An apicoectomy is a surgical procedure in which the tip of a tooth root is removed. It is usually performed after a failed root canal.
During root canal treatment, the canals are cleaned, and inflamed or infected nerve tissue is removed from inside the tooth. But these canal systems are very intricate and can have many small branches. Sometimes, even after a properly done root canal procedure, infected debris can remain in these branches and prevent complete healing.
When a root canal fails it will become infected. There may be no pain at all, you may just have a tenderness in the tooth, or you may have a regular toothache. The first symptom may be draining occurring in the mouth, or it may not show up until an x-ray examination. An infection shows up on the x-ray as a dark circle around the end of the tooth. Sometimes a fistula, or pimple, can be present in the gum, over the area of the tooth apex.
An apicoectomy is not an invasive or complicated surgical procedure, and recovery is usually quick. The local anesthetic used for an apicoectomy has about twice as much epinephrine as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site. A side effect of the epinephrine will be that you will likely notice a speeding up of your heart rate.
The procedure itself may take from 20 to 60 minutes, depending on the location of the tooth and the number of roots involved. Procedures on front teeth are generally the shortest; those on lower molars generally take the longest. The long-term success rate or prognosis for a tooth is significantly reduced when an apicoectomy is needed. Apicoectomy is more difficult to perform in posterior teeth because of difficulty in vision, surgical access and the complexity of multi-rooted teeth.
During the operation the dentist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue is removed along with the last few millimeters of the root tip. The tooth will be examined at this time, and if it is cracked or fractured, the apicoectomy will not continue and extraction will be recommended.
To complete the apicoectomy, the final 1 to 4 millimeters of the tooth’s canal may be cleaned and filled—a procedure called a retrofill. The cleaning may be done with ultrasonic instruments, or with a basic dental drill. This preparation used to be filled with dental amalgam, but other dental restorative materials are now also used. An X-ray of the area is taken before suturing the tissue back into place.
Recovery is usually uneventful, but ice packs may be recommended to keep the swelling down. All soreness and swelling should be completely gone within two weeks.
If the root canal surgery isn’t successful, the tooth will likely need to be extracted.