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 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, Panoramic or intra-oral x-rays will then be taken to enable the oral surgeon to plan the apicoectomy, which will be performed under local anesthesia and/or nitrous oxide or general anesthesia.
A small incision is placed at the "base" of the gum and this tissue is raised to expose the root. In most 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 gum will then be closed with several stitches.
This surgery does not require an overnight stay, and full aftercare instructions and pain medications will be provided. After several months, a repeat x-ray is performed to help monitor the healing result.
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 your dentist's office immediately to schedule an appointment to see if this treatment modality may benefit you.