An apicoectomy is a dental surgical procedure focusing on the root tip of a tooth. It involves removing the root’s very end, known as the apex, along with any infected or inflamed tissue surrounding it. Also referred to as root end surgery or retrograde root canal treatment, its purpose is to preserve a tooth that might otherwise need extraction. It is performed when a conventional root canal has not fully resolved an infection or inflammation at the root’s end.
Reasons for an Apicoectomy
An apicoectomy is necessary when a standard root canal treatment has not fully cleared an infection or inflammation at the tooth’s root tip. Even after a root canal, residual infection or inflammation can persist, often due to complex root canal anatomy that traditional methods cannot reach.
Fractures in the lower part of the tooth root can also lead to the need for an apicoectomy. These tiny cracks, sometimes invisible on X-rays, can allow bacteria to re-enter the root canal system, causing ongoing infection. Calcium buildup within the root canal system is another reason, as it can block the canal, preventing thorough cleaning during a conventional root canal.
The presence of an abscess or cyst at the root tip, a pocket of pus or fluid, often signals a persistent infection that requires surgical removal. Sometimes, an apicoectomy is performed to locate the source of a problem not visible on an X-ray, such as a hidden fracture or an additional, untreated canal.
Steps of the Apicoectomy Procedure
The apicoectomy procedure begins with local anesthetic administration to ensure comfort. Once the area is numb, the endodontist makes a small incision in the gum tissue near the affected tooth. This lifts the gum, exposing the bone and root tip.
Using specialized microsurgical instruments, often with a dental operating microscope for enhanced visibility, the endodontist carefully removes the root tip. Infected or inflamed tissue, such as cysts or granulomas, in the surrounding bone is also removed. This eliminates the source of persistent infection.
After removing the root tip and infected tissue, the root canal end is cleaned and prepared. A small filling, typically made of biocompatible material like mineral trioxide aggregate (MTA), is then placed into the prepared root end to seal the canal. This prevents further bacterial leakage. The gum tissue is then repositioned and secured with sutures.
After the Procedure and Alternatives
Following an apicoectomy, patients can expect some discomfort, swelling, and bruising in the treated area, which typically subsides within days. Over-the-counter pain medication can manage discomfort, and ice packs can reduce swelling. Most patients can resume normal activities within 24 to 48 hours, though strenuous exercise should be avoided for several days.
Post-operative instructions usually include avoiding hard or sticky foods, rinsing gently with a saltwater solution, and maintaining good oral hygiene by carefully brushing around the surgical site. Complete bone healing can take several months. Follow-up appointments, often with X-rays, monitor this process.
Apicoectomies have a high success rate, typically 85% to 95%, especially with modern microsurgical techniques. This procedure offers a strong chance to save a tooth. The primary alternative is tooth extraction.
If tooth extraction is chosen, several options are available to replace the missing tooth. These include dental implants, which are surgically placed into the jawbone and topped with a crown; dental bridges, which use adjacent teeth as anchors for an artificial tooth; or removable partial dentures. Each alternative has considerations regarding cost, appearance, and function, but all aim to restore the bite and prevent adjacent teeth from shifting.