Apicoectomy is an endodontic surgery usually done when there is a severe infection in the pulp or apex of the root. When there is a failure of root canal treatment and the retreatment was not successful, an apicoectomy is considered.

An apicoectomy is done on the root of the tooth, while a Root canal treatment takes place on the crown of the tooth.

Your teeth are placed in the jaw bone by the root of the teeth. The number of roots in a tooth can be one or more. The root ends narrow towards the end, and the tip is called the apex.

Nerves and blood vessels enter through the apex to reach root canal. They pass through the root canal and reach to the pulp chamber. When these nerves or the pulp gets infected, a root canal is required.

If apicoectomy is not possible or the treatment fails, the only option is the extraction of the tooth damaged by infection to prevent the infection from spreading to other teeth.

What is a root canal?

A Root canal is a treatment done to repair or save an infected tooth. In root canal treatment, the pulp is removed and then the cavity, where pulp was present, is disinfected. It is filled with suitable sealing materials and finally, it is sealed to prevent leakage.

Various symptoms are seen when infection invades the tooth. These symptoms are warning that you may have a damaged tooth and you may need a root canal treatment.

Severe pain in your teeth when you chew or apply pressure to a tooth is an indication that the infection has reached to the pulp. In the absence of root canal treatment, a dental abscess might form. The presence of infection acts as stimulation of pain to neurons present in the pulp and often starts as a toothache. (1)

Why is an apicoectomy required?

Root canals of the tooth are very complex, with many small accessory branches off the main canal. Sometimes, even after root canal treatment, small parts of infected pulp or nerves can remain in these branches and possibly prevent healing or again cause infection later.

Root canal failure often occurs due to leakage and thus sealing material should provide a proper sealing of the end root. (2)

Apicoectomy is done due to the failure of root canal treatment. The typical reasons for the failure of a root canal are –

  1. Severely curved root canals.
  2. Fracture at the apical third of tooth.
  3. Perforation of the root.
  4. Presence of irremediable filling material.
  5. Completely calcified root canal.
  6. Large unresolved lesions after root canal treatment.

How is apicoectomy done?

In an apicoectomy, the apex is removed along with the infected tissue. A temporary filling is put in to seal the exposed area.

The Time required for the treatment on front teeth are generally the less as compared to back teeth because front teeth have only one root, while those on lower molars take typically the longest because molar has two to three roots.

The procedure for apicoectomy goes as follows –

  1. Your dentist may take new X-rays of the infected tooth and gum around it.
  2. Local anesthesia is injected into the affected tooth. No more pain is experienced after administration of anesthesia.
  3. Your dentist will make a small incision on the gum to reach the root of the tooth. The Infection will be removed as along with the tip of the tooth for (only a few millimeters). The cleaning usually is done by using an ultra-microscope. (3)
  4. The shape and number of roots are significant factors that influence the total time for the surgery. Mostly the treatment is completed in 30 to 40 minutes.

Precautions and follow-up

  • Avoid hard food. Ingest only soft food and liquids at least for a few days.
  • The tooth and surrounding tissues where the surgery took place may be bruised and swelled, so you will need to apply ice over the treated area during the 12 hours after the surgery.
  • Avoid brushing your teeth or rinsing intensely after a few hours of treatment.
  • Avoid smoking because Smoking slows healing.
  • Recovering from an apicoectomy is comparatively easier than recovering from the original root-canal treatment.

Risks involved in apicoectomy

Your endodontist (dentist specifically concerned the dental pulp) will tell you the dangers before execution of treatment during your visits. The major risk is that the treatment might fail and the tooth may need to be removed.

According to a different position of the teeth different risks are involved. Like, the infection in the tooth present in the back of your jaw can affect your sinuses, which may lead to other serious problems.

The roots of the back teeth in the mandible (lower jaw) are closely related to some major nerves. Surgery on one of these teeth may have a slight risk of nerve damage. (4)

Final words on apicoectomy

Proper treatment for tooth infections is essential as these infections can advance over time and become life-threatening such as sepsis which can spread to other body parts such as ear and gums.

When a tooth infection is left untreated, then a tooth abscess is formed which gives persistent pain in the tooth which can also be spread to the mandible (jawbone), neck and other parts of the head. Tooth abscess leads to pus formation and if left untreated can lead to severe complications.

An apicoectomy is usually a permanent solution. It should last until the tooth is shed or extracted.