What is an apicoectomy?

An apicoectomy is an endodontic procedure that is performed when a root canal treatment fails to remove all the dead nerves and inflamed tissues within the root.  When there is inflammation or infection after the root canal treatment, the dentist will then recommend an apicoectomy procedure, which is removing the apex or root tip, followed by a filling procedure, in order to seal the root and prevent further infection. Infected roots, when left untreated, can spread infection and damage other teeth, causing regression of the jawbone.

It is the strong roots extending into the jawbone that hold teeth firmly in place. The front teeth called incisors have a single root, while the molars and premolars have several roots.  The apex is the tip or end of each root, and is where the blood vessels and nerves enter the tooth, and aids in delivering blood to the crown of the tooth, which is the visible part of your tooth.

Reasons for an apicoectomy

A dentist will suggest apicoectomy procedure only when a prior root canal treatment has not proved to be successful.   Infection and inflammation around the root of a tooth can be exceedingly painful to a patient.  The dentist will perform an apicoectomy to remove all the infection in the tooth tissue and save the tooth from extraction.

Below are some of the reasons why a apicoectomy may be necessary:

  • Adjoining Small Root Branches – Tooth roots contain several tiny branches and are extremely complex.  Inflammation can persist when these tiny branches are not cleaned and sealed when performing the root canal treatment.
  • A Blocked Root Canal – There are instances when a root canal cannot be cleaned effectively by the dentist, especially when the root canal is blocked by a fractured file left back from a previous root canal treatment.  In such cases, infection and debris can set in and affect the adjacent teeth
  • Narrow or Curved Root Canals – There are root canals that are poorly shaped, and in instances like this, it is difficult for the endodontic files to reach the root tip. Continuing infection or reinfection can then occur.

 What does getting an apicoectomy involve?

The dentist will prescribe antibiotic or anti-inflammatory medication to treat any underlying infection prior to the apicoectomy treatment.  Panoramic x-rays are taken to enable the dentist to plan the apicoectomy, which is generally done under local anesthesia.

By making a small incision in the gum, the dentist will expose the root by lifting the gum, and there are some instances where a tiny fraction of the jawbone may have to be removed, to expose the root properly.  Using ultrasonic instruments, the dentist will then remove any infected connective tissue from the edge of the root tip, and will suture the gum with the necessary stitches only after using a retrofill (filling material) and sealing the root.

This surgery does not require an overnight stay, and the dentist will provide the necessary pain medications and full aftercare instructions. After a couple of days, the stitches will be removed by the dentist.  Though the connective tissues generally heal several months after the procedure, most patients can get back to their normal activities the next day.

If you are experiencing any pain or swelling after a root canal treatment, please contact our team at Artistry in Smiles or call us at (209) 812-0041 to set up an appointment. Our office is conveniently located at 816 2nd Street and is open to new and established patients seeking dental care within the community.