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Apicoectomy

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.

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 cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
  • Blocked Root Canal – In some cases, the dentist is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment. 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. Continuing infection or re-infection can then occur.

What does getting an apicoectomy involve?

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

The dentist will make a small incision in the gum and expose the root by lifting away the gum. In some cases, a tiny fraction of the jawbone may be removed to properly expose the root. The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material) and the dentist will suture the gum with several stitches.

This surgery does not require an overnight stay, and full aftercare instructions and pain medications will be provided as needed. After several days, the dentist will remove the stitches, and the connective tissues will fully heal several months after the procedure.

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.

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Testimonials

I went to Dr. Lee and he was the best. He seemed to care a lot about details to make sure everything was done right, and he made me feel very comfortable. Highly recommend.

Sam, Winston – Salem, NC

One of MD's Best! If you are able to be flexible on your dentist, Dr. Lee is one of the best dentist's in Maryland. I had been a patient of his for years until I moved and changed insurance plans. I'm sad to say that I haven't found any dentist quite as good as Dr. Lee had been. He's great at making recommendations, getting ot know each patient individually, and just has an overall great demeanor and personality.

Tatiana, Gaithersburg, MD

I appreciated that they were still concerned about my health even after I left the office. They followed up with me after my appointment and everything. I was completely at ease during my appointment here. They went to great lengths to make sure I was completely relaxed and comfortable the entire time. They are so kind and caring, and they stay open way past their closing time to help anyone who needs them. They wouldn't deny anyone that needed help. I know I can always count on them. They had a huge selection of magazines in the waiting room. I was able to find some of my favorites and they kept me entertained while I was waiting for my appointment. I knew I was getting top-of-the-line treatment when they told me about what they learned at the latest conference they attended, and how they were incorporating that knowledge into the practice.

Marian, Baltimore, MD

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