Resection of the apex of the tooth root: indications for performance, stages of the operation, price in Moscow

Publication date: 01/21/2021

Methods of modern dentistry are aimed at preserving the dental unit. Removal is resorted to as a last resort if gentle treatment techniques are ineffective. Resection of the apex of the tooth root (apicoectomy) is a microsurgical intervention for excision of tissue affected by infection with part of the injured tooth root. The operation is performed if the inflammation has taken the form of a cyst or granuloma. The main condition for the success of such a surgical intervention is the timeliness of the patient’s visit to the dentist. If the pathological process spreads to most of the root, the tooth will have to be removed.

Briefly about the treatment method

Bowel resection is an operation to remove part of the small or large intestine. This is a fairly traumatic procedure, so it is not performed without very compelling reasons.

Types of bowel resection

Different types of resections are performed to remove different parts of the intestine. Each type of bowel resection is named based on what it removes: Segmental small bowel resection: A portion of the small bowel is removed. The surgeon may also remove part of the mesentery (the fold of tissue that supports the small intestine) and lymph nodes in the area. This type is used to remove tumors in the lower duodenum (upper part of the small intestine), jejunum (middle part of the small intestine), or ileum (lower part of the small intestine). Right hemicolectomy: removes part of the ileum, cecum (part of the large intestine), ascending colon (part of the large intestine), hepatic flexure (flexure of the colon), first part of the transverse colon (middle of the large intestine), appendix. Transverse colectomy: the transverse colon, hepatic and splenic flexures are removed. This surgery may be used to remove a tumor in the middle of the colon when the cancer has not spread to other parts of the colon. Left hemicolectomy: Part of the transverse and descending colon, the splenic flexure (the curve in the colon near the spleen), and part or all of the sigmoid colon are removed. Sigmoid colectomy: The sigmoid colon is removed. Low anterior resection: the sigmoid colon and part of the rectum are removed. Proctocomectomy with ileoanal anastomosis: the entire rectum and part of the sigmoid colon are removed. An ileoanal anastomosis is a procedure that a surgeon does to attach the lower portion of the small intestine to the anus. Abdominoperineal resection: The rectum, anus, anal sphincter and muscles around the anus are removed. The surgeon makes one cut or incision in the abdomen and another in the perineum (the area between the anus and vulva in women or between the anus and scrotum in men). This procedure requires a permanent colostomy (taking a section of the colon out) because the anal sphincter is removed. Partial and total colectomy: Surgery to remove part or all of the colon (including the cecum).

Do I need to do a resection or still remove the tooth?

Tooth root resection is a tooth-preserving operation. The dentist will recommend it to you when there is at least the slightest opportunity to save the tooth. If the dentist does not see this possibility, then the conversation will immediately focus on removal.

When will the tooth have to be removed?

• You have a large cyst that affects more than a third of the tooth or several teeth.
• The root of the tooth is destroyed.
• There is severe inflammation of the tissues adjacent to the diseased tooth.
• The tooth is movable.
• Subsequent prosthetic replacement of a diseased, destroyed tooth with a crown is impossible.

Indications and contraindications for the treatment method

Bowel resection is performed to treat the following diseases:

• Cancer in the small intestine, colon, rectum, or anus;
• Cancer that has spread to the intestines (treatment and symptom relief);
• Blockage in the intestines (intestinal obstruction);
• Precancerous polyps before they become cancer (called preventative surgery);
• Inflammatory bowel disease or diverticulitis;
• Ulcerative colitis (characterized by chronic inflammation of the colon and rectum, resulting in bloody diarrhea). Surgery may be indicated when drug therapy does not improve the condition.
• Mesenteric thrombosis or abdominal ischemia;
• Intestinal necrosis.

In addition, surgery is used for intestinal trauma, bleeding, and to close a hole in the intestine (intestinal perforation). The reasons for resection are always carefully assessed by the attending physician. There are a number of contraindications for the operation:

• critical condition of the patient, leading to the inappropriateness of resection,
• coma or unconsciousness of the patient,
• pathology of the heart, kidneys or respiratory system, which can lead to serious complications during or after surgery,
• inoperable tumor.

When surgery is not performed

Like any other surgical intervention, apicoectomy has limitations and contraindications. These include:

• Mobility of teeth II-IV degrees;
• destruction of the crown part of the tooth (more than 50%);
• the presence of cracks in the affected root;
• severe curvature of the root canal (impossible to fill);
• crowding of teeth, which does not allow identifying the affected root;
• acute infectious, viral disease;
• severe bleeding disorders;
• decompensated diabetes mellitus;
• severe immunodeficiency;
• oncology in the active stage.

Some of the limitations to root resection are the indication for removal of the affected unit. The second part refers to general contraindications to any surgical intervention. The risk of surgery for the patient is assessed individually.

The specialists at the Ilatan Clinic make every effort to save the dental unit, if possible. But if there are direct indications for removal, for example, extensive damage to dental tissue, the doctor will not suggest apicoectomy.

Preparing for treatment

Before surgery, diagnostic tests are usually performed to check your general health and ensure that the surgery can be performed. This may include blood sampling, chest x-ray, electrocardiogram (ECG), angiography, CT or ultrasound, or endoscopy. You should follow a diet that excludes legumes, baked goods, alcohol, fresh fruits and vegetables. A liquid diet is administered at least the day before surgery, with nothing taken on the day of surgery. Depending on the type of bowel resection, it may be necessary to cleanse the bowel. This usually involves taking a laxative 1-2 days before surgery. Cleansing enemas may also be given in the hospital. Immediately before the procedure, antibiotics are prescribed to help prevent infection. You should also tell your doctor about all the medications, supplements, and herbal products you take.

How the treatment method works

The surgeon may use open or laparoscopic techniques. With an open technique (laparotomy), the surgeon makes a large longitudinal incision to reach the intestine. In the laparoscopic technique, small holes are made in the abdomen, and then an endoscope (a thin, tubular instrument with a light and lens) and instruments are inserted to perform the operation. The laparoscopic technique tends to result in shorter hospital stays, faster recovery times, fewer complications, and less pain during incisions. However, not all patients can undergo laparoscopic bowel resection due to the location and stage of the disease or other factors. In addition, surgeons require specialized training, skills, and equipment to use laparoscopic techniques. The surgeon examines the cavity and removes the diseased or damaged part of the intestine within healthy tissue. However, some healthy tissue on either side of the affected part may also be removed.

Anastasmosis

When part of the intestine is removed, the surgeon connects the remaining ends of the intestine together using stitches or staples. This procedure is called anastomosis. When the entire large intestine is removed and the anastomosis is between the small intestine and the anus, it is called an ileoanal anastomosis. When it is between the sigmoid colon and the anus, it is called a coloanal anastomosis. For any of these procedures, the surgeon may create a pocket before attaching the intestine to the anus. The pocket creates a place for stool when the rectum is removed. It helps reduce the number of bowel movements a person has and manage incontinence (the inability to control bowel movements).

In some cases, the surgeon does not connect the ends of the intestine together. Instead, it attaches one or both ends of the intestines to an opening in the abdomen. This procedure is called a colostomy or ileostomy (depending on the part of the intestine used) and is an artificial anus. A colostomy can be temporary or permanent.

Advantages of the Clinical Hospital on Yauza

The clinic on Yauza successfully performs surgical interventions of any complexity using laparoscopic and open methods. Hospital treatment has many benefits. The main ones include:

• the latest diagnostic devices;
• modern rehabilitation wards;
• highly qualified personnel;
• individual approach to each patient;
• affordable prices.

You can book an appointment with a surgeon using the hotline number or on the clinic’s website.

Sign up for the procedure

Possible complications during treatment

The side effects that may occur depend mainly on the type of bowel resection and your overall health. They include:

• obstruction (obstruction) of the intestine,
• paralyzed or inactive bowel
• damage to nearby organs such as the bladder, ureter or spleen, anastomotic leak associated with infectious problems,
• excessive bleeding wound infection,
• hernia,
• thrombophlebitis,
• inability to control urination.

The attending physician should be informed of any of the following problems after surgery: severe pain, swelling, redness, drainage or bleeding in the incision area, muscle pain, dizziness or fever, constipation, nausea or vomiting, rectal bleeding or black, tarry stools.

Prognosis after treatment method

The period of time required for recovery varies depending on the initial condition, type of resection, the patient's general health prior to surgery, and the length of bowel removed. The prognosis of bowel resection depends on the severity of the disease. For example, in the case of patients with ulcerative colitis, the disease is cured and most people go on to live normal, active lives. Patients with cancer will have a less positive prognosis (due to possible relapses). Alternatives to bowel resection depend on the specific medical condition being treated.

Why is it better to perform anterior rectal resection at the Swiss University Hospital?

• The clinic was among the first to perform sphincter-preserving operations; to date, the number of surgical interventions on the intestines has exceeded 3,000 operations.
• We employ specialists of the highest category, many of whom, being authorities in surgery, are known not only in domestic but also in foreign clinics. Each of our specialists is fluent in all techniques and can perform more than 100 types of operations within their specific area.
• Every year we consult about 5 thousand people, including patients with proctological pathologies referred from other clinics.
• For diagnostics, our Center carries out almost all necessary studies: from laboratory tests to complex examinations using video endoscopic or computer technology. Thanks to the presence of a histological laboratory, the time for examining patients is minimal, which is extremely important for patients with cancer.
• If necessary, doctors of other specializations can be involved in the diagnosis and treatment of patients with concomitant diseases: endocrinologists, gynecologists, vascular surgeons, etc.
• We were one of the first to carry out simultaneous operations: during one anesthesia, the patient can get rid of other pathologies of the abdominal cavity or pelvic organs.

Observation program after treatment method

After your bowel resection you will need to stay in the hospital for several days. The patient should be given warm, liquid food for 1-2 days after surgery. Solid foods and meals will be introduced gradually. If a colostomy or ileostomy has been performed, a specially trained health care professional will teach the patient how to care for themselves. Temporary ostomies usually remain in place for several months. After the rest of the colon has healed, another operation, an anastomosis, will be performed. The hole in the stomach will be closed. A nasogastric tube is inserted through the nose into the stomach during surgery and may be left in place for 24 to 48 hours after surgery. This eliminates stomach secretions and prevents nausea and vomiting. It will remain until bowel activity resumes. Postoperative patient care also includes monitoring of blood pressure, pulse, respiration and temperature. Fluid intake and output are measured, and the color and amount of drainage from the wound is observed at the incision site. The patient can get out of bed approximately 8-24 hours after surgery. Most patients will stay in the hospital for 5-7 days, although laparoscopic surgery can reduce this stay to 2-3 days. Postoperative weight loss accompanies almost all bowel resections. Weight and strength are slowly restored over several months. You will need to follow a diet prescribed by your doctor. Full recovery from surgery may take two months. Laparoscopic surgery can reduce this time to one to two weeks.