Last updated date: 15-Aug-2023
Originally Written in English
Apicoectomy is a simple and minor surgical procedure performed on children and adults. It aims at saving at-risk teeth and avoiding potentially severe complications. Root end surgery is another name for an apicoectomy. This is due to the fact that it necessitates removing the tip of the tooth's root as well as nearby tissue. It is also known as apical surgery, meaning the tooth's apex or end.
The dentist can recommend an apicoectomy. It’s most likely because, despite having undergone a root canal, there is still inflammation or an infection around the root tip that has spread into the jawbone.
Why Apicoectomy is done?
When a regular root canal treatment has been conducted on a tooth yet it’s not enough to save the tooth and avert additional complications; the procedure is normally recommended.
An apicoectomy might be beneficial in circumstances when there is an anatomical concern with the root tip. This includes one root encroaching into the area of the root close to it, preventing issues that could impact numerous teeth in the future.
If the dentist recommends an apicoectomy, it's normally because there is no other option than to have your entire tooth extracted. To keep the neighboring teeth from slipping, you would require a bridge, implant, or removable partial denture.
Roots that pull out into the jawbone keep your teeth in place. There is usually one root of the front teeth. The premolars and molars, for instance, have two or even more roots. The apex is the tip or end of each root and it is where nerves and blood arteries get into the tooth. They make their way into the pulp chamber via a canal in the root. The chamber is located within the crown, the section of the tooth that is visible in your mouth.
The dentist cleans the canals with special equipment known as files during root canal treatment. Tissue that is inflamed or diseased is removed. If an infection develops or persists following root canal treatment or retreatment, an apicoectomy may be required.
Root canals can be extremely complex, with numerous little branches branching off the major canal. The infected tissue can sometimes linger in these branches even after the treatment. This may obstruct healing or lead to re-infection in the future. The root tip, or apex, along with the damaged tissue, is taken out during an apicoectomy. The tip of the root is then sealed with a filling.
Because an apicoectomy is frequently performed under an operating microscope, it is also known as endodontic microsurgery.
Is apicoectomy painful?
The surgery is usually made more comfortable by the use of local anesthetics. While the incision heals, you may have some discomfort and mild swelling. This is common after any surgical treatment. To relieve your pain, your endodontist will prescribe the proper pain medication.
Your dentist will also provide you with detailed postoperative instructions. Contact your provider if you have any questions following your operation or experiencing pain that is not responding to medication.
How to Prepare For Apicoectomy?
A consultation with the dentist will take place prior to the treatment. An apicoectomy can be performed by a general dentist who has advanced training. Most patients refer to an endodontist or an oral and maxillofacial surgeon due to developments in endodontic microsurgery. An endodontist has completed at least two years of additional training in root canal diagnosis and treatment, as well as apicoectomies.
Your dentist can take several x-rays of the tooth and nearby bone before the surgery. Antimicrobial oral rinses, anti-inflammatories, or antibiotics may be prescribed.
In addition, the dentist will assess your medical background. Be sure that your dentist is aware of any medications you are taking, including over-the-counter medications, vitamins, and other supplements. Your dentist may check with your physician prior to the operation if you have any additional medical concerns. It's also essential to consider apicoectomy costs.
How Apicoectomy is done?
You will receive local anesthesia to numb the region surrounding the problematic tooth before the procedure begins. In order to get to the root, the dentist or endodontist will slice via the gum tissue and push it aside during the treatment. Only a few millimeters of the root, as well as any damaged tissue close to the root, are usually removed.
The root canal within the tooth is then cleaned and sealed using a tiny filling following the root tip is removed to prevent infection later. The dentist can take a second x-ray to ensure that your tooth and jaw are both in good shape and that there aren’t any areas where a new infection might occur.
After that, the tissue will be sutured or sewn to enable the gums to recover and grow back into place. In addition, the jawbone will heal near the filling at the root's end over time.
During the operation, you should experience little to no pain or discomfort. It normally takes about 30 to 90 minutes to do an apicoectomy. The time it takes to finish the procedure depends on the location of the tooth and the complexity of the root structure.
Follow Up and Recovery Following Apicoectomy
The endodontist will advise you on the best medications to take and the foods or beverages you can consume during apicoectomy recovery. Apply ice to the affected area for 20 minutes on and 20 minutes off. You should do this for at least 10 to 12 hours following surgery and then take a break.
The region may bruise and even swell. The second day following the surgery may be more swollen than the first. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin, among others), can help relieve any pain. You might get a prescription for pain medication in some instances. If that's the case, take it according to the directions.
Avoid forceful rinsing or brushing the area to allow for healing. Smoking and eating crunchy or hard foods are also not recommended. If you want to examine the area, don't elevate your lip. This can dislodge the stitches and prevent the blood clot from forming, which is necessary for healing.
After the procedure, you may experience numbness in the region for a few days or even weeks. If this is the case, inform your dentist. The numbness normally resolves with time. The stitches may require removal after two to seven days, or they may disintegrate on their own. Within 14 days, all discomfort and swelling should be gone.
Despite the fact that an apicoectomy is considered surgery, most patients claim that it is easy to recover from than the original root canal treatment.
Success Rate of Apicoectomy
Apicoectomy is a common dental procedure that can be done as an outpatient. According to a recent study, almost 97 percent of all cases had outstanding results up to five years after apical surgery. More than 75 percent of cases had good results after 10 to 13 years.
Another study indicated that apical surgery was a viable technique to save teeth that were infected or had other root abnormalities, with approximately a 91.4% success rate after one year.
Risks and Complications of Apicoectomy
During the consultation session, the endodontist will go through the procedure's risks with you. If anything is unclear, be sure to ask more questions. The most significant danger is apicoectomy failure, and the tooth would have to be taken out.
Other apicoectomy complications may exist based on where the tooth is situated. The infection can spread to the sinuses if the tooth is toward the back of your upper jaw. The physician can prescribe antibiotics and decongestants to prevent infections.
In the lower jaw, the roots located behind the teeth are close to certain main nerves. A small risk of nerve injury exists when one of these teeth is surgically removed. On the other hand, the endodontist will utilize your x-rays to determine how near the roots are towards the nerves. There is a very low probability of nerve injury. In most cases, an apicoectomy is a long-term treatment. It will last the rest of the tooth's life.
When to See a Dentist
Contact your dentist if you experience any discomfort or swelling from a root-canal treatment tooth. A pimple may appear near the tooth following a root canal. This pimple will normally disappear and reappear. This is referred to as a fistula.
It's possible that pus might drain from the fistula. The fistula indicates that you have an infection that is being drained through the pimple. In this case, there is usually no discomfort, but you may detect a terrible taste or odor from the mouth.
An apicoectomy is an alternative outpatient surgical operation when normal root canal treatment is not adequate to save and preserve a tooth. It might be crucial in preventing significant difficulties regarding your mouth and jaw health. An apicoectomy is frequently advised when a root canal procedure has failed, and an infection has developed near the root tip.
You should know that the removal of your entire tooth is an alternative to an apicoectomy. Therefore, if the dentist suggests root tip surgery, think about it carefully. Make a decision about obtaining an apicoectomy as soon as possible. An infection on one of your teeth has the potential to spread and cause significant dental complications.