Apical Resection (Root Tip Surgery): What to do if root canal treatment fails?

Root canal treatment is the most effective method to save the tooth. However, in some cases, root canal treatment may fail or cannot be repeated. In this case, should the tooth be extracted immediately? No! Teeth whose root canal treatment has failed can be saved with the "apical resection" (root end surgery) method applied in modern oral surgery. In this article, I will explain in detail what apical resection is, in which cases it is applied, its process and its role in saving the tooth.

What is Apical Resection?

Apical resection is the process of surgically removing the root tip (apex) of the tooth and cleaning the infected tissue around the root. It is usually done under local anesthesia. During the procedure, the gum is removed, the root tip is reached, the infected root tip is cut and the remaining root canal is closed with a special filling material. Finally, the gum is stitched. This method prevents tooth extraction and ensures that the natural tooth remains in the mouth.

In Which Situations Is Apical Resection Necessary?

• Failure of Root Canal Treatment: If the infection at the root of the tooth continues despite the root canal treatment.
• Failure to Perform Repeat Root Canal Treatment: If the root canal is blocked, there is a broken instrument or the structure of the tooth is not suitable for retreatment.
• Cyst at the Root Tip or Abscess: If a cyst or abscess has formed at the tip of the root and cannot be resolved by root canal treatment.
• Root Fracture: If there is a fracture only at the tip of the root and the rest of the tooth is intact.
• Anatomical Difficulties: Inability to complete root canal treatment due to the root canal being too narrow or curved.
• Foreign Body: Broken instrument or filling in the root canal.

Apical Resection Process Step by Step

1. Examination and Imaging: The condition of the tooth, It is examined in detail with 3D tomography. The location of the root tip and the extent of the infection are determined.
2. Local Anesthesia: The area is anesthetized. The patient does not feel pain during the procedure.
3. Gum Removal (Flap): The gum is carefully lifted to reach the root tip.
4. Bone Window Opening: A very small amount of bone is removed to reach the root tip.
5. Root Tip Resection: The infected root tip (usually 3 mm) is cut and removed.
6. Canal Filling (Retrograde Filling): The end of the root canal is closed with a special filling material (MTA, etc.).
7. Suturing and Closure: The gum is stitched into place. The healing process begins.

Advantages of Apical Resection

• Saving the Tooth: It prevents the tooth from being extracted and ensures that the natural tooth remains in the mouth.
• Cleaning the Infection: The infected tissue at the root tip is completely cleaned.
• Bone Healing: After the infection is cleared, the surrounding bone tissue heals.
• Aesthetics and Function: Since the natural tooth is protected, aesthetics and chewing function are not impaired.
• Fast Healing: Modern surgical techniques and microscope. The healing process is short with its use.

Prof. Dr. İbrahim Duran's Apical Resection Approach

Prof. Dr. İbrahim Duran keeps the patient's safety and comfort at the highest level in sensitive surgical procedures such as apical resection. Thanks to the dental microscope and 3D tomography used in the clinic, the root tip and surrounding tissues are evaluated with millimetric precision. The teacher's expertise in Oral and Maxillofacial Surgery increases the success of this operation. The aim is for the patient to have a healthy smile while preserving their natural teeth.