An apicectomy, or root-end surgery, is a dental procedure that removes the tip of a tooth’s root. Performed by an endodontist or oral surgeon, it addresses persistent infection or inflammation. This targeted surgery aims to save a natural tooth when conventional treatments cannot resolve issues at the root’s end.
Reasons for an Apicectomy
An apicectomy is typically considered when a conventional root canal treatment has not fully resolved an infection or inflammation at the root tip. Bacteria can sometimes persist in tiny, undetected branches within the root canal system, leading to ongoing discomfort or re-infection. This procedure offers a solution by directly addressing the affected area that could not be adequately cleaned through the initial treatment.
Other situations that may necessitate an apicectomy include cysts near the root tip, small fractures in the root, or calcified and blocked root canals that prevent a standard root canal from being fully effective. It can also be performed if there are extra roots that cannot be treated in other ways. This procedure serves as a method to preserve a tooth when standard non-surgical approaches are insufficient or unfeasible.
The Apicectomy Procedure
The apicectomy procedure begins with the administration of a local anesthetic to numb the area around the affected tooth. A small incision is made in the gum tissue, and the gum is gently lifted to expose the underlying bone and the root of the tooth.
The endodontist or oral surgeon then carefully removes the tip of the tooth’s root, along with any infected or inflamed tissue surrounding it. Following the removal of the root tip, a small retrograde filling is placed to seal the end of the root canal. This biocompatible filling helps prevent future bacterial leakage. Finally, the gum tissue is repositioned and sutured back into place, initiating the healing process.
Recovery and Aftercare
Following an apicectomy, managing swelling and discomfort is an immediate priority. Applying an ice pack to the outside of the cheek near the surgical site for 15-minute intervals can help reduce swelling in the first 24 to 48 hours. Pain can be managed with prescribed medications or over-the-counter pain relievers like ibuprofen or acetaminophen. Elevating your head with pillows while resting also helps to minimize swelling.
Dietary adjustments are important during the initial recovery period. Patients should stick to soft foods such as soups, smoothies, and yogurt for the first few days to avoid putting pressure on the surgical area. Avoid hot, spicy, or crunchy foods, as these can irritate the healing site.
Oral hygiene should be maintained gently; brush other teeth normally but avoid brushing directly near the surgical site for a few days. Rinsing the mouth gently with a warm saltwater solution (half a teaspoon of salt in a glass of warm water) several times a day can promote healing and reduce swelling. Strenuous physical activity, smoking, and alcohol should be avoided for at least 48 to 72 hours, as they can hinder the healing process and increase the risk of complications. A follow-up appointment will be scheduled to monitor healing and remove any non-dissolvable sutures.
Success Rates and Alternatives
Apicectomies have a high success rate, often ranging from 85% to 95%, in saving a natural tooth. This procedure allows patients to retain their natural dentition, which is preferred over extraction due to better long-term function and appearance. Success hinges on the complete removal of infected tissue and proper sealing of the root end.
When an apicectomy is not an option or is declined, the primary alternatives include repeating the conventional root canal treatment, if feasible, or tooth extraction. Root canal retreatment involves reopening the tooth to clean and reseal the canals, but this may not be possible if the original problem persists. If extraction is chosen, replacement options for the missing tooth typically involve a dental implant or a dental bridge. Implants are titanium posts surgically placed into the jawbone to support a crown, while a bridge uses adjacent teeth to support a false tooth.