The teeth are held firmly in place by strong roots that extend into the jawbone. Molars and premolars tend to have several roots, whereas the front incisors only have a single root. The end or tip of each root is termed the apex. The apex is where the nerves and blood vessels enter the tooth, and aids in the delivery of blood to the crown (the part of the tooth you can see in your mouth).

A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection persists after the root canal treatment, an apicoectomy may be required. An apicoectomy is essentially the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.

Reasons for an apicoectomy

Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating to the patient. The purpose of an apicoectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. An apicoectomy will rarely be considered by the dentist unless a prior root canal treatment has failed and is not amendable to retreatment.

There are several reasons why an apicoectomy may be necessary:

• Small Adjoining Root Branches – Roots are extremely complex and can contain many tiny branches. If these tiny branches or lateral canals cannot be cleaned and sealed properly when the root canal treatment is performed, inflammation and infection can persist.
• Blocked Root Canal – In some cases, the dentist is unable to effectively clean the complete root canal system because it is blocked by a fractured file left behind from prior root canal treatment or is naturally blocked. Infection and debris can quickly affect adjacent teeth.
• Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip (apex). Continuing infection or re-infection can then occur with persistant pain and swelling.

What does getting an apicoectomy involve?

Prior to the surgery, the endodontist will generally prescribe an antibiotic or anti-inflammatory medication to treat the underlying infection. Digital radiographs (x-rays) will then be taken to enable the doctor to plan the apicoectomy, which will be performed under local anesthesia.

The dentist will make a small entrance into the gum and expose the root tip by displacing the soft tissues away in most cases, a tiny window through the jawbone may be made to properly expose the problem root. The edge of the root tip and any infected connective tissues will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material) and the dentist will suture the gum tissues with several non-resorbable stitches.

This surgery does not require an overnight stay, and full aftercare instructions and a prescription for a pain medication will be provided as needed. After several days, the dentist will remove the stitches. The soft tissues will be well healed in a short period of time, while the bone healing and the surrounding connective tissues will fully heal during the next several months after the procedure. Several follow-up appointments will be included to evaluate the continuing healing process.

If you are experiencing any signs or symptoms, such as pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office immediately to schedule an appointment for a consultation.