Apicoectomy

Why Would I Need It?
Most dental problems involving an infected tooth root are solved by a root canal. Although endodontic treatment has an extremely high rate of success, it is not 100% effective. Some teeth may not respond as expected to the root canal therapy. Sometimes, it is clear from the beginning that the root canal is not working as planned. Other times, it may be years later that the need for other treatment arises.

Typical reasons for an apicoectomy may include re-infection of the root canal site with signs like pain in the tooth, tenderness or swollen gums that occurs after a root canal.

The first and most desirable method of solving the problem is to re-treat the root canal at one or more roots. In other words, the root canal treatment is redone in a method similar to the original therapy. If it is possible to re-treat the root canal with this nonsurgical approach, this is best.

What Is It?
If not, a different form of treatment, an apicoectomy (root end surgery), must be considered. An apicoectomy is an oral surgery procedure that removes the tip of a tooth root to save the tooth from being pulled out. Keeping your teeth intact is the dentist's mission.

Teeth are held in place by tooth roots. The tips of each root, called the apex, serve as an entrance for nerves and blood vessels into the tooth. During an apicoectomy, the apex is removed, almost with the infected tissue, and then sealed with a tooth filling. 

What Can Be Corrected With An Apico

• teeth that have narrow, curved roots
• "blockages" of the canal
• root resorption
• persistent infection
• fractures
• a wide open apex
• associated cysts

Reasons Not To Perform The Apico

• surgical inaccessibility
• poor or lack of bone support
• short roots
• vertical fracture of the root.

The Procedure 
1. The root or roots that are to receive the apicoectomy are measured with radiographs, and the approximate location of the root tip is estimated.
2. The area to be treated is anesthetized with a local anesthetic.
3. An incision of the gum is made over the root tip area and the gum is moved to the side. Access is made through the bone, and the tip or apex of the root can then usually be seen through this "window" in the bone. 4. The infection is visualized and cleaned out.
5. The tip of the root is usually removed, and a sealing filling is placed in the remaining tip opening.
6. The tissue is then sutured back into place.

Done with a surgical microscope, this procedure is also known as endodontic microsurgery and usually takes between 30 to 90 minutes, depending on the tooth's location and complexity of the root structure.

Who Performs The Procedure
Though general dentists can do an apicoectomy, most are performed by endodontists, or root canal experts.

What To Expect After The Procedure
The tooth does not lose significant stability from this procedure. There is no pain during the surgery. Postoperative discomfort will be eliminated with anti-inflammatory and analgesic medication. There is usually some slight swelling of the surgical site. The swelling is temporary and will disappear after a few days. When the "apico" is begun and the tooth can actually be seen, another type of problem may be noted. A fractured root may be the problem, and an apico would not work and the tooth would have to be removed. This procedure can be completed by a general dentist, but it is most often referred to an endodontist (root canal specialist) for evaluation and treatment.

Recovery Tips

• Apply a cold compress to the area for 10 to 12 hours after the surgery
• Avoid any strenuous activities and make sure to get enough rest
• Take over-the-counter pain medication to manage any discomfort
• Allow your tooth and the gums around it to rest while it heals. Avoid eating crunch or hard foods, as well as brushing the affected area and rinsing too vigorously 

If you have any questions about apicoectomy, please feel free to ask us.