The bony lid approach for the apical root resection of lower molars

The apical root resection of mandibular molars is an operation seldom performed and then one limited primarily to the lower first molars. Although the first paper on this topic was published at the beginning of the 20th century, little progress has been observed since then. This is due to the thickness of the buccal bony plate in the lower molar region which makes surgery very difficult and leads to a substantial loss of bone. The resultant limitation of the operating field prevents good vision. The aim of our approach is to minimize or to eliminate these problems by opening a bony lid above the roots which are to be resected. This can be made large enough for the surgeon to have easy access and good vision during apical surgery. At the end of the operation the same lid is replaced in order to avoid a bony defect and to facilitate the healing process. Of the 75 patients treated using this technique during a 3-year period, only one post-operative complication has been observed. A complete healing of the bone was observed in the majority of cases within 6 months.