Coronoradicular separation: indications, technique

The desire to have a beautiful smile has allowed dentistry to step forward. Many modern clinics today are ready to offer their clients a new service - separation of teeth.

The essence of the procedure is to create the necessary space between the adjacent teeth.

There are two main types of separation - proximal (lateral) and coronary-radicular.

The first involves grinding a small layer of enamel (1/4 mm) on the sides using special dental instruments to give the tooth an aesthetic appearance.

The second requires surgical intervention and is curative in nature.

The essence of coronary-radicular separation

The operation is performed when the root system is damaged and is aimed at preserving the bone organ.

Coronoradical separation involves sawing a two-rooted tooth at the site of the grooves and removing pathology in the bifurcation area (separation of the interdental roots). After healing, prosthetics is performed - a stump tab is installed on each part, to which a crown is then attached.

As a result of the operation, instead of one tooth with two roots, two single-rooted units appear.

If the crown is destroyed with a healthy root, the damaged coronal part is removed, and the prosthesis is installed on the root system.

Indications

Separation is carried out on the mandibular molars. The condition of the damaged organ is assessed by the dentist and he also decides on the need for surgery.

The main indications include:

• damage periodontal tissues II and III degrees in the place of bifurcation and death of the upper part of the inter-root septum;
• severe tooth decay as a result of improper therapy;
• perforation of the tooth cavity in connection with the development of destructive processes;
• the presence of extra-channels connecting the dental cavity with the periodontium in the bifurcation zone.

Contraindications

The procedure is canceled if during the examination the dentist discovers the following problems:

• accretion of the root system;
• too close location of the bifurcation to the apex of the roots - otherwise, a rather large part of the tooth can be removed;
• inflammation periodontal tissues;
• strongest osteomyelitis;
• destructive process of bone tissue and caries subgingival root zone;
• tooth mobility - in this case, separation can cause severe damage (up to 50% of the root length) alveolar tissue;
• obstruction of root canals requiring preservation;
• the presence of a thin layer of bone tissue near the root system, which will not allow the molar unit to withstand a large chewing load.

In addition, the operation will be postponed if the patient has diseases of the cardiovascular system, diabetes mellitus, viral and colds, liver pathologies, neuropsychiatric problems, blood diseases, renal dysfunction, as well as age limits (for the elderly patients).

Forecast

According to the doctors themselves, coronary-radicular separation is a great achievement of medical dentistry, which has a lot of advantages:

1. It is possible to save the damaged tooth.
2. The operation takes a little time and is easy to carry out.
3. After the procedure, there is no need to restore bone tissue.
4. The operation is carried out under local anesthesia and is completely painless.

However, it should be borne in mind that coronary-radicular separation is not yet carried out everywhere. Dentists take it up only when there are no other possibilities to save the damaged tooth and there are no contraindications.

The main disadvantages of coronary-radicular separation include the fragility of "new" teeth and possible complications.

Preoperative stage

Coronoradicular separation is planned in advance.

First, the patient undergoes the necessary examination, consisting of the following procedures:

1. Taking anamnesis - fixing all the diseases the patient has at the time of treatment.
2. An in-depth examination of the body - general urine and blood tests, biochemical blood tests, tests for HIV infection, tests for syphilis and viral hepatitis. Based on the results obtained, it becomes clear whether the operation is possible or not. When other diseases are mentioned in the medical history, additional tests are taken. If serious contraindications are found during the examination, the patient will be offered an operation after undergoing an appropriate course of treatment.
3. Removal of allergic tests for the drugs used during the operation.
4. X-ray of the oral cavity.
5. Computed tomography - allows you to see the place of damage, its shape and size.
6. Preparation of the oral cavity - professional cleaning with certain means; treatment of teeth growing next to each other; removal of roots that are already unsuitable for restoration; root canal filling.
7. Organization of the psychological attitude.

Operation progress

The operation is carried out in the following sequence:

1. Preparation of tools.
2. Introduction of anesthesia.
3. An incision in the mucous membrane in the damaged area, an incision in the periosteum.
4. Detachment of tissue, creation of a periosteal flap, providing an approach to the alveolar ending.
5. Removal with a drill of bone tissue above the root area.
6. Separation of the coronal part.
7. Removal of damaged areas of the coronal zone and root.
8. Sanding sharp edges with a level.
9. Removal of granulants, curettage.
10. Antiseptic treatment of the operation area, drying the wound.
11. Hemostasis.
12. Fixing parts of the organ with a splint or noracryl with adjacent elements.
13. Return the flap flap to its original location.
14. Sewing the outer surface.

After the operation, impressions are taken from parts of the tooth to create crowns and the roots are being prepared for their installation.

The importance of curettage

Curettage - a necessary procedure for coronary-radicular separation.

It is performed if the patient:

• damaged periodontal tissues;
• inflamed gums;
• large (3 mm and higher) periodontal pockets;
• voluminous deposits of stone;
• healthy tissue turns into granulation.

Curettage cleans the outer part of the tooth, the peri-toothed area, pockets, eliminates bleeding gums and granulants, and prevents infection. If the procedure is abandoned, the patient faces severe pain and developing inflammatory pathologies.

Curettage is performed using various instruments (scaler, hoe, curette) or ultrasound.

Curettage of periodontal pockets on video:

Postoperative stage

The recovery period in the absence of complications and pathologies usually lasts 7-8 days. As the anesthesia ceases to work, unpleasant sensations are possible at the site of the operation.

Every day for 5 days, an antiseptic treatment of the damaged area is carried out, on the sixth day the stitches are removed.

During the rehabilitation period, the patient should:

• observe oral hygiene, while carefully bypassing the damaged area;
• eat soft, puree foods;
• do not chew on the damaged side;
• when eating, avoid sudden temperature changes;
• drink more fluids;
• use antispasmodics and regenerating agents recommended by your doctor;
• quit smoking in the first few hours after surgery;
• apply cold;
• avoid heavy physical exertion.

Temporary crowns can be placed one month after the operation, permanent crowns are attached after 4-5 months in the absence of complications.

Complications

Despite the fact that the operation is rather quick and painless, the following complications are not excluded in the postoperative period:

• pulp damage;
• gingivitis - arises from the use of non-sterile instruments or improper oral care after surgery;
• bleeding - is eliminated by means that constrict blood vessels and ensure good blood clotting;
• divergence of seams - occurs most often due to the fault of the patient in case of non-compliance with the doctor's prescriptions;
• increased sensitivity of the perioperative area.

Price

Cash costs are determined by the following factors:

• diagnostics;
• the amount of work performed during the operation;
• the price of anesthetic and other medications;
• the cost of specialist consultations and additional services.

On average, in Moscow and the Moscow region, the procedure costs from 4000 rubles.