Apicectomy

What is an apicoectomy?

Apicoectomy is an endodontic surgery performed to remove the root tip and the surrounding infected tissue of an abscessed tooth, when inflammation or infection persists in the bony area around the end of a tooth after a root canal procedure.

What are the conditions that are treated through an apicoectomy?

Apicoectomy is done to treat the following

• Fractured tooth root
• A severely curved tooth root
• Teeth with caps or posts
• Cyst or infection which is untreatable with root canal therapy
• Root perforations
• Recurrent pain and infection
• Persistent symptoms that do not indicate problems from x-rays.

• Calcification
• Damaged root surfaces and surrounding bone requiring surgery

Are there any risks and complications associated with the procedure?

• The surgery may not work and the tooth may need to be extracted
• Nerve damage, if the tooth is in the back of the upper jaw
• If the tooth is cracked or fractured, it will need to be extracted

What are the procedures followed prior to the treatment?

• During the initial consultation, the expectations of the patient are understood
• The dental history, complete medical history and X-rays are taken
• Photographs are taken for further comparison after procedure.
• The dentist discusses and advises on options of treatment, type of facilities, risks, anaesthesia, limitations and cost with the patient.

Patient preparation

• The patient may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.
• The patient must inform the dentist if he/she has high blood pressure or knows that they have problems with epinephrine in local anaesthetics
• The patient must arrange for transportation and assistance to leave for home after the surgery.

What happens during the procedure?

• The tooth is numbed and the gum is cut and lifted to access the root of the tooth.
• The surrounding infected tissue and 2-3 millimetres of the root end is removed
• A dye is used to detect any cracks or fractures in the tooth.  The apicoectomy is stopped if the tooth is found fractured or cracked, in which case it will have to be extracted.
• To complete the apicoectomy, the tooth's canal is cleaned and filled to seal the end of the root canal
• The gum is repositioned, and held in place by a few ordinary or dissolvable sutures

The procedure takes between 30 to 90 minutes

What can be expected post-operatively?

Symptoms

• The area usually will bruise and swell being more swollen the second day after the procedure than the first day
• All soreness and swelling are usually gone by 14 days after the procedure
• There may be some pain, which can be controlled with prescription medication
• The patient may have some numbness in the area for days or weeks from the trauma of the surgery

What are the guidelines to be followed for post-operative recuperation and to get best results?

The stitches if non-dissolving will be removed two to seven days after the procedure

• The patient will receive postoperative instructions from the endodontist about taking medications and dietary restrictions.
• The patient should ice the area for 10 to 12 hours after the surgery and rest meanwhile.
• The patient should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods, to aid healing
• The patient must not lift the lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.
• The tooth may need to be extracted, if the surgery does not work
• The patients can return to work or other routine activities from the next day