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 or end of each root is called the apex. Nerves and blood vessels enter the tooth through the apex. They travel through a canal inside the root, and into the pulp chamber. This chamber is inside the crown (the part of the tooth you can see in your mouth).
During root canal treatment, your dentist cleans the canals using special instruments called files. Inflamed or infected tissue is removed. An apicoectomy may be needed when an infection develops or won’t go away after root canal treatment or retreatment.
Root canals can be very complex, with many tiny branches off the main canal. Sometimes, even after root canal treatment, infected tissue can remain in these branches. This can 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 endodontic microsurgery because it is often done using an operating microscope.
What It’s Used For
If a root canal procedure has been done in the past and it becomes infected again, it’s often because of a problem near the apex of the root. In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect other canals that were not adequately treated. In this case, they may be able to clear up the infection by doing a second root canal procedure. This will avoid the need for an apicoectomy.
An apicoectomy is done only after a tooth has had at least one root canal procedure and retreatment has not been successful or is not possible. For example, retreatment is often not a good option when a tooth has a crown or is part of a bridge. Retreatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An apicoectomy is often considered in a situation like this.
An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip
Before the procedure, you will have a consultation with your dentist. A general dentist with advanced training may do an apicoectomy. However, with the advances in endodontic microsurgery most patients are referred to an endodontist or to an oral and maxillofacial surgeon. An endodontist has at least two years of extra education in diagnosis and root canal treatment, including apicoectomies. Oral and maxillofacial surgeons are dentists who have an extra four to six years of training in surgery.
Before the surgery, your dentist may take more X-rays of the tooth and surrounding bone. You may be given an antimicrobial mouth rinse, a medicine to reduce inflammation, and/or antibiotics.
Your dentist also will review your medical history. Make sure you tell your dentist of all medicines you take. This includes over-the-counter medicines, vitamins and supplements. Depending on other existing medical conditions, your dentist may consult with your physician before the procedure.
How It’s Done
The endodontist will make a small incision (cut) in your gum and lift the gum away from the tooth and bone. The dentist may need to use a drill to gain access to the root. The infected tissue will be removed along with the last few millimeters of the root tip. The endodontist may use a dye to highlight cracks and breaks in the tooth. If the tooth has large cracks or breaks, it may need to be extracted. In this case, the apicoectomy will not continue.