An apicoectomy is a dental procedure that is required when a normal root canal treatment is unable to get rid of infected tissues in the root canal. When this happens, it can impede the healing process of the teeth or cause reinfection. During an Apicoectomy, the end of a root canal is sealed with a filing after the root tip (apex) and infected tissues are removed. Apicoectomy is also called an Endodontic Microsurgery since it is generally done using an operating microscope.
Often a root canal becomes infected again after a root canal treatment (RCT) as a result of some problem near the apex of the root. Dentists or endodontists usually recommend another RCT before opting for an apicoectomy. If your dentist can clear up the infection with a repeat root canal procedure, you don’t have to go for an apicoectomy.Thanks to new technology, improperly treated root canals can be easily identified today.
Note that an apicoectomy is not the first option to get rid of a root canal infection. At least one root canal treatment must have failed before your dentist should decide on an apicoectomy. People often confuse apicoectomy with root resection but it’s not same. In an apicoectomy, only the root tip or apex is removed but in a resection, an entire root is removed, not just the tip.
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Who performs an Apicoectomy?
Usually, a dentist who has taken advanced training in the procedure can perform an apicoectomy. However, an endodontist or an oral and maxillofacial surgeon also performs the surgery nowadays as the field has been enhanced by recent advances in endodontic surgery. An endodontist is one who has minimum 2 years of additional education and training in diagnosis and root canal treatment. Oral and maxillofacial surgeons have an additional 4 to 6 years training in surgery.
Your doctor, before the apicoectomy, will review your medical history and inquire about any drug allergies that you may have. You have to mention to the doctor all the medications, vitamins and supplements that you are taking and other medical conditions. Before the procedure, additional X-rays of the tooth and the surrounding bone are taken. You may also be given antibiotics and anti-inflammatory drugs, as well as an antimicrobial mouthwash.
Your endodontist will make a small cut in your gum and lift it so that the tooth and bone can be isolated from the gum. He will then use a drill to get to the root of the tooth and remove the infected tissue along with a fraction of the root tip. To verify whether there are cracks in the tooth, your doctor may use a dye to identify them. If the tooth has large cracks, your dentist will recommend extraction over apicoectomy.
In case everything goes fine, the tooth canal’s end is cleaned and sealed using the microscopic and ultrasonic equipment. These instruments create ample light and magnification to help the doctor perform the procedure successfully. Finally, before stitching the tissue back, the doctor will take an X-ray of the area.
After the surgery, your endodontist will recommend the kind of diet you need to follow and what you can drink. The area may bruise and swell, therefore, your doctor will advise you to apply ice to the area every 20 minutes. This needs to be followed for the next 10-12 hours after the surgery. You also need to take rest for the same duration.You may experience some numbness in the affected area for a few days or weeks. Though you should inform your dentist about this, it usually goes away with time. Though surgical in nature, some people find recovering from apicoectomy to be easier than a root canal procedure.
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Risks & Complications
You must ask your endodontist all the risks and complications of apicoectomy before you go for the procedure. The primary risk of an apicoectomy is that at times the surgery may not work and the teeth may have to be extracted eventually. The location of your tooth may also create some risks. In case your afflicted tooth lies in the inside of the upper jaw, it may spread to the sinuses if there is an infection. Also, if it’s a tooth on the back of the lower jaw, some major nerves may be at a slight risk of damage during an apicoectomy. However, with the use of very advanced and precision tools, endodontists make sure that the risks are very negligible.