Apicoectomy

Apicoectomy is a procedure that the endodontist will perform for you. In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly. Over a period of months, the bone heals around the end of the root.

Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort. Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.

An apicoectomy is a straightforward, minor surgical procedure that’s done on children and adults as a way to save at-risk teeth and prevent potentially serious complications.

An apicoectomy is also known as root end surgery. This is because it involves the removal of a tooth’s root tip and surrounding tissue. It’s also called apical surgery, which refers to the “apex,” or end, of the tooth.

If your dentist tells you that you need an apicoectomy, it’s probably because even though your tooth has already had a root canal, there’s residual inflammation or infection near the root tip that reaches into your jawbone.

The procedure is usually recommended when a standard root canal treatment has already been performed on a tooth but isn’t sufficient to save the tooth and prevent further complications.

In cases where there’s an anatomical concern with the root tip, such as one root crowding into the space of the root next to it, an apicoectomy may be helpful in preventing problems that could affect multiple teeth later on.

If your dentist is recommending an apicoectomy, it’s because there’s no real alternative except removal of your entire tooth. In that event, you’d need an implant, bridge, or a removable partial denture to keep the nearby teeth from shifting.

An apicoectomy can be more invasive than a typical root canal surgery, meaning the recovery time is usually more painful. Patients will receive local anesthesia during an apicoectomy to help prevent any pain.

Minor discomfort and swelling are normal after the procedure. A 2008 study found that postoperative pain usually decreased steadily during the first few days, with more than one-third of patients studied choosing not to take any pain medications.

Those patients who did take medication after an apicoectomy found adequate relief from over-the-counter pain relievers.

Here’s a breakdown of the procedure itself:

  1. Before any work is done, you’ll be given a local anesthetic to numb the area around the affected tooth.
  2. During the procedure, your dentist or endodontist cuts through your gum and pushes the gum tissue aside in order to reach the root. Usually just a few millimeters of the root are removed, as is any infected tissue surrounding the root.
  3. After the root tip is removed, the root canal inside the tooth is cleaned and sealed with a small filling to prevent future infection. Your dentist or endodontist may then take another X-ray to make sure your tooth and jaw look good and that there are no spaces where a new infection could take hold.
  4. The tissue will then be sutured (stitched), so your gum can heal and grow back in place. Your jawbone will also eventually heal around the filling at the end of the root. You shouldn’t feel much, if any, pain or discomfort during the procedure.

An apicoectomy usually takes 30 to 90 minutes. The location of the tooth and the intricacy of the root structure can affect the time needed to complete the surgery.

After the apicoectomy procedure you may experience some minor discomfort and swelling once the anesthetic wears off. This gradually lessens over the next few days, though, and within a day or two, you should be able to resume normal activities.

Your doctor may prescribe antibiotics to help fight an existing infection or prevent a postoperative infection. For pain, anti-inflammatory medications such as ibuprofen should be sufficient.

Stitches are usually removed within a week. You’ll need to be careful brushing and flossing near the site of your surgery while the stitches are in place.

Apicoectomies are considered routine outpatient dental procedures. A 2020 study found that about 97 percent of cases still experienced excellent results following apical surgery up to 5 years later, and good results in more than 75 percent of cases after 10 to 13 years.

Another 2020 study found that apical surgery was a reliable way to preserve teeth affected by infection or other problems at the root, with a 91.4 percent success rate after 1 year.

On rare occasions, you may experience further infection or nerve damage. However, these are unlikely complications — and they can occur with many types of dental procedures, not just an apicoectomy.

Failure

An apicoectomy is considered a failure if it fails to relieve symptoms or doesn’t heal properly. This is rare, especially if your dentist or endodontist is experienced with this procedure.

One 2011 study showed that the main cause of apical surgery failure is a gap in the filling at the end of the root. This causes bacteria to leak back into the tooth.

Takeaway

An apicoectomy is a routine outpatient surgical procedure that’s performed when standard root canal therapy isn’t enough to save a tooth. It can be very important in preventing serious complications involving the health of your mouth and jaw.

Apicoectomies are usually recommended if a root canal procedure was unsuccessful and there’s an infection present around the root tip of a tooth.

Be aware that the alternative to an apicoectomy is removal of your whole tooth. So, if your dentist recommends root tip surgery, give it serious consideration.

Don’t delay on making a decision about getting an apicoectomy. An infection around one of your teeth could spread, causing serious dental health problems.

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