An apicoectomy is a surgical procedure that attempts to remove infection usually the result of a failed root canal surgery from the tip of the tooth root (apex) the are where nerves and blood vessels enter the tooth and travel through a canal inside the root and into the pulp chamber which is inside the crown or the part of the tooth visible in the mouth. During root-canal treatment the canals are cleaned and inflamed or infected nerve tissue is removed. Root-canal systems are very complicated with many small off-shooting branches. Sometimes even after root-canal treatment infected debris can remain in these branches and possibly prevent healing or cause re-infection later
When a root canal fails it is usually due to an unusual and undetectable tooth anatomy small accessory and lateral nerve canals that cannot be instrumented cyst formation or a cracked tooth. Most of these failed root canals can be saved with the exception of a severely cracked tooth.
The resulting infection of a failed root canal may be present in the absence of pain and 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.
An apicoectomy sometimes called endodontic microsurgery because the procedure is performed under an operating microscope is usually performed only after a tooth has had at least one root-canal procedure and usually a second root-canal treatment.
Before an apicoectomy it is more than likely that you will have a consultation with your dentist. 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 local anesthetic used for an apicoectomy has about twice as much epinephrine which is similar to adrenaline as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site. An effect of the local anesthetic will be an increase in heartbeat as the body responds to the epinephrine.
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. 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 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.
After surgery it is a good idea to ice the area for 10 to 12 hours and rest during that time as the area will usually bruise and swell. It may be more swollen the second day after the procedure than the first day. All soreness and swelling is typically gone after 14 days.
The procedure is very safe however if the surgery may does not work then the tooth may need to be extracted.