Dental abscesses and the Apisectomy
A non vital tooth will cause the body to react against the necrotic tissue inside the root canal. This will form an abscess with facial swelling and pain.
The dentist will perform a root canal treatment, and if successful, will solve the problem.
In some instances this abscess will become chronic, and a cyst can develop which will destroy the surrounding bone.
In this case, an apisectomy will be performed.
Only in cases of sufficient tooth structure present and easy access to the apex of the tooth, will an apisectomy considered. In all other cases, the tooth will be removed and an implant placed.
The long term success of an apisectomy will be determined by the effiency of the root canal performed, and the accessibility of the tooth.
After root canal treatment on a tooth, residual debris and necrotic material left in the canal after treatment can cause the body to react against this.
This results in the formation of an abscess at the apex of the tooth. The resulting gas formation causes extreme pain in the bone represents a throbbing pain.
If this abscess persists, the tooth will become pressure sensitive and mobile. A fistula forms in the direction of least resistance, presenting as a lump in the mouth with puss draining from this lump.
Facial swelling occurs, and in some cases, can spread into the facial spaces, resulting in the so called Ludwig’s Angina which can either spread to the thorax, or the brain, resulting in death.
The Dental Cyst
A long standing abscess will eventually form a granuloma, visible on X- rays. Some of these granulomas are asymptomatic, and will stay asymptomatic for a long time.However, most of these granulomas will transform into the formation of a cyst destroying adjacent bone and teeth. Some of these cystic lesions can grow silent, invading structures like the maxillary sinus, the nasal cavity, and involving healthy adjacent teeth.
Most of these cysts, developing from chronic abscesses, are called radicular cysts, which indicate their infectious background. They are filled with fluid, and possess an epithelial lining.
They destroy bone and tooth structure in their immediate vicinity. The lining of the cyst must be removed, and in some cases a bone grafting will have to be performed as well.
They can vary in size from 10mm. to large cysts of 10cm. in diameter. Because a tooth with an abscess initially caused the cyst to form, it is advised to remove this tooth instead of performing an apisectomy. Again, implant placement will be performed after bone healing..