Periapical infections are one of the most common pathologies that dental surgeons diagnose in dental practice. In general, they are caused by infections inside the tooth that lead to necrosis of the pulp and, finally, this infection affects the entire root of the tooth. The pulp chamber can become non-vital (die or stop working) if the tooth has trauma, decay or damage during restorative procedures such as fillings, crowns or bridges. Once the pulp tissue dies, an infection develops within the pulp chamber. The infection has no other place to leave than the tip of the root called the apex of the root.
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A root canal is usually the treatment of choice for dental infections that develop soon after the pulp tissues have died. A root canal treatment involves removing the infected dental pulp. The procedure is highly qualified and carried out by a dentist. During root canal treatment, dead pulp and infected material are removed from the inside of the tooth. Small files are used to clean the internal space and to eradicate bacteria and other germs from inside the tooth.
Root canal treatment will not remedy a well-developed granuloma or cyst at the tip of a root unless it is removed. The surgical procedure to remove the cyst from a root is called an apicoectomy. During this treatment, the tip of the root is removed along with the granuloma/cysts in question.
Clinically, a dental cyst removal is usually asymptomatic and is usually detected on radiographs or when periapical radiographs are taken. On radiographs, they appear as radiolucency (dark area) around the tip (apex) of the root of a tooth. More recently, CT scans are used to identify the size, position, and extent of dental cysts.
If the cysts are not treated, they can cause infection in the teeth, gums or surrounding bone tissues. In most cases, periapical cysts are easily removed under local anesthesia or sedation. After removal of the infected tooth and cyst, the area will usually heal. The reason for this is that the local area will be free of diseases and new bone can be grown in the area. When dealing with large cysts, a bone graft may be required to replace the bone that was damaged or lost due to infection. In general, a six-month healing period is recommended to allow a good bone to develop in the affected area.