Minimally invasive root apex resection: evaluation of postoperative outcomes in dental practice

Abstract

Root apex resection (apical resection) remains a key method for preserving teeth in chronic periapical pathologies that are not amenable to endodontic treatment. However, traditional surgical approaches associated with extensive access, trauma to soft and bone tissues often lead to postoperative complications (edema, pain, long-term rehabilitation) and the risk of tooth instability. Objective of the study: To evaluate the clinical efficacy, safety and postoperative outcomes of minimally invasive root apex resection in comparison with traditional surgical approaches.
Materials and methods.
Depending on the surgical treatment method, all study participants (n=78) were divided into two equal groups of 39 patients each. The study group (n=39) included patients who underwent minimally invasive root apex resection using microsurgical technologies; the control group (n=39) included patients who underwent surgery using the traditional (classical) technique without the use of microsurgical optics and ultrasonic osteotomy. The procedure in the study group involved a microsurgical incision of the mucoperiosteal flap, the length of which did not exceed 8—10 mm; an ultrasonic tip with a 3—4 mm diamond bur was used. All stages were monitored under an operating microscope (mag. 12—16x). The root apex was resected perpendicular to the tooth axis, preserving at least 3 mm of apical dentin. Retrograde filling was performed using a bioceramic material (MTA). Control group technique: A standard approach was used, creating a full-thickness mucoperiosteal flap. Osteotomy was performed with a 6—8 mm round bur. The procedure was performed without the use of optical magnification (microscope/binoculars). Root resection was performed using a standard technique.
Results.
The results of the study demonstrated statistically significant differences in postoperative outcomes between the groups. In the main group (minimally invasive resection), the pain intensity according to VAS on the 1st day was 3.2 points, which was 42% lower than in the control group (5.5 points; p<0.001). By the 7th day, the pain syndrome in patients of the main group was completely relieved in 35 (90%) patients, while in the control group it persisted in 9 (23%) patients (p=0.003).
Conclusions.
The study confirmed that minimally invasive resection of the tooth root apex using microsurgical technologies and bioceramic materials (MTA) has significant advantages over traditional surgical approaches. The minimally invasive nature of the method was achieved through a microsurgical approach. The root apex resection in the control group was performed using the conventional technique.