An apicoectomy, also known as a root-end resection, is a surgical procedure that removes infection at the root tip as well as the surrounding infected areas of an abscessed tooth.
An apiocoectomy is usually needed due to a failed root canal treatment. During a root canal, the canals are cleaned and inflamed and infected nerve tissue is removed. Root canal systems are very complicated with many small off-shooting branches. Sometimes even after a root canal treatment infected debris can remain in these branches and possibly prevent healing or cause re-infection later.
The resulting infection of a failed root canal may be present in the absence of pain, therefore, X-ray evidence is usually required to diagnose the problem. An infection shows up on an X-ray as an unresolved black circle around the tooth. Sometimes a fistula or pimple might be present in the gum.
The procedure itself takes between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest; those on lower molars generally take the longest. Since the local anesthetic used for an apicoectomy has about twice as much epinephrine as the anesthetics used when getting a filling, if you have high blood pressure or know that you have problems with epinephrine in local anesthetics, let your dentist know at the consultation.
- The surgeon, or endodontist (root canal specialist), 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. If the tooth is cracked or fractured, it may have to be extracted and the apicoectomy will not continue.
- To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and filled. The cleaning usually is done under a microscope using ultrasonic instruments. An X-ray of the area is taken before suturing the tissue back in place.
- Ice the area frequently for 20 minutes at a time for the next day to help reduce bruising and swelling. All soreness and swelling is typically gone after 14 days.
- Rinse with a warm salt water solution, which will reduce swelling and possible infection.
- Eat soft foods to avoid causing further trauma to your mouth.
- Take ibuprofen as needed for pain.
If the surgery does not clear up the infection, the tooth may need to be extracted.
To find out whether you’re a candidate for an apicoectomy, consult a dentist in your area.