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Apicoectomy

What Is It?
Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth). A root canal may need to be done if there is an infection or abcess in the tooth. A root canal procedure removes all of the infected tissue and abcess from within the chamber and canals of the infected tooth.

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.
An apicoectomy is sometimes called a “surgical root canal.”

What It’s Used For?

If a root canal becomes infected again after a root canal has been done, it’s often because of a problem near the apex of the root. Drs. Gorab, Marsh and Scoggins can do an apicoectomy to fix the problem so the tooth doesn’t need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.

In some cases, a second root canal treatment may be considered before an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Preparation
Before the procedure, you may have a consultation with Drs. Gorab, Marsh and Scoggins. Your general dentist or the specialist referring you to our office may send a recent x-ray of the tooth. If not, an x-ray will be taken in our office. At the consultation visit, Drs. Gorab, Marsh and Scoggins will evaluate the tooth and determine if an apicoectomy procedure is in your best interest or if another procedure would be more beneficial. If an apicoectomy is decided upon, you will be scheduled and the type of anesthesia for your surgery discussed.

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How It’s Done
The doctors will make an incision and lift the gum away from the bone so the root is easily accessible. The infected tissue will be localized and removed along with the last few millimeters of the root tip. If it is determined that the infection is being caused by a cracked or fractured tooth and that the tooth may have to be extracted, the apicoectomy will not continue.
If a fracture is not seen, the apicoectomy will continue and the tip of the infected root(s) will be removed. After this step, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done using ultrasonic instruments with very fine tips. Your surgeon then will suture the incision closed and take an X-ray of the area.
Most apicoectomies take 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.

Follow-Up
You will receive instructions from the doctors about which medications to take and what you can eat or drink. You should ice the area for 10 to 12 hours after the surgery, and rest during that time.
The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.
You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.
Stiches placed will likely be dissolvable and will disappear from 4-7 days after the surgery. All soreness and swelling are usually gone by 5-7 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

Risks
Drs. Gorab, Marsh and Scoggins will review the risks of the procedure at the consultation appointment. The main risk is that the surgery may not work and the tooth may need to be extracted.
Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, Drs. Gorab, Marsh and Scoggins will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small. An apicoectomy is usually a permanent solution, and should last for the life of the tooth.