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As a result of poor-quality root canal filling, an inflammatory process often occurs due to an infection, which leads to the formation of a cyst or granuloma. In this case, the dentist prescribes a cystectomy with resection of the root apex. It is important to note that this surgery is aimed at preserving the tooth, not removing it.
What is a cyst/granuloma
Our body is constantly forced to fight off the attacks of a variety of harmful viruses and bacteria. Therefore, over many years of evolution, a whole system of protective functions has been created, and the formation of a cyst is one of them. When the infection enters the root canal of the tooth, it gets fertile ground for the rapid growth of bacteria and their spread to healthy tissues. To prevent this process, the infected site begins to thicken, thus creating a barrier around the affected area, in which dead cells and harmful microorganisms remain. If such a focus is more than 1 cm in diameter, it is a radicular cyst, if less, such a formation is called a granuloma or cystogranuloma.
Most often, the disease is the result of improper endodontic treatment, that is, root canals, but infection is possible due to injuries received by a person or past infectious diseases, such as sinusitis.
In most cases, a person does not experience any discomfort and is unaware of the neoplasm. This can lead to an aggravation of the disease, in which not only the epithelium is affected, but also the bone, and the tooth becomes impossible to save due to complete destruction or severe loosening. The only way to detect a cyst at an early stage is an x-ray.
At the same time, dentists recommend paying attention to discomfort when taking solid food, darkening of the tooth or its slight displacement. Such symptoms may indicate the presence of a cyst in the oral cavity. If the inflammation is at an advanced stage, a purulent fistula is formed, pain is present. It is also possible fever, swollen lymph nodes, general malaise.
Cystectomy as a way to save a tooth
After carrying out the necessary diagnostics and the presence of an x-ray, the dentist will be able to assess the degree of tissue damage. To eliminate the problem and ensure the safety of the tooth, the doctor most often decides to perform a cystectomy – an operation to remove the cyst.
The indications for this are:
- large size of the infected sac;
- location in the area of two or more teeth;
- the neoplasm occurred due to a malformation of the epithelium;
- the cyst is located in the area where the tooth is missing;
- the integrity of the jaw bones is broken.
The complexity of the procedure lies in the fact that it is necessary to eliminate even the smallest particles of infected tissues. In the case of a poorly done work by a dental surgeon and the presence of at least a minimum number of cyst cells, the patient is expected to relapse the disease.
Resection of the apex of the tooth root
If the cyst is located at the edge of the root, then in addition to the membrane and the internal fluid, its upper part is usually removed to prevent further reproduction of microorganisms and their penetration into the deeper layers of tissues. This procedure is called resection. It is important that at the time of the operation there is no active inflammatory process, for example, inflammation of the gums and pain during palpation.
The main stages of the operation can be divided into three parts:
- providing access to the hearth;
- cyst removal and tooth resection;
- suturing.
After an incision in the region of the top of the affected tooth, the gum moves back, opening access to the bone tissue. Using a drill, the surgeon drills a “window” that allows you to get to the cyst or granuloma and clean it. The next step is cutting off the top of the root.
The most modern techniques also involve “retrograde root canal filling” after resection. This will be especially a godsend for people whose root canals have been sealed for a long time, but there is no need to redo it before performing a cystectomy. Often, the dentist makes such a decision when a crown is installed on the tooth, and the planned operation will lead to repeated prosthetics and an increase in the cost of the final cost. The procedure itself involves additional filling of the upper part of the root canal from the cut-off side. Thus, a specialist using an ultrasonic nozzle removes the filling to a depth of 2 mm from the saw cut, after which the canal is obturated with a special material. This allows you to almost completely eliminate the risk of re-infection.
The final stage of cystectomy with resection of the upper tooth root is the filling of the resulting hole with artificial bone material, which over time promotes the regeneration of its own bone tissue cells. The final touch – the gum is sewn into place.
The operation itself is not difficult for a specialist and is performed under local anesthesia. During the procedure, the patient will not feel anything, but after the end of the anesthesia, analgesics will be needed to reduce pain.
Therapeutic treatment of cysts/granulomas
Do not be afraid to go to the doctor if you suspect that you fall under the described symptoms of having a cyst. First, only an x-ray can accurately show whether this is actually the case; secondly, the sooner you go to the dentist, the higher the chances that you can do without surgery. Extreme measures are resorted to only when therapeutic treatment has not brought the desired result, or the focus of inflammation is in an advanced stage.
However, there is no guarantee that the treatment will have a positive outcome and there will be no need for surgery. In addition, this process is lengthy and has many stages. To reduce and resolve the cyst or granuloma, the source of infection must be neutralized. At this stage, the doctor works with the root canals: if they have not been sealed, he removes the pulp and performs treatment; if the fillings have been installed, he removes and rinses the canal with an antiseptic.
After that, the doctor installs a temporary medical filling paste based on calcium hydroxide for several months. To determine the effectiveness of therapy, it is necessary to re-take an x-ray. In case of successful treatment and reduction of the focus of inflammation, a permanent filling will be installed for the patient.
Laser cyst removal
Science is advancing, and now there are methods to eliminate the infected sac without unpleasant incisions and long-term treatment. Laser removal of a neoplasm has several advantages. So, if there is no need to remove the nerves, the procedure takes place without painkillers, as it is completely painless. In addition, the laser has an antiseptic and regenerating effect, no bleeding and minimization of complications. Most often, the doctor can close the root canal with a filling immediately after the manipulation.
This procedure involves opening the channels, for which the filling is removed from the tooth, after which a laser is inserted there. The beam is directed to the cyst and destroys all microorganisms. Naturally, this procedure will cost the patient more. It is also worth considering that if the formation continues to increase after the procedure, then you still have to resort to cystectomy with resection of the apex of the tooth root.