Apicoectomy: Exploring the Procedure and Indications for Treatment

An Apicoectomy, also known as root-end surgery, is a minor surgical procedure done to further save infected teeth. An infected tooth is usually treated with a root canal treatment. Although root canal treatments have a high success rate, they are not 100%. In those cases wherein a root canal treatment is not sufficient to totally eliminate the infection of the tooth, an apicoectomy is usually the next treatment in line.

How do I know if I need Apicoectomy?

When a tooth is starting to experience pain and swelling even after a root canal treatment, the source of the problem usually arises from the apex or the tip of the tooth. In this case, a second root canal treatment is indicated to re-treat the infection. If doing the second root canal treatment, an apicoectomy is unnecessary. However, re-treatment may not be feasible for all cases, such as those wherein the infected root-canal-treated tooth has a crown or is used as an abutment for a bridge. Retreating the tooth would mean removing the crown, increasing the risk of damage or fracture of the natural tooth. In cases like this, an apicoectomy is a much more favorable choice.

Procedure of Apicoectomy:

1. Before anything else, the tooth in question will be anesthetized to numb the area. This will prevent any discomfort throughout the procedure.
2. The dentist will make an incision, then retract the incised gums to expose the apex or root tip area. The type of incision will depend on the surgeon, location, and size of the lesion.
3. A lesion, formed by the infection, is usually found at the apex. The infected tissue or lesion is totally removed and a few millimeters of the root is cut or removed. 
4. After removal of the root tip, the root tip is smoothed, then sealed with a filling to avoid entry of bacteria from the root end, preventing further infection.
5. The dentist will then put the retracted tissue back in place and suture it with the dentist’s suture material of choice. 
6. Gums will eventually heal and bone will form around the apex area. 

Post-operative Instructions

1. Pain and discomfort may be experienced on the first few days. Antibiotics may be prescribed to prevent post-operative infection. Over the counter pain relievers may also be taken to help with the pain.
2. Swelling is expected. Cold compress can help subside the swelling.
3. Stitches are usually removed after a week. However some types of stitches, such as chromic gut, dissolve naturally after a few days, therefore suture removal is not needed.