Also known as a root-end resection, an apicoectomy is a surgical endodontic procedure typically performed after a root canal procedure has failed. A root canal treats infected tissue inside the tooth by removing the dental pulp, and filling the tooth with gutta-percha, a biocompatible material. Although this procedure is usually successful, infected debris may remain in the canals of the tooth, sometimes leading to future infections.
A patient whose tooth becomes reinfected after a root canal may experience pain or tenderness in, or swelling of, the gums, but other patients may experience no symptoms at all. The infection is often discovered through an ultrasound exam.
An apicoectomy removes the root tip, called the apex, as well as the infected tissue, to ensure complete removal of the infection, and to allow the tooth to return to a healthy state. The tip of the root is where the nerves and blood vessels enter the tooth, then travel through the canals to the pulp chamber. Removing the root tip removes the infected tissue at the source of the problem, making certain no infected tissue remains in the tooth. A doctor may perform a second root canal before performing this procedure.
The Apicoectomy Procedure
Apicoectomy is performed under local anesthesia at an endodontist's office, and usually takes 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. During the procedure, the endodontist cuts the gum and moves it away from the tooth in order to gain access to the tooth root. The infected tissue and the last few millimeters of the root tip are then removed. The tooth may also need to be extracted if there are large cracks or breaks within it. If the tooth is removed, the apicoectomy procedure is stopped.
Once the tip of the root has been removed, the tooth canal is cleaned and sealed to protect the tooth from future infection. An X-ray of the tooth will be taken before the tissue is sutured back into place. Over time, the bone will heal around the end of the root.
Most patients experience little-or-no discomfort during an apicoectomy. In fact, this procedure is often less invasive than the preceding root canal procedure, and involves a shorter and less painful recovery.
Risks or Complications of Apicoectomy
Although an apicoectomy is considered safe, there are certain risks associated with any type of dental procedure.
Some of these risks may include:
- Further infection
- Nerve damage
- A failed procedure
These risks are considered rare, and most patients undergo this procedure with no major complications. If an apicoectomy is not successful in completely removing the infected tissue from a tooth, the tooth may need to be extracted.
Although apicoectomy is successful in treating many patients, it is not for everybody. Patients with high blood pressure should note that this procedure uses a higher dosage of anesthesia than other procedures.
Recovery From Apicoectomy
After an apicoectomy, patients may experience bruising and swelling in the area for several days. These symptoms, as well as any pain, can be controlled with over-the-counter anti-inflammatory medication such as ibuprofen. Patients should apply ice to the area for the first 10 to 12 hours after surgery. Hard or crunchy foods should be avoided for a few days to avoid irritating the region.
The stitches from this procedure are removed after two to seven days, and most side effects diminish within two weeks. Patients can usually return to work and other normal activities within a few days.
An apicoectomy usually protects a patient from future infections in the treated tooth.