Dental Apicoectomy

An apicoectomy procedure is not the same as a root resection. A root resection involves the removal of an entire root, rather than just the tip.

Our teeth are held in place by roots that extend into the jawbone. The front teeth usually have one root, while the back teeth contain two or more. The tip of a root, called the apex, is the area where the nerves and blood vessels enter the tooth. If infected tissue is found outside of the apex area, an apicoectomy is performed to remove the infected tissue.

Apicoectomy Consultation

During your consultation, the risks associated with the procedure is explained to you. One of the main risks is that it may not work and the tooth will need to be extracted. It is important to understand what your chances are, and what your options are. A single implant, a fixed bridge or even a partial denture may be some alternatives you may need to investigate, before undergoing this procedure.

There may be other risks that are dependent on the location of the tooth. If the tooth is located in the back upper jaw area, the infection can involve the sinuses, and the use of antibiotics and decongestants may be recommended. If the tooth is located in the back lower jaw area, an area that is close to some major nerves, surgery in this area carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and discuss his findings with you accordingly. Do not hesitate to ask any questions or request clarification on anything that may not be clear. You are having surgery, and with any surgery there are risks. You should have enough information that makes you comfortable enough to make an informed decision.

The Procedure

An apicoectomy procedure involves the endodontist cutting and lifting the gum away from the tooth to make access to the root. Infected tissue will then be removed along with a few millimeters of the root tip. A dye will then be applied to the tooth in order to highlight any cracks and fractures in the tooth. If the tooth contains any cracks or fractures, an extraction may be advised instead. If there are no damages to the tooth, the procedure will continue. In order to complete the procedure, 3 to 4 millimeters of the tooth's canal will be cleaned and sealed. The cleaning is usually performed with the use of a microscope and ultrasonic instruments. This increases the chances for success because light and magnification allows for an optimal view of the area.

Apicoectomy Procedure

Average Surgery Time

The average surgery time of an apicoectomy can range from 30 to 90 minutes. This is dependent upon the location of the tooth, the complexity of the root structure and of course, the skills of the endodontist. If the procedure is performed on the anterior, it will generally be shorter, than if performed on the molar teeth.

Post Care Instructions

In addition to receiving post care instructions regarding medications and food intake from your dentist, you should place an icepack on the outside of the mouth at the surgical site for at least 10 to 12 hours after the surgery. This will help to alleviate bruising and swelling. To help with the healing process, avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Also, do not lift your lip to examine the area, as this can disrupt the blood-clot formation and loosen the sutures.

Some individuals may experience numbness at the surgical site for days or even weeks. While this is not necessarily a sign of nerve damage, you should let your dentist know about it. Generally, if all goes well, the sutures are removed 2 to 7 days after the procedure has been performed and any soreness and swelling that was experienced, should be gone by the 14th day.

Possible Alternatives

An apicoectomy involves removing infected tissue and is performed only after a tooth has had at least one root canal. If it is performed during the root canal procedure, the canals are cleaned, and the infected tissue is removed. But, due to the complexities involved in a root canal procedure, which involves several branches of the tooth, sometimes after the procedure is performed, infected debris can remain in these branches. This can disrupt the healing process and cause reinfection. This is usually a sign of a problem near the apex of the tooth. In many cases, a second root canal treatment may be considered before an apicoectomy procedure is performed.

Because of the advancements in technology, dentists often can detect additional canals that need retreatment and can clear up the infection by doing a second root canal procedure, avoiding the need for an apicoectomy. If a second root canal cannot be performed, the apicoectomy is performed and the tip of the root (the apex), is removed along with the infected tissue. A dental filling is then used to seal the end of the root. Considered a permanent solution, once an apicoectomy is performed it is expected to last for the lifetime of a tooth.

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