Peri-apical infections are one of the most common pathologies which dental surgeons diagnose in the dental practice. Usually, they are caused by infections within the tooth which lead to pulp necrosis and eventually this infection affects the entire root of the tooth. The pulp chamber may become non-vital (die or stop functioning) if the tooth has trauma, dental decay or damage during restorative procedures such as fillings, crowns or bridges. Once the pulp tissue dies an infection develops inside the pulp chamber. The infection has no where else to exit other than by the tip of the root which is called the root apex.
A root canal treatment is usually the treatment of choice for dental infections which develop soon after the pulp tissues have died. A root canal treatment involves removing the infected dental pulp. The procedure is highly skilled and carried out by a dentist or endodontist. During the root canal treatment the dead pulp and infected material is removed from inside the tooth. Small files are used to clean the internal space and to eradicate the bacteria and other germs from inside the tooth.
Once the internal area is cleaned thoroughly it is sealed with special materials to create a perfect seal. Because the procedure is technically difficult the success rate of root canal treatments can vary greatly. Posterior teeth with greater number of canals are usually more difficult to treat.
If root treatments are unsuccessful or if dental infection is left without treatment for a long time then a granuloma or cyst will develop. The recommended treatment of peri-apical cysts is extraction of the infected tooth together with the cysts found on the apex of the tooth.
Root canal treatment will not remedy a well developed granuloma or cyst on the tip of a root unless it is removed. The surgical procedure of removing the cyst of a root is called an apicectomy. During this treatment the tip of the root is removed together with the granuloma/cysts in question.
Clinically a cyst is usually asymptomatic and they are usually detected on radiographs or when peri-apical x-rays are taken. On radiographs, they appear as radiolucency (dark area) around the tip (apex) of a tooth’s root. More recently a CT scans are being used to identify the size, position and extent of dental cysts.
If the cysts are left untreated, they may cause infection to surrounding teeth, gum, or bone tissues. In most cases, peri-apical cysts are removed easily under local anaesthetic or sedation. After extraction of the infected tooth and cyst then the area will usually heal. The reason for this is that the local area will be disease free and new bone will be able to grown into the area. When dealing with large cysts, bone grafting may be required in order to replace the bone which was damaged or lost due to the infection. A six month healing period is usually recommended to allow for good bone to grown into the affected area.
If dental implants are to be considered to replace the missing tooth an assessment should be made of the site. A thorough assessment of the patient and site where an implant is to be placed should be carried out. A CT scan should be used to determine if there is sufficient bone present for an implant to be placed.