This article will take a brief look at apiocectomies (apicectomy in the UK). This is a surgical dental treatment, performed on teeth that do not settle after root canal treatment.
Apicoectomy is a surgical-endodontic procedure – involving the reduction of the apical (tip) portion of a tooth root. This usually is done after a failed root canal treatment and involves the sealing of this infected tip area with a biocompatible material.
It is also known as root-end resection.
When might it be needed
There are two groups of reasons why one may need this procedure:
1. Biological indications
- Where there are persistent symptoms (such as post-root canal pain) and/or a continued presence of pathology (eg an abscess or draining ‘sinus’/fistula)
- Blockage of the natural root canal spaces due to calcification (also known as ‘sclerosis’) – Whereby conventional endodontics may be impossible.
2. Technical indications
- For remedy of iatrogenic defects (ie those caused by the original endodontic treatment) like ledges, fractured instruments and perforation defects.
- For better visualization of the periradicular area (ie the tip of the root), where sealing this area can’t be achieved otherwise.
The procedure is usually only recommended after endodontic re-treatment has been tried, although this recommendation may vary depending on where you live in the world.
Very briefly, here is a typical procedure broken down into steps:
- Prescription of anti-inflammatory medications and/or antibiotics beforehand.
- X-rays of the surgical area are required for proper planning of the procedure.
- The area is anaesthetized with the help of local anesthetic (usually lignocaine).
- The dentist will first cut the gum above the tooth, with the help of an incision to design a marginal (sulcular) flap for better visibility and accessibility.
- This flap is lifted away from the tooth with the help of elevators, exposing the bone surrounding the teeth.
- A “window” is created around the tooth root by removing some bone (alveolectomy). This is done using a dental drill and copious normal saline irrigation, to expose the tooth tip.
- Then, the root tip is resected (ie cut away), usually 1-3 mm is taken. This is done either with the help of a dental drill or laser.
- A “retrograde cavity” (ie a space that extends slightly into the root of the tooth) is prepared and cleaned.
- This cavity is filled with a “retrograde” filling of amalgam or reinforced zinc oxide cements. These seal the area, with the aim of preventing further infection.
- Finally, the gum tissue is sutured back in its position.
Your dentist will then give you post operative instructions, to help with fast healing. This may include some of the below points…
Recovery time and aftercare
Recovery should be quick and is usually without complications.
After care instructions that you will need to follow include:
- Maintenance of good oral hygiene
- Placement of ice packs on the surgical site, to help reduce swelling
- Avoid vigorous brushing around the surgical site
- Take any medications prescribed.
- Avoid smoking for at least two days.
You may need to be reviewed a few days after the surgery, on the day of suture removal and then after first, sixth and twelfth month and later as needed. This is to ensure proper healing in the first instance and then to ensure that the area continues to remain free form pathology (ie infection).
Apicoectomy Success Rate
The prognosis depends on several factors, including:
- The skills of the operator
- Any specialist eqiuipment used – eg use of a microscope may improve success rates.
- The quality of the ‘traditional’ endodontic treatment
- Other ‘tooth’ factors such as gum health and proper restoration with a crown or filling
- The condition of the root tip in terms of level of infection
- General health of the patient, in particular bone health.
But in general, so long as it is properly planned in terms of patient/tooth suitability, the procedure enjoys excellent success rates (of more than 90% when used in ideal conditions).
Possible apicoectomy complications
As with any surgical procedure, there are some possible complications and side effects. Your dentist will inform you of these and take every possible step in terms of planning and treatment to reduce these risks:
- Pain, usually only lasts a few days and should be manageable with analgesics
- Tenderness or swelling of the gum area
- Mobility of tooth – it may fee looser for a time
- Infection of the surgical site
- Prolonged numbness after surgery is a known risk you should be informed about.
Possible causes of apicoectomy failure
Any failure of the treatment may be due to one of these factors:
- Improper selection in the first place – ie the tooth/patient was not suitable for an apicoectomy. An example here would be where the conventional root canal treatment is inadequate, and should have been repeated before any surgery.
- Reinfection inside the root canal even after the procedure.
- Improper apical sealing – allowing reinfection
- A poor ‘coronal’ seal – basically means that a filling or crown has not sealed the tooth adequately.
If failure occurs, the tooth will likely have to be extracted.
The cost of an apicoectomy procedure depends upon many variables! The include the position of the tooth, whether or not any sedation is needed, any follow up treatment such as crown work and of course where you live.
Ask your dentist if you have any further queries about an apicoectomy.