip of a root?
It´s an operation technique which is effected almost since 100 years. If one translates it word-for-word, this operation means: apex – separation.
Es handelt sich hierbei um eine Operationstechnik, die schon seit fast genau 100 Jahren durchgeführt wird. Wörtlich übersetzt heißt der Eingriff: Wurzelspitzen - Abtrennung.
Behind this expression an important part of the interference is hidden. Thereby a part of the apex is separated.
At the apex area the interstices of a tooth are ramified like the branches of a tree. Because of this, the conventional root channel treatment of the dentist cannot reach every lateral channel sufficiently.
Therefore, these last millimetres of the apex are separated with special drills.
Therefore, these last millimetres of the apex are separated with special drills.
To avoid a new invasion of bacteria into the root channel, it is sealed up the same way your dentist did it from top down, but just at the bottom of the tooth.
Within the retrograde root channel filling, the root channel is cleaned and reamed with tenuous ultrasonic instruments from the apex.This method is used e.g. if a permanent pin inhibited a normal access to the root channel.
Normally the separation of the apex is effected with a regional anaesthesia. After having opened the mucosa and having posed important structures, the bone above the apex is removed. Then the apex itself is separated laration of the apex is effected with a regional anaesthesia. After having opened the mucosa and having posedike it is shown in graphic no. 2. The inflamed tissue is removed and the root channel is cleaned. This happens normally with small files the dentist also uses. If it isn´t possible to do a conventional preparation, the root channel must be cleaned with ultrasonic instruments (see also graphic no. 4) and must be reamed to bring in a filling material. At the end, after the root channel is filled up, the wound is closed up with single sutures. These are removed one week later.
My dentist told me that there´s a cyst, too. Do I have to worry about this?
Definitely NO. A cyst is not a tumour, more than ever not a malicious one. Furthermore, it is the consequence of a long lasting inflammation.
Because of the inflammation at the apex, the bone resolves. At the beginning, this cavity is filled up with soft tissue. But if this cavity reaches a special size, the soft tissue crumbles and is substituted by liquids. Around this liquid another tissue uprises, it is called cyst skin (??). This cyst skin must be removed, otherwise the cyst can rise up again. Should the cyst be under suspicion to be a tumour, the tissue isn´t discarded after removing, but it is sent to a microscopical test. In the end, the suspicion about a cyst is mostly ratified
Does the treated tooth become loose if a part of it is separated?
Yes. Often we recognize with special electronic measurement instruments (“Periotest”) an intensivied movement (about 20 %) after the operation (compared to the stage before). Therefore, one should avoid during the first postoperative time eating stiff food. A time of above 10 weeks must pass by until the tooth is fixed the same way as before. In the meantime, one should accept this mobility without lamenting cause otherwise (that means without removing the inflammation) one would loose the tooth that would become more and more loose.
How long can one wait until the apex has to be separated?
This operation should be put through if there is an evidence on an inflammation that´s impossible to be treated with a conventional root channel treatment. Each and every inflammation of the body should be eliminated immediately cause it´s encumbering.
Is it possible that the inflammation disappears itself?
Every man´s body is able to fight against an inflammation of a tooth successfully (even if it is in the jaw) if the root channel has been filled up not long ago (or a medicament has been put into the root channel). But it is necessary that the patient doesn´t feel pain. If a root channel treatment has been finished long time ago and you get an inflammation then, it is mostly impossible that the inflammation disappears itself.
Is there any limit for treating teeth?
Nowadays, even the apex of a wisdom tooth can be separated. Of course, these interventions are more difficult cause the access there is worse. Furthermore, the nerve of the lip passes by very densely sometimes and very much bone complicates the access to the apex. But in every individual case must be verified if it is useful to separate the apex of a wisdom tooth (effort of such an intervention vs. importance of the tooth). Every other tooth can be treated with this intervention at any time.
Is it useful to treat such a broken tooth with this intervention?
This question is justified on each tooth. And in fact, there are different factors you have a look on to in every patient case: chances of success, risks of complication, financial aspects, state of health, motivation of the patient, etc.
Since then, implants have reached such a standard that one should always think about it. Of course, your dentist tries to safe your natural teeth as long as possible. And a natural tooth is able to measure the pressure exerted on itself while masticating, too. This feature can´t be substituted by implants. Nowadays, the patient decides after having been enlightened about the alternatives/options.
What about the chances of success?
In literature the chances of success are stated with about 75 % having a view on it for a longer time. With modern methods like an operation microscope much more secureness, even in difficult areas, can be reached. Indeed, teeth much more behind are operated today efficiently, although in the past they couldn´t be treated, because they were deemed as very difficult. And even nowadays it´s not easy to handle them as successfully as the teeth in the front.
Someone told me it would be better pulling the tooth because the inflammation at the apex remains?
An inflammation at the apex can endanger your whole body. Indeed, one always has to evaluate if the removal of a tooth causes more damage in your whole body than it benefits. A lost tooth is not easy to be substituted. Behind this seemingly lifeless hard mass of a tooth, there hides a complicated organ with a lot of sensitive structures, that are only recognized while feeling tooth pain. But nevertheless these structures are sending very much information to the brain during masticating. If someone suffers under an uprising inflammation concerning his eyes, never ever anotherone would suggest to remove the eyes. In every individual case we evaluate the risk of an apex inflammation against losing the tooth. Often this consideration is not easy.
Do I have to take antibiotics?
Not in every case. But I consider antibiotics to be useful if the risk of a wound inflammation is exalted obviousely.
How long am I put on the sick list?
The medical certificate has to be displayed for every patient individually. It not only depends on the complexity of the operation but also on one´s profession. We ask our patients for informing their employees before such an operation because the patients can potentially be of sick for the operation day and two days further.
Does the health insurance fund pay for removing wisdom teeth?
On general, removing the apex of a tooth is a service of the health insurance fund. Special services, e.g. giving jabs of decongestant medicinal drugs like Cortison, which are normally not necessary and just mean an additional amenity, shouldn´t be paid by the supportive society. Besides, one have to evaluate because of the legal position if the removal of the whole tooth and a following replacement of the tooth space is a more efficient solution, particularly in regard to the social legislation.
Does the austrian health insurance refund your honorarium?
Austrian health insurances refund the honorarium of all doctors in the EC in such a way, as if the patients had been treated in their own country at a doctor they have chosen themselves. Therefore the german doctors are equated to the Austrian doctors in everything that concerns refunding. I am not able to publish my exact honorarium as a german doctor on this internet page.
What about complications ?
What makes you feel less comfortable is a swelling and tolerable pain.
Unfortunately, this discomfort appears regularly and normally one can handle it easy with permanent cooling or with taking analgesics.
Unpleasing for your appearance is a haematoma. This is medically inconsiderable, but it doesn´t look nice in public. The haematoma can possibly last about one week. But fortunately such discolourations are rarely. Often the patients tell us that a limited oral aperture and the disorders while swallowing are so cumbersome during the first few days.
In the maxilla the sinus maxillary can be opened. This connection between oral cavity and sinus maxillary has to be sutured densely, therewith no bacteria can infiltrate into the sinus maxillary. If you follow our special tips of behaviour, e.g. avoiding to blow your nose and no lifting of weighty loads, this connection heals without any problems. Normally, the patients often only lament the difficult prevention of blowing one´s nose and less nosebleeding of one nostril. Only sometimes the sinus maxillary gets inflamed and has to be treated with antibiotics.
In the lower jaw a nerve passes to the lower lip and another one to the tongue. Only the surgeon is able to tell you by ordaining the distance between nerve and apex with a x-ray image, if and how likely it is that the nerves are endangered.
What do I have to think about after the operation?
After the operation every patient gets some slips of paper concerning the behaviour after the operation. The rationale of caring for a surgical wound is tranquillity and cleanness. This applies to the mouth, too. How to reach this precept, please have a look on the slips of paper with a lot of tips you get from us.
For patients interested in naturopathy, a doctor who owns this special medical title (Dr. Körfgen) conceptualized a pamphlet for us, on which these special medicaments are listed, even with informations how to take them in an effective way. This pamphlet is printed on our internet page.
When will it be possible for me to go in for sports?
It depends on the form of sport and the complexity of the wound. Normally, I ask you for avoiding stress on your blood circulation during the first week.
Basis of an untroubled bone regeneration is a steady blood clot. It can become unstable because of disquietude and enhanced cardiac actions.
If you have any further queries or improvement suggestions, please do not hesitate to contact us per mail.