Apical delta

The apical delta is an intricate network of minute canals located at the apex or tip of a tooth root. The anatomy of this region plays a pivotal role in endodontic therapy, primarily because of its potential impact on the success rate of certain treatments. Given its delta-like structure, reminiscent of a river's branching pattern, understanding and addressing the apical delta is vital for optimal endodontic outcomes.

Anatomy and Description

• Branching Pattern: The apical delta consists of multiple small accessory canals and minor foramina. These structures, when viewed under a microscope after being sectioned, display a branching pattern analogous to a river delta.
• Location: Located at the apex or the very tip of some tooth roots, the apical delta is not present in all teeth but can be found in a significant number of cases.

Clinical Implications

• Endodontic Challenges: Due to the complexity and the minute size of the anatomy, the presence of an apical delta may complicate endodontic treatments. The numerous portals of entry to the root canal system, often more than a single apical foramen, make it challenging to effectively clean and seal the root canal system.
• Risk of Infection: Residual pulp tissue or bacteria can remain within the small branches of the apical delta, increasing the risk of persistent infection or post-treatment flare-ups.

Apicoectomy and the Apical Delta

An apicoectomy is a surgical procedure performed to address the challenges posed by the apical delta:

• Procedure: During an apicoectomy, the very tip of the tooth root is surgically removed. This action eliminates the apical delta, ensuring that the multiple small canals and foramina are no longer present.
• Rationale: By removing the root tip and subsequently sealing the end of the root, dentists can maximize the chance of successful healing, reducing the potential for recurrent infections or treatment failures.

References

• Color Atlas and Textbook of Oral Anatomy, Histology, and Embryology
• by B. K. Berkovitz, G. R. Holland, B. J. Moxham
• Hardcover, Mosby, ISBN 0-8151-0697-1

(0-8151-0697-1)