Apicoectomy is a surgical dental procedure during which the apex, or tip, of an infected dental root is removed. A dentist might also refer to this procedure as root-end surgery or endoscopic microsurgery. The goals of apicoectomy are to treat recurrent infection and prevent tooth loss. Apicoectomy may be necessary if a previous root canal treatment has failed, and the root of a tooth has remained infected or become infected again following the initial treatment.
In some instances of dental infection, it is best to treat the tooth roots directly rather than performing a traditional root canal procedure.
Why Root Canals Fail
It is important to remember that most root canal treatments are successful. However, there are several reasons why treatment may fail, some of which are not within the patient’s or dentist’s control. Some teeth may have more canals, or even roots, than are normally found. Very small dental roots are often hard to detect, even on x-rays, meaning they may not be treated during the root canal procedure. There may also be microscopic cracks in the affected root, which can cause persistent pain or allow infection to reenter the tooth following treatment. The sealing material within the treated tooth or the external restoration may break down over time, which can result in recontamination of the tooth.
Apicoectomy may be necessary if a previous root canal treatment has failed, and the root of a tooth has remained infected or become infected again following the initial treatment.
Choosing a Provider
Although general dentists sometimes perform root canal therapy, endodontists are extensively trained in the procedure, apicoectomies, and all related treatments. An endodontist is a specialist dedicated to maintaining the internal structures of teeth. Like all dentists, endodontists attend four years of dental school to achieve a doctorate in dental medicine (DMD) or doctorate in dental science (DDS). After earning their general dentistry degree, an endodontist must complete an additional two-year program in the discipline of endodontics, including a residency.
An endodontist can elect to go through training and a rigorous testing process to become board-certified with the American Association of Endodontists, although this distinction is not required in order to practice.
Before an apicoectomy, the doctor will typically take x-rays of the tooth and surrounding tissues. They will review the patient’s medical history and current medications before performing any procedure. Your dentist or endodontist may prescribe medications to be used prior to and after the procedure, including an antimicrobial mouthwash, anti-inflammatory such as ibuprofen, and antibiotics. These medications are meant to prevent or control pain, inflammation, and infection.
Before beginning the apicoectomy, a local anesthetic will be applied to numb the treatment area. The doctor will make a small incision in the gum, often using a soft tissue laser, to access the affected tooth’s root. Next, they will remove infected gum tissue surrounding the root, as well as the tip of the root itself. During the procedure, the doctor may use tools for more precise treatment, including dye to highlight any cracks in the root of the tooth and a lighted microscope to view the intricate structures. To complete the procedure, the doctor will place a dental filling at the root tip to seal the canal. A small number of stitches will be used to close the gum tissue and allow the area to heal.
Following treatment, you may experience some pain, bruising, or numbness near the treatment site. Discomfort can typically be managed with an over-the-counter anti-inflammatory. Cold compresses may also provide relief. The patient should avoid brushing near the surgical site, eating anything hard or difficult to chew, and smoking. Stitches may need to be removed in the week following the procedure, though some types dissolve on their own. In general, most patients can expect a full recovery within two weeks of the procedure.
There are a few potential risks associated with apicoectomy, mostly related to the location of the affected tooth. If the tooth is in the back of the upper jaw, the sinuses could become infected and require treatment with antibiotics or decongestants. If the affected tooth is in the back of the lower jaw, the procedure may impact a major nerve located near the area. X-rays can help your doctor determine whether this could be an issue.
The most significant consideration associated with apicoectomy is that the procedure may be unsuccessful, which would typically necessitate extraction. In order to maintain the health of the jaw and reduce the risk for further tooth loss, most dentists will recommend replacing an extracted tooth with a single dental implant and crown.
Protect Your Oral Health
Pain, discomfort, or swelling near a tooth that has previously undergone root canal treatment could indicate that the tooth has been reinfected. Dental trauma can also injure the root canals. If you think you may need an apicoectomy, schedule an appointment with a dentist or endodontist. Prompt treatment is the most effective way to protect the health and appearance of your smile.
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