Understanding Apicoectomies and Why They Are Performed

3 October 2016
 Categories: Dentist, Articles


If you have a root-canal procedure performed, then there is a slim chance that the treatment will fail. Only about 1.3 percent of all root canals fail and require additional treatment. However, if this happens, then you will need surgery. The surgery that is most likely to be performed is called an apicoectomy. An apicoectomy is somewhat invasive, but it can save your tooth and eliminate infections altogether. To understand the treatment and why it is performed, keep reading.

Why Is an Apicoectomy Required?

When a root canal is performed, your dentist or endodontist will spend a good deal of time cleaning out your tooth. The pulp chamber is cleared out first, and then the roots are cleaned. Root cleaning must be completed in a gentle manner, or the tips of the tooth roots may crack or break off. If a horizontal crack forms, then the broken tooth tip will need to be surgically removed. If a vertical crack forms though, then the whole tooth may need to be extracted, since the crack will spread and possibly cause the tooth to break apart. 

To reduce damage, your dentist will use a tool to measure the length and diameter of the tooth roots. Files will then be used that match the shape and size of the root cavities. However, some dental roots will have an extremely small apex. The apex is the hollow tip of the root where blood vessels are attached to the tooth. If a file cannot clean out the small apex, then infected material and bacteria may be left behind. The tooth cavity may be filled with an antibiotic dressing to kill bacteria so this can be avoided. However, some dental roots cannot even be fully reached by medication. 

If the medication does not reach through the apex or apexes, then a new infection can develop. If antibiotics do not resolve the infection, then the tooth may be cleaned out again, and a new crown will be secured. However, this is extremely expensive, since a new crown alone can cost more than $1,500. Also, there is no guarantee that an additional cleaning will prevent a new infection. However, removing the ends of the tooth roots through a microsurgery can eliminate the bacteria, infected tissues, and open cavities where the infectious material can gather. This is why your dental professional may choose to complete an apicoectomy instead of cleaning the tooth out again. 

How Is an Apicoectomy Performed?

An apicoectomy is a surgical procedure, but it can be completed without the need for a general anesthetic. Your dentist will likely need to use a local anesthetic with more epinephrine than usual. This will help to constrict the blood vessels that run through your gums so bleeding risks are reduced. The epinephrine will increase your heart rate, so make sure to speak with your dentist about any heart problems you may have before the surgical procedure is scheduled. 

Once the dentist numbs the area, a scalpel will be used to cut the gums near the treated tooth. The gums are pulled away so the professional can see the dental roots. The scalpel is used to cut the tips of the tooth roots and any infected tissue that is noticed. The ends of the remaining roots are cleaned out thoroughly and then sealed with filling material. The gum tissues are then stitched up. 

You may be asked to use an antibacterial rinse or take antibiotic pills after the operation is completed. This helps to reduce infection risks around the surgical site. Dissolvable stitches may be used during the procedure. If they are not used, then you will need to make arrangements with your dentist to have the stitches removed after several days. 

Talk to a dentistry such as Milner Dentistry for more information.