An apical surgery, often referred to as an apicoectomy or root-end resection, is a specialized dental procedure performed at the very tip of a tooth’s root. This microsurgical approach aims to resolve infections or inflammation that persist in the bony area surrounding the root, even after conventional root canal treatment. It involves carefully removing the affected root tip and sealing the area to prevent future issues, thereby preserving the natural tooth.
Reasons for an Apical Surgery
An apical surgery becomes necessary when a tooth continues to exhibit infection or inflammation despite having undergone a traditional root canal procedure. In approximately 10% of root canal cases, issues can persist, often due to complex anatomy or lingering bacteria.
This can occur if bacteria remain in tiny, inaccessible canals or if the previous treatment did not fully eliminate the infection. Additionally, anatomical complexities such as very narrow, curved, or blocked root canals can prevent a thorough cleaning during a standard root canal procedure. In such instances, an apicoectomy allows direct access to the root tip to remove the affected tissue.
The procedure is also indicated when there is a cyst or lesion at the root apex that fails to heal following initial root canal therapy. Sometimes, a fractured root or a root with a hole that cannot be repaired conventionally may also necessitate this surgery to save the tooth.
The Surgical Procedure
Apical surgery typically begins with a local anesthetic to thoroughly numb the area around the affected tooth, ensuring patient comfort throughout the procedure. While you should not feel pain, you might experience some mild pressure.
A small incision is made in the gum tissue near the affected tooth, and the gum is gently lifted to expose the underlying bone and root. Using specialized micro-surgical instruments, the infected tissue and the very end of the root tip, typically about 3 millimeters, are carefully removed.
After removing the infected tip, the end of the root canal is cleaned. A small, biocompatible filling material, often mineral trioxide aggregate (MTA), is then placed into the sealed end of the root canal. This material seals the canal and prevents reinfection. Finally, the gum tissue is repositioned, and sutures are placed to close the incision for healing. The entire surgery generally takes less than 90 minutes, with many procedures completed in under an hour.
Recovery and Aftercare
Following apical surgery, it is normal to experience discomfort, swelling, and bruising after the procedure. Over-the-counter pain relievers, such as ibuprofen, or prescribed medications can manage this discomfort. Applying an ice pack to the outside of the cheek over the surgical site in cycles of 20 minutes on and 20 minutes off can help reduce swelling, especially during the first 24 hours.
During recovery, stick to soft foods like soups, yogurts, and smoothies for the first few days. Avoid hot beverages, spicy foods, and foods requiring vigorous chewing on the surgical side. Maintaining oral hygiene is important, but avoid direct brushing of the surgical site for the first 24 hours. After this period, gentle rinsing with warm salt water several times a day can aid in healing and keep the area clean.
Avoid strenuous physical activity for at least 48 hours to minimize bleeding or swelling. Refraining from smoking and using straws is also advised for at least 72 hours, as the suction and chemicals can disrupt the healing process and increase infection risk. Most patients can resume normal activities within a few days, but full bone healing around the treated root may take several months. Follow-up appointments are scheduled to monitor the healing progress and, if necessary, remove sutures, typically within a week. A follow-up exam is often performed six months post-surgery to evaluate the treatment outcome.
Apical Surgery Versus Other Dental Procedures
Apical surgery is distinct from a standard root canal, though both procedures aim to save an infected tooth. A traditional root canal treats infection by cleaning and sealing the internal root canal system, which involves removing infected pulp from inside the tooth. In contrast, an apical surgery, or apicoectomy, is a surgical intervention performed when a conventional root canal has not fully resolved the problem, specifically addressing infection or inflammation at the very tip of the tooth’s root.
This procedure often serves as a necessary follow-up to a failed root canal, targeting issues that are inaccessible through internal retreatment. An apicoectomy is a tooth-saving measure, allowing patients to retain their natural tooth rather than resorting to extraction. While tooth extraction is an alternative, it involves removing the entire tooth, which can lead to further complications like jawbone shrinkage or shifting of adjacent teeth. Therefore, apical surgery is often considered a definitive step to preserve the tooth’s function and maintain the integrity of the dental arch when other less invasive options are no longer viable.